Revision 18 for 'Adenocarcinoma of the lung'All Revisions
Adenocarcinoma of the lung
Adenocarcinoma of the lung is one of the non-small cell carcinomas of the lung and is a malignant tumor with glandular differentiation or mucin production. This tumor exhibits various patterns and degrees of differentiation, including lepidic, acinar, papillary, micropapillary, and solid with mucin formation 1.
It is now considered the most common histological subtype in terms of prevalence.
Early symptoms are fatigue with mild dyspnea followed by a chronic cough and hemoptysis at a later stage.
Classification of the tumor subtype is based on the estimate of the percentage of histologic patterns and the predominant subtype. The terminology of mixed subtype is to be avoided:
- lepidic predominant adenocarcinoma of the lung: formerly non-mucinous bronchioloalveolar carcinoma (BAC) pattern, with >5 mm invasion
- acinar predominant adenocarcinoma of the lung
- papillary predominant adenocarcinoma of the lung
- micropapillary predominant adenocarcinoma of the lung
- solid predominant with mucin
Variants of invasive adenocarcinoma:
- invasive mucinous adenocarcinoma (formerly mucinous BAC)
- fetal (low and high grade)
Sometimes it is impossible to radiographically distinguish between other histological lung cancer types.
A lung nodule is a rounded or irregular region of increased attenuation measuring less than 3 cm in. The amount of attenuation can further classify the nodules as either ground glass, subsolid or solid.1,2
Histologically, the ground-glass attenuation corresponds to a lepidic growth pattern and the solid component corresponds to invasive patterns. Hence, the preinvasive category of adenocarcinoma in situ, minimally invasive adenocarcinoma, and the invasive subtype of lepidic-predominant adenocarcinoma are often seen as a ground-glass nodule or a subsolid nodule with a predominant ground-glass component. On the other hand, the remaining invasive subtypes of adenocarcinoma usually manifest as a solid nodule but may also be subsolid and are only occasionally seen as ground glass nodule 1,2.
The invasive mucinous adenocarcinoma subtype (formerly mucinous BAC) can have a variable appearance, including consolidation, air bronchograms, or multifocal subsolid nodules or masses 2.
Treatment and prognosis
Recommendation for follow-up of solid nodules is as per Fleischner Society guidelines. Please consult the 2017 Macmahon et al article, Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner Society 2017 3.