IS Case 251: Bronchioloalveolar cell carcinoma

Sara Ann Majewski, MD

Imaging Sciences URMC 2008
Publication Date: 2009-05-26

History

Patient is a 58-year-old female with incidental left lower lobe pulmonary nodule found at the time of trauma. She has a 5-year history of smoking as well as significant exposure to second-hand smoke. Subsequent PET scan revealed no hypermetabolic activity in this nodule.

Diagnosis

Bronchioloalveolar cell carcinoma

Discussion

Bronchioloalveolar cell carcinoma is a type of adenocarcinoma which typically occurs after the age of forty equally in males and females. Up to half of patients have history of heavy smoking. Patient presentation is often symptomatic, but some can present with pleuritic chest pain, cough, hemoptysis, bronchorrhea, shortness of breath, weight and fever.

These cancers originate from type II pneumoncytes lining alveolar walls. They spread along the parenchymal structure without distorting it, often occurring in areas of pulmonary fibrosis. The majority are mucinous, but can also be of nonmucinous type.

Bronchioloalveolar cell carcinoma is peripheral and can be localized or diffuse. Most occur as the localized form as ground glass attenuation or a mass. Others occur as the diffuse or pneumonic form presenting with diffuse consolidation, lobar disease or multiple nodules. Bronchioloalveolar cell carcinoma can also present with air-bronchograms, bubble-like lucencies or pseudocavitation. This cancer can be difficult to distinguish from pneumonia.

Bronchioloalveolar cell carcinoma can metastasize to almost any organ. Spread can be tracheobronchial, lymphatic or hematogenous.

References

  1. Dahnert WF. Radiology Review Manual. 6th ed., Lippincott Williams & Wilkins: Philadelphia, 2007.
  2. Lee JK, Sagel SS, Stanley RJ, Heiken JPl. Computed Body Tomography with MRI Correlation. 4th ed., Lippincott Williams & Wilkins: Philadelphia, 2006.
  3. Lee KS, Kim Y, Han J, Ko EJ, Park CK, Primack SL. Bronchioloalveolar carcinoma: clinical, histopathologic, and radiologic findings. Radiographics. 1997 Nov-Dec;17(6):1345-57. [PMID: 9397450]

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