Presentation
Incidental finding on trauma scan.
Patient Data
There is a left upper lobe mass-like lesion with irregular contours, just adjacent to the oblique fissure, measuring about 3 cm in its larger axis, and showing both solid and groundglass components. The lungs, pleural spaces, and the remainder of the chest are unremarkable.
Minimal FDG uptake within the left upper lobe lesion.
Macroscopy: Labeled "LUL lung lesion". A pale grey tissue core 7 mm.
Microscopy: Core biopsies of the lung, show alveolar spaces lined by pleomorphic columnar epithelial cells with cytoplasmic mucin. Cell nuclei show hyperchromasia and cells are mildly crowded. There is minimal tissue.
Conclusion: Left upper lobe lung lesion–adenocarcinoma - Lepidic subtype.
Case Discussion
The imaging features are highly suggestive of lung adenocarcinoma. Core-biopsy of the lesion was performed confirming it and showing a lepidic pattern. The main differentials to consider are made between:
- minimally invasive adenocarcinoma: localized adenocarcinomas measuring ≤3 cm and demonstrating either pure lepidic or predominant lepidic growth pattern, with neoplastic cells along the alveolar structures and ≤5 mm of stromal invasion
- invasive adenocarcinoma: lesion with >5 mm of invasion into the normal surrounding lung (i.e. lymphatics, pleura, or blood vessels) and/or the presence of tumor necrosis on the basis of histology of the surgical resection specimen.
As the diagnosis, at this point, was made on a single core-biopsy sampling, there was a limited assessment of the invasion extension, if less or more than 5mm. The fact that we have some large solid components of the lesion and the tumor extension on CT is just above 3.0 cm, make this more likely to represent a lepidic-predominant invasive adenocarcinoma.
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