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T1 Non–Small Cell Lung Cancer: Imaging and Histopathologic Findings and Their Prognostic Implications¹

¹ From the Department of Radiology and Center for Imaging Science (K.S.L., Y.J.J.), the Department of Diagnostic Pathology (J.H.), the Department of Nuclear Medicine (B.T.K.), and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (H.K., O.J.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135–710, Korea. Presented as an education exhibit at the 2003 RSNA scientific assembly. Received February 13, 2004; revision requested March 26; final revision received April 19; accepted April 19. Supported in part by a grant from the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (00-PJ1-PG1-CY03–0001). All authors have no financial relationships to disclose. Address correspondence to K.S.L. (e-mail: melon2@samsung.co.kr).

View larger version (113K): [in a new window]   Figure 1a.  T1 N0 bronchioloalveolar carcinoma (BAC) in a 53-year-old man. (a) Initial transaxial thin-section (1-mm collimation, 170 mA) CT scan (lung window) obtained at the level of the bronchus intermedius shows a small nodular area of ground-glass attenuation in the right upper lobe (arrow). (b) Follow-up CT scan (5-mm collimation, 50 mA) obtained 48 months later shows increased nodule size (arrow). The lobectomy specimen showed BAC without nodal metastasis.

View larger version (104K): [in a new window]   Figure 1b.  T1 N0 bronchioloalveolar carcinoma (BAC) in a 53-year-old man. (a) Initial transaxial thin-section (1-mm collimation, 170 mA) CT scan (lung window) obtained at the level of the bronchus intermedius shows a small nodular area of ground-glass attenuation in the right upper lobe (arrow). (b) Follow-up CT scan (5-mm collimation, 50 mA) obtained 48 months later shows increased nodule size (arrow). The lobectomy specimen showed BAC without nodal metastasis.

View larger version (127K): [in a new window]   Figure 2a.  Noguchi type A adenocarcinoma (localized BAC) in a 63-year-old woman. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the apical segmental bronchus of the right upper lobe shows a 10-mm nodular area of ground-glass attenuation (arrow). (b) Low-power photomicrograph (original magnification, x4; hematoxylin-eosin [H-E] stain) of a surgical specimen shows tumor cells growing along the alveolar walls (lepidic growth) (arrows), which appeared as nodular ground-glass attenuation at CT. The alveolar walls are mildly thickened. The surgical specimens showed no hilar or mediastinal nodal metastasis, and no recurrence was seen at postoperative follow-up.

View larger version (182K): [in a new window]   Figure 2b.  Noguchi type A adenocarcinoma (localized BAC) in a 63-year-old woman. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the apical segmental bronchus of the right upper lobe shows a 10-mm nodular area of ground-glass attenuation (arrow). (b) Low-power photomicrograph (original magnification, x4; hematoxylin-eosin [H-E] stain) of a surgical specimen shows tumor cells growing along the alveolar walls (lepidic growth) (arrows), which appeared as nodular ground-glass attenuation at CT. The alveolar walls are mildly thickened. The surgical specimens showed no hilar or mediastinal nodal metastasis, and no recurrence was seen at postoperative follow-up.

View larger version (111K): [in a new window]   Figure 3a.  Noguchi type B adenocarcinoma (localized BAC with foci of alveolar collapse) in a 48-year-old man. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the aortic arch shows a 20-mm nodular area of ground-glass attenuation in the left upper lobe. Note that the lesion has a solid component (arrow). (b) Low-power photomicrograph (original magnification, x12; H-E stain) of a surgical specimen shows thickening of the alveolar walls with tumor cell replacement (lepidic growth). Note the foci of alveolar collapse (arrows). At CT, the foci of lepidic growth appeared as areas of ground-glass attenuation, whereas the foci of alveolar collapse corresponded to the solid component of the lesion. The surgical specimens showed no hilar or mediastinal nodal metastasis, and no recurrence was seen at postoperative follow-up.

View larger version (196K): [in a new window]   Figure 3b.  Noguchi type B adenocarcinoma (localized BAC with foci of alveolar collapse) in a 48-year-old man. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the aortic arch shows a 20-mm nodular area of ground-glass attenuation in the left upper lobe. Note that the lesion has a solid component (arrow). (b) Low-power photomicrograph (original magnification, x12; H-E stain) of a surgical specimen shows thickening of the alveolar walls with tumor cell replacement (lepidic growth). Note the foci of alveolar collapse (arrows). At CT, the foci of lepidic growth appeared as areas of ground-glass attenuation, whereas the foci of alveolar collapse corresponded to the solid component of the lesion. The surgical specimens showed no hilar or mediastinal nodal metastasis, and no recurrence was seen at postoperative follow-up.

View larger version (137K): [in a new window]   Figure 4a.  Noguchi type C adenocarcinoma (localized BAC with active fibroblastic proliferation) in a 52-year-old woman. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the left main bronchus shows a 13-mm nodule in the superior segment of the left lower lobe. Note the areas of ground-glass attenuation in the periphery of the nodule (arrow). (b) Low-power photomicrograph (original magnification, x12; H-E stain) of a surgical specimen shows tumor consisting of foci of lepidic growth (spread of neoplastic cells on airspace surface with preservation of underlying lung architecture) (arrows), along with fibrosis and alveolar collapse (arrowheads). At CT, the latter findings appeared as hyperattenuating nodules, whereas the foci of lepidic growth appeared as areas of ground-glass attenuation. The surgical specimens showed no hilar or mediastinal nodal metastasis, but intrapulmonary recurrence was seen at postoperative follow-up.

View larger version (179K): [in a new window]   Figure 4b.  Noguchi type C adenocarcinoma (localized BAC with active fibroblastic proliferation) in a 52-year-old woman. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the left main bronchus shows a 13-mm nodule in the superior segment of the left lower lobe. Note the areas of ground-glass attenuation in the periphery of the nodule (arrow). (b) Low-power photomicrograph (original magnification, x12; H-E stain) of a surgical specimen shows tumor consisting of foci of lepidic growth (spread of neoplastic cells on airspace surface with preservation of underlying lung architecture) (arrows), along with fibrosis and alveolar collapse (arrowheads). At CT, the latter findings appeared as hyperattenuating nodules, whereas the foci of lepidic growth appeared as areas of ground-glass attenuation. The surgical specimens showed no hilar or mediastinal nodal metastasis, but intrapulmonary recurrence was seen at postoperative follow-up.

View larger version (125K): [in a new window]   Figure 5a.  Noguchi type D adenocarcinoma (poorly differentiated adenocarcinoma) in a 62-year-old woman. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the left main bronchus shows a 21-mm nodule with a spiculated margin in the left upper lobe. (b) Low-power photomicrograph (original magnification, x12; H-E stain) of a surgical specimen shows a poorly differentiated solid adenocarcinoma with a well-defined margin (arrows). The surgical specimens showed no hilar or mediastinal nodal metastasis, and no recurrence was seen at postoperative follow-up.

View larger version (153K): [in a new window]   Figure 5b.  Noguchi type D adenocarcinoma (poorly differentiated adenocarcinoma) in a 62-year-old woman. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the left main bronchus shows a 21-mm nodule with a spiculated margin in the left upper lobe. (b) Low-power photomicrograph (original magnification, x12; H-E stain) of a surgical specimen shows a poorly differentiated solid adenocarcinoma with a well-defined margin (arrows). The surgical specimens showed no hilar or mediastinal nodal metastasis, and no recurrence was seen at postoperative follow-up.

View larger version (140K): [in a new window]   Figure 6a.  Noguchi type E adenocarcinoma (tubular adenocarcinoma) in a 53-year-old man. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the bronchus intermedius shows a 22-mm nodule with a spiculated margin in the right upper lobe straddling the right minor fissure (arrows). (b) Low-power photomicrograph (original magnification, x12; H-E stain) of a surgical specimen shows a lobulated solid mass with no acinar structure. The surgical specimens showed no hilar or mediastinal nodal metastasis, but brain metastasis was seen at follow-up magnetic resonance (MR) imaging performed 2 years after surgery.

View larger version (194K): [in a new window]   Figure 6b.  Noguchi type E adenocarcinoma (tubular adenocarcinoma) in a 53-year-old man. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the bronchus intermedius shows a 22-mm nodule with a spiculated margin in the right upper lobe straddling the right minor fissure (arrows). (b) Low-power photomicrograph (original magnification, x12; H-E stain) of a surgical specimen shows a lobulated solid mass with no acinar structure. The surgical specimens showed no hilar or mediastinal nodal metastasis, but brain metastasis was seen at follow-up magnetic resonance (MR) imaging performed 2 years after surgery.

View larger version (93K): [in a new window]   Figure 7a.  Noguchi type F adenocarcinoma (papillary adenocarcinoma with compressive and destructive growth) in a 48-year-old woman. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the basal segmental arteries shows a 25-mm lobulated nodule in the left lower lobe. (b) Low-power photomicrograph (original magnification, x12; H-E stain) of a surgical specimen shows papillary carcinoma composed of branching true papillae. The surgical specimens showed hilar nodal metastasis, and intrapulmonary recurrence was seen at postoperative follow-up.

View larger version (160K): [in a new window]   Figure 7b.  Noguchi type F adenocarcinoma (papillary adenocarcinoma with compressive and destructive growth) in a 48-year-old woman. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the basal segmental arteries shows a 25-mm lobulated nodule in the left lower lobe. (b) Low-power photomicrograph (original magnification, x12; H-E stain) of a surgical specimen shows papillary carcinoma composed of branching true papillae. The surgical specimens showed hilar nodal metastasis, and intrapulmonary recurrence was seen at postoperative follow-up.

View larger version (186K): [in a new window]   Figure 8a.  BAC in a 45-year-old woman. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the basal segmental bronchi shows a 13-mm nodular area of ground-glass attenuation in the right lower lobe (arrow). (b) High-power photomicrograph (original magnification, x100; H-E stain) shows the spread of neoplastic cells (lepidic growth).

View larger version (210K): [in a new window]   Figure 8b.  BAC in a 45-year-old woman. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the basal segmental bronchi shows a 13-mm nodular area of ground-glass attenuation in the right lower lobe (arrow). (b) High-power photomicrograph (original magnification, x100; H-E stain) shows the spread of neoplastic cells (lepidic growth).

View larger version (175K): [in a new window]   Figure 9a.  T1 N2 adenocarcinoma in a 40-year-old man. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the azygos arch shows a 25-mm nodule with a lobulated and spiculated margin in the anterior segment of the right upper lobe. Mediastinoscopy revealed microscopic lymph node metastases in the right lower paratracheal nodes. (b) Low-power photomicrograph (original magnification, x4; H-E stain) of a surgical specimen shows spiculated adenocarcinoma with bronchovascular invasion (arrows).

View larger version (160K): [in a new window]   Figure 9b.  T1 N2 adenocarcinoma in a 40-year-old man. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the azygos arch shows a 25-mm nodule with a lobulated and spiculated margin in the anterior segment of the right upper lobe. Mediastinoscopy revealed microscopic lymph node metastases in the right lower paratracheal nodes. (b) Low-power photomicrograph (original magnification, x4; H-E stain) of a surgical specimen shows spiculated adenocarcinoma with bronchovascular invasion (arrows).

View larger version (149K): [in a new window]   Figure 10a.  T1 adenocarcinoma with vascular invasion in a 66-year-old man. (a, b) Transaxial thin-section CT scans (lung window) obtained at the levels of the main bronchi (a) and right upper lobar bronchus (b) show a 20-mm nodule with a lobulated margin and thickened bronchovascular bundles in the right upper lobe (arrow). (c) Low-power photomicrograph (original magnification, x4; H-E stain) shows tumor invasion of adjacent bronchovascular bundles (arrows).

View larger version (155K): [in a new window]   Figure 10b.  T1 adenocarcinoma with vascular invasion in a 66-year-old man. (a, b) Transaxial thin-section CT scans (lung window) obtained at the levels of the main bronchi (a) and right upper lobar bronchus (b) show a 20-mm nodule with a lobulated margin and thickened bronchovascular bundles in the right upper lobe (arrow). (c) Low-power photomicrograph (original magnification, x4; H-E stain) shows tumor invasion of adjacent bronchovascular bundles (arrows).

View larger version (164K): [in a new window]   Figure 10c.  T1 adenocarcinoma with vascular invasion in a 66-year-old man. (a, b) Transaxial thin-section CT scans (lung window) obtained at the levels of the main bronchi (a) and right upper lobar bronchus (b) show a 20-mm nodule with a lobulated margin and thickened bronchovascular bundles in the right upper lobe (arrow). (c) Low-power photomicrograph (original magnification, x4; H-E stain) shows tumor invasion of adjacent bronchovascular bundles (arrows).

View larger version (127K): [in a new window]   Figure 11a.  Atypical adenomatous hyperplasia in a 44-year-old man. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) shows an 8-mm focal nodular area of ground-glass attenuation in the right upper lobe (arrow). The nodule did not change in size over a follow-up period of 12 months. (b) High-power photomicrograph (original magnification, x100; H-E stain) shows atypical epithelial cell proliferation along thickened alveolar septa (arrows), findings that indicate atypical adenomatous hyperplasia.

View larger version (116K): [in a new window]   Figure 11b.  Atypical adenomatous hyperplasia in a 44-year-old man. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) shows an 8-mm focal nodular area of ground-glass attenuation in the right upper lobe (arrow). The nodule did not change in size over a follow-up period of 12 months. (b) High-power photomicrograph (original magnification, x100; H-E stain) shows atypical epithelial cell proliferation along thickened alveolar septa (arrows), findings that indicate atypical adenomatous hyperplasia.

View larger version (96K): [in a new window]   Figure 12a.  T1 squamous cell carcinoma with extrathoracic metastases in a 64-year-old man. (a) Conventional (7-mm collimation) CT scan (lung window) obtained at the level of the liver dome shows a small, 10-mm nodule in the right lower lobe (arrow). Note the areas of ground-glass attenuation and irregular linear areas of hyperattenuation in the surrounding lung, findings that suggest underlying pulmonary fibrosis. (b) CT scan obtained at the level of the right portal vein shows a small metastatic nodule in the liver (arrowhead) and metastatic lymphadenopathy in the left gastric area (arrow).

View larger version (149K): [in a new window]   Figure 12b.  T1 squamous cell carcinoma with extrathoracic metastases in a 64-year-old man. (a) Conventional (7-mm collimation) CT scan (lung window) obtained at the level of the liver dome shows a small, 10-mm nodule in the right lower lobe (arrow). Note the areas of ground-glass attenuation and irregular linear areas of hyperattenuation in the surrounding lung, findings that suggest underlying pulmonary fibrosis. (b) CT scan obtained at the level of the right portal vein shows a small metastatic nodule in the liver (arrowhead) and metastatic lymphadenopathy in the left gastric area (arrow).

View larger version (125K): [in a new window]   Figure 13a.  Adenocarcinoma in a 35-year-old woman. (a) Transaxial thin-section (1-mm collimation) CT scan (mediastinal window) obtained at the level of the left main bronchus shows a 15-mm nodule in the left upper lobe (arrow). (b) FDG PET scan demonstrates a focus of high glucose uptake (arrowhead).

View larger version (56K): [in a new window]   Figure 13b.  Adenocarcinoma in a 35-year-old woman. (a) Transaxial thin-section (1-mm collimation) CT scan (mediastinal window) obtained at the level of the left main bronchus shows a 15-mm nodule in the left upper lobe (arrow). (b) FDG PET scan demonstrates a focus of high glucose uptake (arrowhead).

View larger version (89K): [in a new window]   Figure 14a.  BAC in a 36-year-old woman. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the aortic arch show a 15-mm nodular area of ground-glass attenuation with a lobulated margin in the left upper lobe. Note also the dark bubble within the lesion (arrow). (b) On an FDG PET scan, the lesion demonstrates little glucose uptake (arrowhead) compared with other non-small cell lung cancers (not shown).

View larger version (130K): [in a new window]   Figure 14b.  BAC in a 36-year-old woman. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the aortic arch show a 15-mm nodular area of ground-glass attenuation with a lobulated margin in the left upper lobe. Note also the dark bubble within the lesion (arrow). (b) On an FDG PET scan, the lesion demonstrates little glucose uptake (arrowhead) compared with other non-small cell lung cancers (not shown).

View larger version (91K): [in a new window]   Figure 15a.  Endobronchial carcinoid tumor in a 54-year-old woman. (a) Transaxial contrast material-enhanced CT scan (2.5-mm collimation) obtained at the level of the lingular segmental bronchus shows a round, 21-mm endobronchial nodule in the bronchus intermedius (arrow) with attendant distal obstructive atelectasis in the right lower lobe. The nodule demonstrates strong enhancement (40 HU). Note also the calcific attenuation within the lesion (arrowhead). (b) FDG PET scan demonstrates little glucose uptake at the nodule site (arrow).

View larger version (98K): [in a new window]   Figure 15b.  Endobronchial carcinoid tumor in a 54-year-old woman. (a) Transaxial contrast material-enhanced CT scan (2.5-mm collimation) obtained at the level of the lingular segmental bronchus shows a round, 21-mm endobronchial nodule in the bronchus intermedius (arrow) with attendant distal obstructive atelectasis in the right lower lobe. The nodule demonstrates strong enhancement (40 HU). Note also the calcific attenuation within the lesion (arrowhead). (b) FDG PET scan demonstrates little glucose uptake at the nodule site (arrow).

View larger version (74K): [in a new window]   Figure 16a.  Squamous cell carcinoma with ipsilateral hilar lymph node metastasis in a 75-year-old man. (a) Transaxial CT scan (2.5-mm collimation, mediastinal window) obtained at the level of the left atrium shows an 18-mm nodule in the right lower lobe (bottom arrowhead), along with ipsilateral hilar lymph node enlargement (top arrowhead). (b) Low-power photomicrograph (original magnification, x40; avidin-biotin complex method) obtained after immunostaining for VEGF shows strong cytoplasmic positive staining (arrows). (c) High-power photomicrograph (original magnification, x100; avidin-biotin complex method) obtained after immunostaining for microvessel density with CD 31 shows numerous stromal microvessels (arrows). (d) Serial CT scans obtained at 30-second intervals at similar levels after power injection of 120 mL of 30% iodinated contrast material (injection rate, 3 mL/sec) allow a dynamic enhancement study of the nodule. Peak attenuation of the nodule was 121 HU, net enhancement (peak minus precontrast attenuation) was 68 HU, and time to peak enhancement was 60 seconds (very strong and rapid enhancement). Scale at left is in Hounsfield units.

View larger version (177K): [in a new window]   Figure 16b.  Squamous cell carcinoma with ipsilateral hilar lymph node metastasis in a 75-year-old man. (a) Transaxial CT scan (2.5-mm collimation, mediastinal window) obtained at the level of the left atrium shows an 18-mm nodule in the right lower lobe (bottom arrowhead), along with ipsilateral hilar lymph node enlargement (top arrowhead). (b) Low-power photomicrograph (original magnification, x40; avidin-biotin complex method) obtained after immunostaining for VEGF shows strong cytoplasmic positive staining (arrows). (c) High-power photomicrograph (original magnification, x100; avidin-biotin complex method) obtained after immunostaining for microvessel density with CD 31 shows numerous stromal microvessels (arrows). (d) Serial CT scans obtained at 30-second intervals at similar levels after power injection of 120 mL of 30% iodinated contrast material (injection rate, 3 mL/sec) allow a dynamic enhancement study of the nodule. Peak attenuation of the nodule was 121 HU, net enhancement (peak minus precontrast attenuation) was 68 HU, and time to peak enhancement was 60 seconds (very strong and rapid enhancement). Scale at left is in Hounsfield units.

View larger version (185K): [in a new window]   Figure 16c.  Squamous cell carcinoma with ipsilateral hilar lymph node metastasis in a 75-year-old man. (a) Transaxial CT scan (2.5-mm collimation, mediastinal window) obtained at the level of the left atrium shows an 18-mm nodule in the right lower lobe (bottom arrowhead), along with ipsilateral hilar lymph node enlargement (top arrowhead). (b) Low-power photomicrograph (original magnification, x40; avidin-biotin complex method) obtained after immunostaining for VEGF shows strong cytoplasmic positive staining (arrows). (c) High-power photomicrograph (original magnification, x100; avidin-biotin complex method) obtained after immunostaining for microvessel density with CD 31 shows numerous stromal microvessels (arrows). (d) Serial CT scans obtained at 30-second intervals at similar levels after power injection of 120 mL of 30% iodinated contrast material (injection rate, 3 mL/sec) allow a dynamic enhancement study of the nodule. Peak attenuation of the nodule was 121 HU, net enhancement (peak minus precontrast attenuation) was 68 HU, and time to peak enhancement was 60 seconds (very strong and rapid enhancement). Scale at left is in Hounsfield units.

View larger version (67K): [in a new window]   Figure 16d.  Squamous cell carcinoma with ipsilateral hilar lymph node metastasis in a 75-year-old man. (a) Transaxial CT scan (2.5-mm collimation, mediastinal window) obtained at the level of the left atrium shows an 18-mm nodule in the right lower lobe (bottom arrowhead), along with ipsilateral hilar lymph node enlargement (top arrowhead). (b) Low-power photomicrograph (original magnification, x40; avidin-biotin complex method) obtained after immunostaining for VEGF shows strong cytoplasmic positive staining (arrows). (c) High-power photomicrograph (original magnification, x100; avidin-biotin complex method) obtained after immunostaining for microvessel density with CD 31 shows numerous stromal microvessels (arrows). (d) Serial CT scans obtained at 30-second intervals at similar levels after power injection of 120 mL of 30% iodinated contrast material (injection rate, 3 mL/sec) allow a dynamic enhancement study of the nodule. Peak attenuation of the nodule was 121 HU, net enhancement (peak minus precontrast attenuation) was 68 HU, and time to peak enhancement was 60 seconds (very strong and rapid enhancement). Scale at left is in Hounsfield units.

View larger version (122K): [in a new window]   Figure 17a.  Adenocarcinoma with no mediastinal or hilar lymph node metastasis in a 66-year-old man. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the right upper lobar bronchus shows a 14-mm nodule with a lobulated margin in the right upper lobe. (b) Low-power photomicrograph (original magnification, x12; avidin-biotin complex method) obtained after immunostaining for VEGF shows weak cytoplasmic positive staining. (c) High-power photomicrograph (original magnification, x100; avidin-biotin complex method) obtained after immunostaining for microvessel density with CD 31 shows few stromal microvessels, a finding that suggests low vascularity. (d) On a dynamic enhancement study consisting of CT scans obtained with the same parameters as those in Figure 16d, the nodule had a peak enhancement of 84 HU, a net enhancement of 38 HU, and a time to peak enhancement of 80 seconds (moderate enhancement). Scale at left is in Hounsfield units. On an FDG PET scan (not shown), the nodule demonstrated less glucose uptake than other non-small cell lung cancers.

View larger version (162K): [in a new window]   Figure 17b.  Adenocarcinoma with no mediastinal or hilar lymph node metastasis in a 66-year-old man. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the right upper lobar bronchus shows a 14-mm nodule with a lobulated margin in the right upper lobe. (b) Low-power photomicrograph (original magnification, x12; avidin-biotin complex method) obtained after immunostaining for VEGF shows weak cytoplasmic positive staining. (c) High-power photomicrograph (original magnification, x100; avidin-biotin complex method) obtained after immunostaining for microvessel density with CD 31 shows few stromal microvessels, a finding that suggests low vascularity. (d) On a dynamic enhancement study consisting of CT scans obtained with the same parameters as those in Figure 16d, the nodule had a peak enhancement of 84 HU, a net enhancement of 38 HU, and a time to peak enhancement of 80 seconds (moderate enhancement). Scale at left is in Hounsfield units. On an FDG PET scan (not shown), the nodule demonstrated less glucose uptake than other non-small cell lung cancers.

View larger version (200K): [in a new window]   Figure 17c.  Adenocarcinoma with no mediastinal or hilar lymph node metastasis in a 66-year-old man. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the right upper lobar bronchus shows a 14-mm nodule with a lobulated margin in the right upper lobe. (b) Low-power photomicrograph (original magnification, x12; avidin-biotin complex method) obtained after immunostaining for VEGF shows weak cytoplasmic positive staining. (c) High-power photomicrograph (original magnification, x100; avidin-biotin complex method) obtained after immunostaining for microvessel density with CD 31 shows few stromal microvessels, a finding that suggests low vascularity. (d) On a dynamic enhancement study consisting of CT scans obtained with the same parameters as those in Figure 16d, the nodule had a peak enhancement of 84 HU, a net enhancement of 38 HU, and a time to peak enhancement of 80 seconds (moderate enhancement). Scale at left is in Hounsfield units. On an FDG PET scan (not shown), the nodule demonstrated less glucose uptake than other non-small cell lung cancers.

View larger version (55K): [in a new window]   Figure 17d.  Adenocarcinoma with no mediastinal or hilar lymph node metastasis in a 66-year-old man. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the right upper lobar bronchus shows a 14-mm nodule with a lobulated margin in the right upper lobe. (b) Low-power photomicrograph (original magnification, x12; avidin-biotin complex method) obtained after immunostaining for VEGF shows weak cytoplasmic positive staining. (c) High-power photomicrograph (original magnification, x100; avidin-biotin complex method) obtained after immunostaining for microvessel density with CD 31 shows few stromal microvessels, a finding that suggests low vascularity. (d) On a dynamic enhancement study consisting of CT scans obtained with the same parameters as those in Figure 16d, the nodule had a peak enhancement of 84 HU, a net enhancement of 38 HU, and a time to peak enhancement of 80 seconds (moderate enhancement). Scale at left is in Hounsfield units. On an FDG PET scan (not shown), the nodule demonstrated less glucose uptake than other non-small cell lung cancers.

View larger version (130K): [in a new window]   Figure 18a.  T1 adenocarcinoma of the lung with brain metastasis in a 52-year-old man. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the left upper lobar bronchus shows a 19-mm nodule with a spiculated margin in the left upper lobe. (b) Transaxial gadolinium-enhanced T1-weighted MR image shows metastatic nodules in the right parietal and occipital lobes (arrows).

View larger version (130K): [in a new window]   Figure 18b.  T1 adenocarcinoma of the lung with brain metastasis in a 52-year-old man. (a) Transaxial thin-section (1-mm collimation) CT scan (lung window) obtained at the level of the left upper lobar bronchus shows a 19-mm nodule with a spiculated margin in the left upper lobe. (b) Transaxial gadolinium-enhanced T1-weighted MR image shows metastatic nodules in the right parietal and occipital lobes (arrows).

View larger version (89K): [in a new window]   Figure 19a.  T1 adenocarcinoma with pleural and bone metastases in a 72-year-old woman. (a) Conventional (5-mm collimation) CT scan (lung window) obtained at the level of the thoracic inlet shows an 18-mm nodule in the right upper lobe. (b) Thin-section (1-mm collimation) CT scan obtained at the level of the right upper lobar bronchus shows subpleural nodules in the right upper lung zone, findings that suggest pleural metastases. (c) Bone scintigram shows rib metastases (arrowheads).

View larger version (117K): [in a new window]   Figure 19b.  T1 adenocarcinoma with pleural and bone metastases in a 72-year-old woman. (a) Conventional (5-mm collimation) CT scan (lung window) obtained at the level of the thoracic inlet shows an 18-mm nodule in the right upper lobe. (b) Thin-section (1-mm collimation) CT scan obtained at the level of the right upper lobar bronchus shows subpleural nodules in the right upper lung zone, findings that suggest pleural metastases. (c) Bone scintigram shows rib metastases (arrowheads).

View larger version (125K): [in a new window]   Figure 19c.  T1 adenocarcinoma with pleural and bone metastases in a 72-year-old woman. (a) Conventional (5-mm collimation) CT scan (lung window) obtained at the level of the thoracic inlet shows an 18-mm nodule in the right upper lobe. (b) Thin-section (1-mm collimation) CT scan obtained at the level of the right upper lobar bronchus shows subpleural nodules in the right upper lung zone, findings that suggest pleural metastases. (c) Bone scintigram shows rib metastases (arrowheads).