Clinical and radiologic features of peripheral solitary nodular bronchioloalveolar carcinoma

Introduction; Bronchioloalveolar carcinoma may present with a variety of radiologic and clinical pattern. The major spectrum of radiologic patterns are followings; 1) a solitary nodule or mass, 2) a localized consolidation, and 3) multicentric or diffuse disease. The localized consolidation pattern and solitary nodular pattern of bronchioloalveolar carcinoma are often misdiagnosed as lobar pneumonia or tuberculous granuloma, especially in the prevalence area of pulmonary tuberculosis. Methods; The clinical and radiologic features of patients with histologically proven solitary nodular bronchioloaveolar carcinoma reviewed retrospectively. Results; There were seven patients, 2 women and 5 men, aged 46-69 years (mean, 58.8). The four patients were asymptomatic and the carcinoma was discovered in them by routine chest roentgenogram. The two patients had cough and non-copious sputum. One patient had blood streaked sputum. The sputum cytology were negative for malignancy and bronchoscopic examination showed no abnormal findings in all patients. The pathologic diagnosis was obtained by transbronchial lung biopsy in two patients and by open thoracotomy via video-as-sited thoracoscopy in five patients. The computed tomography findings (including high resolution CT) revealed consolidation with ground glass appearance (5 patients), internal bubblelike lucencies (2 patients), open bronchus sign (2 patients) and pleural tag (2 patients). The positron emission tomography was performed in six patients, but only two patients revealed suggestive of malignancy. All patients were performed lobectomy and postoperative pathologic staging were T₂N₀M₀ in two patients and T₁N₀M₀ in five patients. Conclusions; The seven patients of bronchioloalveolar carcinoma presenting with solitary pulmonary nodules were asymptomatic and had incidental radiologic abnormality. But, the CT finding such as consolidation with ground glass appearance, internal bubblelike lucencies, open bronchus sign and pleural tag in solitary pulmonary nodule may be suggestive findings of bronchioloalveolar carcinoma.