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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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