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CT Findings and Progression of Small Peripheral Lung Neoplasms Having a Replacement Growth Pattern

Shodayu Takashima1, Yuichiro Maruyama1, Minoru Hasegawa1, Takeshi Yamanda2, Takayuki Honda3, Masumi Kadoya1 and Shusuke Sone4

1 Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
2 Department of Surgery, Shinshu University School of Medicine, Matsumoto 390-8621, Japan.
3 Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto 390-8621, Japan.
4 Department of Radiology, JA Azumi General Hospital, 3207-1 Ikeda, Nagano 399-8695, Japan.



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  		Fig. 1A. —66-year-old man with atypical adenomatous hyperplasia first detected on serial low-dose CT. Lesion is barely identifiable on initial transverse low-dose CT scan.

 


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  		Fig. 1B. —66-year-old man with atypical adenomatous hyperplasia first detected on serial low-dose CT. Serial transverse low-dose CT scan obtained 951 days after A shows 9.5-mm nodule of ground-glass opacity (arrow).

 


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  		Fig. 1C. —66-year-old man with atypical adenomatous hyperplasia first detected on serial low-dose CT. Transverse high-resolution CT scan shows ground-glass opacity nodule (arrowhead) in which air bronchograms are seen.

 


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  		Fig. 1D. —66-year-old man with atypical adenomatous hyperplasia first detected on serial low-dose CT. Photomicrograph of histopathologic specimen shows growth of atypical cells along alveolar lining. (elastica—van Gieson,x12.5)

 


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  		Fig. 2A. —71-year-old woman with type A tumor that showed growth on serial high-resolution CT. Initial transverse high-resolution CT scan shows 5-mm nodule of ground-glass opacity (arrowhead).

 


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  		Fig. 2B. —71-year-old woman with type A tumor that showed growth on serial high-resolution CT. Serial transverse high-resolution CT scan obtained 503 days after A shows growth of nodule to 6-mm with ground-glass opacity (arrowhead).

 


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  		Fig. 2C. —71-year-old woman with type A tumor that showed growth on serial high-resolution CT. Photomicrograph of histopathologic specimen shows growth of tumor cells replacing alveolar lining cells without alveolar collapse. (H and E,x12.5)

 


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  		Fig. 3A. —51-year-old woman with type B tumor that has developed solid portions in ground-glass opacity nodule visualized on serial high-resolution CT. Initial transverse high-resolution CT scan shows slightly lobulated 10-mm nodule of ground-glass opacity (arrow).

 


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  		Fig. 3B. —51-year-old woman with type B tumor that has developed solid portions in ground-glass opacity nodule visualized on serial high-resolution CT. Serial transverse high-resolution CT obtained 395 days after A shows growth to 12-mm nodule of ground-glass opacity in which solid component (arrowhead) is seen.

 


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  		Fig. 3C. —51-year-old woman with type B tumor that has developed solid portions in ground-glass opacity nodule visualized on serial high-resolution CT. Photomicrograph of histopathologic specimen shows replacement-type tumor growth with foci of alveolar collapse (AC). (H and E, x12.5)

 


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  		Fig. 4A. —56-year-old woman with type C tumor that has developed solid portions visualized on serial low-dose CT. Initial transverse low-dose CT scan shows 8-mm nodule of ground-glass opacity (arrow). (Reprinted with permission from [30])

 


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  		Fig. 4B. —56-year-old woman with type C tumor that has developed solid portions visualized on serial low-dose CT. Serial transverse low-dose CT scan obtained 615 days after A shows growth to 14-mm nodule of ground-glass opacity in which solid component (arrowhead) is now visible. (Reprinted with permission from [30])

 


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  		Fig. 4C. —56-year-old woman with type C tumor that has developed solid portions visualized on serial low-dose CT. Transverse high-resolution CT scan shows lobulated nodule that consists of solid portion (asterisk) and ground-glass opacity area (arrowheads). (Reprinted with permission from [30])

 


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  		Fig. 4D. —56-year-old woman with type C tumor that has developed solid portions visualized on serial low-dose CT. Photomicrograph of histopathologic specimen shows areas of fibroblastic proliferation (F) and replacement-type tumor growth along alveolar lining. Disrupted framework was verified in specimen stained by elastica—van Gieson (not shown). (H and E, x12.5)

 


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  		Fig. 5A. —69-year-old woman with type C tumor that has increased in solid component seen on serial high-resolution CT. Initial transverse high-resolution CT scan shows lobulated solid nodule of 8 mm with small cavities (arrowhead).

 


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  		Fig. 5B. —69-year-old woman with type C tumor that has increased in solid component seen on serial high-resolution CT. Serial transverse high-resolution CT scan obtained 385 days after A shows growth of solid nodule to 13 mm. Small cavities (arrowheads) in nodule have become more prominent since A.

 


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  		Fig. 6A. —64-year-old woman with atypical adenomatous hyperplasia with dotlike solid portions shown on high-resolution CT. Transverse high-resolution CT scan shows 9-mm nodule (arrow) of ground-glass opacity in which dotlike solid portions are seen.

 


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  		Fig. 6B. —64-year-old woman with atypical adenomatous hyperplasia with dotlike solid portions shown on high-resolution CT. Photomicrograph of histopathologic specimen corresponding to dotlike solid portions on high-resolution CT scan (A) shows areas of markedly reduced alveolar lumina associated with intense lymphocytic infiltration. Growth of atypical cells along alveolar lining is also seen. (H and E, x400)

 

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