Adenocarcinoma of the lung

Changed by Yaïr Glick, 13 Jun 2017

Updates to Article Attributes

Body was changed:

Show markup changes

Adenocarcinoma of the lung is one of the non-small cell carcinomas of the lung and is a malignant tumour with glandular differentiation or mucin production. This tumour exhibits various patterns and degrees of differentiation, including lepidic, acinar, papillary, micropapillary, and solid with mucin formation ¹.

Epidemiology

It is now considered the most common histological subtype in terms of prevalence.

Clinical presentation

Early symptoms are fatigue with mild dyspnoea followed by a chronic cough and haemoptysis at a later stage.

Classification

Classification of the tumour 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~~: 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)
colloid
fetal (low and high grade)
enteric

Radiographic features

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, ~~sub-solid~~subsolid or solid.^1,2

Histologically, the ground-glass attenuation corresponds to a lepidic growth pattern and the solid component ~~correspond~~corresponds to invasive patterns. Hence, the preinvasive category of ~~AIS~~adenocarcinoma in situ, ~~MIA~~minimally invasive adenocarcinoma, and the invasive subtype of ~~LPA is~~lepidic-predominant adenocarcinoma are often seen as a ground ~~glass~~-glass nodule or ~~sub-solid~~a subsolid nodule with a predominant ground-glass component. On the other hand, the remaining invasive subtypes of adenocarcinoma ~~is usually~~usually manifest as a solid nodule but may also be subsolid ~~and~~and are only occasionally seen as ground glass nodule ^1,2.

~~Invasive~~The invasive mucinous adenocarcinoma subtype (formerly mucinous BAC) can have a variable appearance ~~ranging from~~, including consolidation, ~~air~~ air bronchograms, or ~~seen as~~ multifocal subsolid nodules or masses ².

Treatment and prognosis

Recommendation for follow-up of solid nodules is as per Fleischner Society guidelines. ~~Recommendation for ground glass or subsolid nodules has recently been proposed, please~~Please consult ~~Naidich~~the 2017 Macmahon et al article ~~- Recommendations~~, Guidelines for ~~the~~ management of ~~sub-solid~~incidental pulmonary nodules detected aton CT images: ~~a statement~~ from the Fleischner Society 2017 ³.

-<p><strong>Adenocarcinoma of the lung </strong>is one of the <a href="/articles/non-small-cell-lung-cancer">non-small cell carcinomas of the lung</a> and is a malignant tumour with glandular differentiation or mucin production. This tumour exhibits various patterns and degrees of differentiation, including lepidic, acinar, papillary, micropapillary and solid with mucin formation <sup>1</sup>. </p><h4>Epidemiology</h4><p>It is now considered the most common histological subtype in terms of prevalence.</p><h4>Clinical presentation</h4><p>Early symptoms are fatigue with mild dyspnoea followed by chronic cough and <a href="/articles/haemoptysis-1">haemoptysis</a> at a later stage.</p><h4>Classification</h4><p>Classification of the tumour 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:</p><ul>
+<p><strong>Adenocarcinoma of the lung </strong>is one of the <a href="/articles/non-small-cell-lung-cancer">non-small cell carcinomas of the lung</a> and is a malignant tumour with glandular differentiation or mucin production. This tumour exhibits various patterns and degrees of differentiation, including lepidic, acinar, papillary, micropapillary, and solid with mucin formation <sup>1</sup>. </p><h4>Epidemiology</h4><p>It is now considered the most common histological subtype in terms of prevalence.</p><h4>Clinical presentation</h4><p>Early symptoms are fatigue with mild dyspnoea followed by a chronic cough and <a href="/articles/haemoptysis-1">haemoptysis</a> at a later stage.</p><h4>Classification</h4><p>Classification of the tumour 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:</p><ul>
-<a href="/articles/lepidic-predominant-adenocarcinoma-of-lung">lepidic predominant adenocarcinoma of lung</a> (formerly non-mucinous <a href="/articles/adenocarcinoma-in-situ-minimally-invasive-adenocarcinoma-and-invasive-adenocarcinoma-of-lung">bronchioloalveolar carcinoma (BAC)</a> pattern, with >5 mm invasion)</li>
~~-<li><a href="/articles/acinar-predominant-adenocarcinoma-of-lung">acinar predominant adenocarcinoma of lung</a></li>~~
~~-<li><a href="/articles/papillary-predominant-adenocarcinoma-of-lung">papillary predominant adenocarcinoma of lung</a></li>~~
~~-<li><a href="/articles/micropapillary-predominant-adenocarcinoma-of-lung">micropapillary predominant adenocarcinoma of lung</a></li>~~
+<a href="/articles/lepidic-predominant-adenocarcinoma-of-lung">lepidic predominant adenocarcinoma of the lung</a>: formerly non-mucinous <a href="/articles/adenocarcinoma-in-situ-minimally-invasive-adenocarcinoma-and-invasive-adenocarcinoma-of-lung">bronchioloalveolar carcinoma (BAC)</a> pattern, with >5 mm invasion</li>
+<li><a href="/articles/acinar-predominant-adenocarcinoma-of-lung">acinar predominant adenocarcinoma of the lung</a></li>
+<li><a href="/articles/papillary-predominant-adenocarcinoma-of-lung">papillary predominant adenocarcinoma of the lung</a></li>
+<li><a href="/articles/micropapillary-predominant-adenocarcinoma-of-lung">micropapillary predominant adenocarcinoma of the lung</a></li>
~~-</ul><p>Variants of invasive adenocarcinoma</p><ul>~~
+</ul><p>Variants of invasive adenocarcinoma:</p><ul>
-</ul><h4>Radiographic features</h4><p>Sometimes it is impossible to radiographically distinguish between other histological lung cancer types.</p><p>A <a href="/articles/pulmonary-nodule-1">lung nodule</a> is a rounded or irregular region of increased attenuation measuring less than 3 cm. The amount of attenuation can further classify the nodules as either ground glass, sub-solid or solid.<sup>1,2</sup> </p><p>Histologically, the ground-glass attenuation corresponds to a lepidic growth pattern and the solid component correspond to invasive patterns. Hence the preinvasive category of AIS, MIA, and the invasive subtype of LPA is often seen as ground glass nodule or sub-solid nodule with a predominant ground-glass component. On the other hand, the remaining invasive subtypes of adenocarcinoma is usually a solid nodule but may also subsolid and only occasionally seen as ground glass nodule <sup>1,2</sup>. </p><p>Invasive mucinous adenocarcinoma subtype (formerly mucinous BAC) can have a variable appearance ranging from consolidation, air bronchograms or seen as multifocal subsolid nodules or masses <sup>2</sup>. </p><h4>Treatment and prognosis</h4><p>Recommendation for follow-up of solid nodules is as per <a href="/articles/fleischner-society-pulmonary-nodule-recommendations">Fleischner Society</a> guidelines. Recommendation for ground glass or subsolid nodules has recently been proposed, please consult Naidich et article - Recommendations for the management of sub-solid pulmonary nodules detected at CT: a statement from the Fleischner Society <sup>3</sup>.</p>
+</ul><h4>Radiographic features</h4><p>Sometimes it is impossible to radiographically distinguish between other histological lung cancer types.</p><p>A <a href="/articles/pulmonary-nodule-1">lung nodule</a> 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.<sup>1,2</sup> </p><p>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 <sup>1,2</sup>. </p><p>The invasive mucinous adenocarcinoma subtype (formerly mucinous BAC) can have a variable appearance, including consolidation, air bronchograms, or multifocal subsolid nodules or masses <sup>2</sup>.</p><h4>Treatment and prognosis</h4><p>Recommendation for follow-up of solid nodules is as per <a href="/articles/fleischner-society-pulmonary-nodule-recommendations">Fleischner Society</a><a title="Fleischner society pulmonary nodule recommendations" href="/articles/fleischner-society-pulmonary-nodule-recommendations"> guidelines</a>. Please consult the 2017 Macmahon et al article, Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner Society 2017 <sup>3</sup>.</p>

References changed:

3. MacMahon H, Naidich DP, Goo JM, Lee KS, Leung AN, Mayo JR, Mehta AC, Ohno Y, Powell CA, Prokop M, Rubin GD, Schaefer-Prokop CM, Travis WD, Van Schil PE, Bankier AA. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology. <a href="https://doi.org/10.1148/radiol.2017161659">doi:10.1148/radiol.2017161659</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28240562">Pubmed</a> <span class="ref_v4"></span>
3. Naidich DP, Bankier AA, Macmahon H et-al. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology. 2013;266 (1): 304-17. <a href="http://dx.doi.org/10.1148/radiol.12120628">doi:10.1148/radiol.12120628</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/23070270">Pubmed citation</a><div class="ref_v2"></div>

Tags changed:

update

Sections changed:

Systems changed:

Oncology

ADVERTISEMENT: Supporters see fewer/no ads

{"current_user":null,"inclusions":[{"imageId":144533,"studyId":8634,"caseSlug":"lung-cancer-adenocarcinoma-1","caption":"Case 1","thumbnail":"https://prod-images-static.radiopaedia.org/images/144533/36a81617b8cd7b9f3901888d0e7104e5fe337890d093891a1b55957427a10108_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":35860975,"studyId":65410,"caseSlug":"multifocal-lung-adenocarcinoma-1","caption":"Case 2: likely multifocal","thumbnail":"https://prod-images-static.radiopaedia.org/images/35860975/5a3e15b33dd3bd72f83de21e6dd037_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":2862824,"studyId":21269,"caseSlug":"adenocarcinoma-of-the-lung-with-chest-wall-invasion","caption":"Case 3: with chest wall invasion","thumbnail":"https://prod-images-static.radiopaedia.org/images/2862824/acd8d74a357feb5fbede46f6eb03482ecde96d7548381b4a39dcd4aef628be8c_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":2929564,"studyId":21642,"caseSlug":"lung-biopsy-adenocarcinoma-1","caption":"Case 4 ","thumbnail":"https://prod-images-static.radiopaedia.org/images/2929564/94c78b958afaf74a46ecce7827d33d_big_gallery.jpg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":6688708,"studyId":29129,"caseSlug":"lepidic-predominant-adenocarcinoma-of-the-lung-2","caption":"Case 5: lepidic predominant","thumbnail":"https://prod-images-static.radiopaedia.org/images/6688708/6192fc6b2a9bb80af6847386398d6e_big_gallery.jpg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":21148028,"studyId":47658,"caseSlug":"lung-adenocarcinoma-3","caption":"Case 6: right upper lobe","thumbnail":"https://prod-images-static.radiopaedia.org/images/21148028/9eee179bae204d83612ead3d162e49_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":25248795,"studyId":53037,"caseSlug":"lung-adenocarcinoma-6","caption":"Case 7","thumbnail":"https://prod-images-static.radiopaedia.org/images/25248795/57c46ed7e118af3e470774ee9caba7_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":17351726,"studyId":43755,"caseSlug":"adenocarcinoma-of-the-lung-3","caption":"Case 8","thumbnail":"https://prod-images-static.radiopaedia.org/images/17351726/cb560c96b56994f4c62a5409661247_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":22103012,"studyId":48759,"caseSlug":"adenocarcinoma-of-the-lung-2","caption":"Case 9","thumbnail":"https://prod-images-static.radiopaedia.org/images/22103012/c80cdd5d21a8594ea7495724c62997_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":35477658,"studyId":64972,"caseSlug":"pulmonary-adenocarcinoma-1","caption":"Case 10","thumbnail":"https://prod-images-static.radiopaedia.org/images/35477658/a5a336e7f056640bf11b064d16d94f_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":39279934,"studyId":68394,"caseSlug":"lung-adenocarcinoma-occult-in-collapsed-lung","caption":"Case 11: occult in collapsed lung","thumbnail":"https://prod-images-static.radiopaedia.org/images/39279934/a8545e92629206dd844cf33dfa157c_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":32376172,"studyId":61727,"caseSlug":"metastatic-adenocarcinoma-of-the-lung-1","caption":"Case 12: mestatstic ","thumbnail":"https://prod-images-static.radiopaedia.org/images/32376172/ab15fcf39409c2cd6ce7caf38847a0_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52463136,"studyId":88441,"caseSlug":"multifocal-lung-adenocarcinoma-slow-growth","caption":"Case 13: slow growth over time","thumbnail":"https://prod-images-static.radiopaedia.org/images/52463136/68b2a5b41c16cef6d650dd1ef6b15d_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":46486133,"studyId":75426,"caseSlug":"multifocal-adenocarcinoma-of-the-lung-egfr-mutated","caption":"Case 14: EGFR-mutated","thumbnail":"https://prod-images-static.radiopaedia.org/images/46486133/7bcda4d4c184e074a975df0123c78a_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":52975101,"studyId":92327,"caseSlug":"metastatic-adenocarcinoma-of-the-lung-2","caption":"Case 15: left retrocardiac","thumbnail":"https://prod-images-static.radiopaedia.org/images/52975101/cc31aebaee9e7754ee6c60a6f9498bd9acecba31008afca1ba36266742d0da9e_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":53386428,"studyId":95319,"caseSlug":"lung-adenocarcinoma-recurrence-after-stereotactic-body-radiotherapy","caption":"Case 16: recurrence after stereotactic radiotherapy","thumbnail":"https://prod-images-static.radiopaedia.org/images/53386428/Screen_Shot_2020-08-26_at_19.08.43_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":56773259,"studyId":115572,"caseSlug":"multinodular-lung-adenocarcinoma","caption":"Case 17: multinodular form","thumbnail":"https://prod-images-static.radiopaedia.org/images/56773259/96._big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":59367813,"studyId":125291,"caseSlug":"lung-adenocarcinoma-17","caption":"Case 18","thumbnail":"https://prod-images-static.radiopaedia.org/images/59367813/ac39c5e8bf993f7537005930ad3f4a4558154f9d4162ffac914ec21cb771ff10_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":61130803,"studyId":132126,"caseSlug":"ct-angiogram-sign-lung-1","caption":"Case 19: with CT angiogram sign","thumbnail":"https://prod-images-static.radiopaedia.org/images/61130803/5c9802f6e79f5f7f757d5a2e7afd900c8349b1e06ea6faf45e82393f7d7db5bb_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":64984448,"studyId":147427,"caseSlug":"lung-adenocarcinoma-19","caption":"Case 20","thumbnail":"https://prod-images-static.radiopaedia.org/images/64984448/2ed88d1286a63fde678ec70dddb7e508d5978737a04df8abf505147e81e9028f_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"}],"ddx_inclusions":[],"lang":"us"}