Multifocal adenocarcinoma of the lung: multinodular type

Case contributed by Dr Ian Bickle


Presented to A & E with non-specific symptomatology and weight loss. No fever.

Patient Data

Age: 70
Gender: Female

At intial presentation a CXR was taken ( unavailable ) showing diffuse miliary nodules.

1.5cm spiculated mass in the apical segment of the right lower lobe.

Innumerable miliary nodules, with a rather groundglass appearance throughout both lungs.


CT guided biopsy was performed.

Diffuse miliary nodules throughout the lungs.

1.5cm spiculated lesion not targeted due to its adherance to the left oblique fissure and deep location due to higher pneumothorax risk.

A tiny procedural pneumothorax is evident. 

Lung biopsy

Neoplastic cuboidal to columnar cells growing along alveolar walls in a lepidic fashion.

Positive for CK7 and TTF1.

Appearances are those of a non-mucinous bronchoalveolar carcinoma of the lung

Case Discussion

Traditionally and still often referred to as bronchoalveolar carcinoma (BAC), this form of lung cancer is now classified as adenocarcinoma in situ, minimally invasive adenocarcinoma and invasive adenocarincoma of lung based on histological findings.

Classically it presents insidiouosly with an unresolving pneumonic process, but can also present as a pulmonary nodule or cluster of diffuse nodules as in this case.

Three recognized radiographic patterns are described:

  • single mass or nodular form (commonest): ~45 %
  • consolidative form: ~30 %
  • multinodular form: ~25 %     ( this case )
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Case information

rID: 38002
Published: 13th Jul 2015
Last edited: 14th Aug 2019
System: Chest
Inclusion in quiz mode: Included