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BRONCHOALVEOLAR CELL CARCINOMA
Authored By: Joanna Fair and Bennett Greenspan.
Patient: 54 year old
History: Presenting for evaluation of pulmonary nodules.
Image Size:[small][as-submitted]

Fig. 1
Coronal whole-body PET images

Fig. 2
Axial PET-CT images

Fig. 3
Chest radiograph obtained 6 weeks after the PET-CT

Fig. 4
Chest CT
Image Size:[small][as-submitted]

Findings: The PET-CT images demonstrate focal, moderate FDG-avid consolidation in the left upper lobe (Fig. 1, Fig. 2).  There were additionally small pulmonary nodules, predominantly in the superior segment of the left lower lobe, too small to characterize (not shown).


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The chest radiograph and CT obtained approximately 6 weeks later showed persistent left upper lobe consolidation (Fig. 3, Fig. 4).  The CT also re-demonstrated small left lower lobe (superior segment) nodules.
Diagnosis: Bronchoalveolar cell carcinoma
General Discussion: Full patient history:

54-year-old man presenting for evaluation of pulmonary nodules seen on chest radiographs.  The patient had a chronic cough and chronic dyspnea, previously attributed to COPD.  Chest radiographs had also shown an area of consolidation thought to represent pneumonia. 

The PET-CT images were interpreted as moderately FDG-avid left upper lobe consolidation, likely representing pneumonia.  The largest pulmonary nodules (still less than 1 cm size) were mildly FDG avid.  A chest CT performed 6 weeks later showed increasing consolidation and increasing nodules, thought to represent bacterial pneumonia or tuberculosis with bronchogenic spread.

The patient underwent bronchoscopic biospy of the left upper lobe consolidation approximately 8 weeks after the PET-CT examination.  The pathology showed well differentiated adenocarcinoma, bronchial alveolar type.

Discussion:

Bronchioloalveolar carcinoma (BAC) is an uncommon type of lung cancer (~2-10% of all lung cancers).  BAC is a well-differentiated adenocarcinoma; the World Health Organization (WHO) classification as of 1999 includes only noninvasive lesions as BAC. 

A retrospective study of 41 patients with pathologically-proven BAC who underwent preoperative PET (not PET-CT) showed that, using the criterion of uptake greater than blood pool within the lesion, PET correctly identified BAC in 41/46 lesions and 39/41 patients (1).  However, other studies have shown a much higher rate of false negative scans for FDG-PET (2).
References: 1.  Yap CS et al, "FDG-PET imaging in lung cancer: how sensitive is it
for bronchioloalveolar carcinoma?" Eur J Nucl Med 2002 Nov; 29(9): 1166-1173.

2.  Gandara DR, "Radiographic imaging of bronchioloalveolar carcinoma: screening, patterns of presentation and response assessment,"  J Thorac Oncol 2006 Nov;1(9 Suppl):S20-6.

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Additional Details:

Case Number: 206878Owner(s): Joanna Fair and Bennett GreenspanLast Updated: 12-07-2011
Anatomy: Cardiopulmonary   Pathology: Neoplasm
Modality: Conventional Radiograph, PETAccess Level: Readable by all users, writable by NucMed Certifiers
Keywords: ptnm, bronchoalveolar carcinoma, lungACR: 60000.32160

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Certified by Bennett Greenspan on 06-25-2009

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