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DOI: 10.1148/rg.272065061
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Nodular Ground-Glass Opacity at Thin-Section CT: Histologic Correlation and Evaluation of Change at Follow-up1

Chang Min Park, MD, Jin Mo Goo, MD, Hyun Ju Lee, MD, Chang Hyun Lee, MD, Eun Ju Chun, MD and Jung-Gi Im, MD

1 From the Department of Radiology, Seoul National University College of Medicine and the Institute of Radiation Medicine, Seoul National University Medical Research Center, 28 Yeongeon-dong, Jongno-gu, Seoul 110-744, Republic of Korea. Presented as an education exhibit at the 2005 RSNA Annual Meeting. Received April 11, 2006; revision requested June 12 and received July 25; accepted August 1. All authors have no financial relationships to disclose.

Figure 1A
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  		Figure 1a.  Pseudo-ground-glass opacity at CT in a 53-year-old man. (a) Axial low-dose CT image (5-mm-thick section) shows a nodular ground-glass opacity in the upper lobe of the left lung. No solid component is visible in the 10-mm poorly marginated lesion. (b) Thin-section CT image obtained at the level of the aortic arch depicts a well-defined oval solid nodule instead of the nodular ground-glass opacity shown in a. (c) CT image obtained with a mediastinal window setting shows a densely calcified granuloma.

 

Figure 1B
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  		Figure 1b.  Pseudo-ground-glass opacity at CT in a 53-year-old man. (a) Axial low-dose CT image (5-mm-thick section) shows a nodular ground-glass opacity in the upper lobe of the left lung. No solid component is visible in the 10-mm poorly marginated lesion. (b) Thin-section CT image obtained at the level of the aortic arch depicts a well-defined oval solid nodule instead of the nodular ground-glass opacity shown in a. (c) CT image obtained with a mediastinal window setting shows a densely calcified granuloma.

 

Figure 1C
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  		Figure 1c.  Pseudo-ground-glass opacity at CT in a 53-year-old man. (a) Axial low-dose CT image (5-mm-thick section) shows a nodular ground-glass opacity in the upper lobe of the left lung. No solid component is visible in the 10-mm poorly marginated lesion. (b) Thin-section CT image obtained at the level of the aortic arch depicts a well-defined oval solid nodule instead of the nodular ground-glass opacity shown in a. (c) CT image obtained with a mediastinal window setting shows a densely calcified granuloma.

 

Figure 2A
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  		Figure 2a.  Pseudo-ground-glass opacity at CT in a 66-year-old man. (a) Axial low-dose CT image (5-mm-thick section) obtained at the level of the left brachiocephalic vein shows a mixed ground-glass opacity lesion with a central solid component (arrow) in the upper lobe of the left lung, a finding suggestive of cancer. (b) Thin-section CT images show an irregularly shaped solid mass without nodular ground-glass opacity. (c) Coronal slab maximum intensity projection image shows a flat focus of atelectasis above the aortic arch (arrow) and no ground-glass opacity.

 

Figure 2B
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  		Figure 2b.  Pseudo-ground-glass opacity at CT in a 66-year-old man. (a) Axial low-dose CT image (5-mm-thick section) obtained at the level of the left brachiocephalic vein shows a mixed ground-glass opacity lesion with a central solid component (arrow) in the upper lobe of the left lung, a finding suggestive of cancer. (b) Thin-section CT images show an irregularly shaped solid mass without nodular ground-glass opacity. (c) Coronal slab maximum intensity projection image shows a flat focus of atelectasis above the aortic arch (arrow) and no ground-glass opacity.

 

Figure 2C
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  		Figure 2c.  Pseudo-ground-glass opacity at CT in a 66-year-old man. (a) Axial low-dose CT image (5-mm-thick section) obtained at the level of the left brachiocephalic vein shows a mixed ground-glass opacity lesion with a central solid component (arrow) in the upper lobe of the left lung, a finding suggestive of cancer. (b) Thin-section CT images show an irregularly shaped solid mass without nodular ground-glass opacity. (c) Coronal slab maximum intensity projection image shows a flat focus of atelectasis above the aortic arch (arrow) and no ground-glass opacity.

 

Figure 3A
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  		Figure 3a.  Atypical adenomatous hyperplasia in a 53-year-old woman. (a) Thin-section CT image of the right lung shows an 11-mm well-defined nodular ground-glass opacity without a solid component in the lower lobe. (b) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows thickened alveolar walls lined by an intermittent single layer of atypical cuboidal pneumocytes.

 

Figure 3B
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  		Figure 3b.  Atypical adenomatous hyperplasia in a 53-year-old woman. (a) Thin-section CT image of the right lung shows an 11-mm well-defined nodular ground-glass opacity without a solid component in the lower lobe. (b) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) shows thickened alveolar walls lined by an intermittent single layer of atypical cuboidal pneumocytes.

 

Figure 4A
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  		Figure 4a.  Concurrent atypical adenomatous hyperplasia and adenocarcinoma in a 71-year-old woman. (a) Thin-section CT image at the level of the carina shows an 18-mm-diameter mixed nodular ground-glass opacity with a solid component in the upper lobe of the right lung and a 10-mm pure nodular ground-glass opacity in the lower lobe of the left lung. (b) Photomicrograph of a resected specimen (original magnification, x40; hematoxylin-eosin stain) from a superior segment of the lower lobe of the left lung shows atypical epithelial cell proliferation along thickened alveolar septa, findings suggestive of atypical adenomatous hyperplasia. (c) Photomicrograph of a histologic slice (original magnification, x40; hematoxylin-eosin stain) from the right upper lobectomy specimen shows adenocarcinoma, with carcinoma of the bronchioloalveolar subtype at the periphery of the lesion.

 

Figure 4B
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  		Figure 4b.  Concurrent atypical adenomatous hyperplasia and adenocarcinoma in a 71-year-old woman. (a) Thin-section CT image at the level of the carina shows an 18-mm-diameter mixed nodular ground-glass opacity with a solid component in the upper lobe of the right lung and a 10-mm pure nodular ground-glass opacity in the lower lobe of the left lung. (b) Photomicrograph of a resected specimen (original magnification, x40; hematoxylin-eosin stain) from a superior segment of the lower lobe of the left lung shows atypical epithelial cell proliferation along thickened alveolar septa, findings suggestive of atypical adenomatous hyperplasia. (c) Photomicrograph of a histologic slice (original magnification, x40; hematoxylin-eosin stain) from the right upper lobectomy specimen shows adenocarcinoma, with carcinoma of the bronchioloalveolar subtype at the periphery of the lesion.

 

Figure 4C
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  		Figure 4c.  Concurrent atypical adenomatous hyperplasia and adenocarcinoma in a 71-year-old woman. (a) Thin-section CT image at the level of the carina shows an 18-mm-diameter mixed nodular ground-glass opacity with a solid component in the upper lobe of the right lung and a 10-mm pure nodular ground-glass opacity in the lower lobe of the left lung. (b) Photomicrograph of a resected specimen (original magnification, x40; hematoxylin-eosin stain) from a superior segment of the lower lobe of the left lung shows atypical epithelial cell proliferation along thickened alveolar septa, findings suggestive of atypical adenomatous hyperplasia. (c) Photomicrograph of a histologic slice (original magnification, x40; hematoxylin-eosin stain) from the right upper lobectomy specimen shows adenocarcinoma, with carcinoma of the bronchioloalveolar subtype at the periphery of the lesion.

 

Figure 5A
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  		Figure 5a.  Localized bronchioloalveolar carcinoma in a 63-year-old woman. (a) Thin-section CT image obtained at the level of the right upper anterior segmental bronchus shows a 10-mm well-defined nodular ground-glass opacity without a solid component in the lower lobe of the right lung. Note the presence of pulmonary vessels in the lesion. (b) Photomicrograph of a histologic specimen (original magnification, x100; hematoxylin-eosin stain) shows replacement of the alveolar lining by neoplastic columnar epithelium, without evidence of stromal invasion.

 

Figure 5B
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  		Figure 5b.  Localized bronchioloalveolar carcinoma in a 63-year-old woman. (a) Thin-section CT image obtained at the level of the right upper anterior segmental bronchus shows a 10-mm well-defined nodular ground-glass opacity without a solid component in the lower lobe of the right lung. Note the presence of pulmonary vessels in the lesion. (b) Photomicrograph of a histologic specimen (original magnification, x100; hematoxylin-eosin stain) shows replacement of the alveolar lining by neoplastic columnar epithelium, without evidence of stromal invasion.

 

Figure 6A
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  		Figure 6a.  Localized bronchioloalveolar carcinoma in a 49-year-old woman. (a) Thin-section CT image obtained at the level of the right bronchus intermedius shows a 14-mm well-defined nodular ground-glass opacity with a solid component (arrow) in the lower lobe of the right lung, abutting the vertebral body. (b) Photomicrograph of a histologic specimen (original magnification, x40; hematoxylin-eosin stain) shows replacement-type tumor cell growth, as well as foci of fibroblastic proliferation and alveolar collapse (arrowheads).

 

Figure 6B
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  		Figure 6b.  Localized bronchioloalveolar carcinoma in a 49-year-old woman. (a) Thin-section CT image obtained at the level of the right bronchus intermedius shows a 14-mm well-defined nodular ground-glass opacity with a solid component (arrow) in the lower lobe of the right lung, abutting the vertebral body. (b) Photomicrograph of a histologic specimen (original magnification, x40; hematoxylin-eosin stain) shows replacement-type tumor cell growth, as well as foci of fibroblastic proliferation and alveolar collapse (arrowheads).

 

Figure 7A
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  		Figure 7a.  Adenocarcinoma with mixed acinar and bronchioloalveolar carcinoma in a 50-year-old woman. (a) Thin-section CT image obtained at the level of the aortic arch shows a 28-mm well-defined mixed ground-glass opacity lesion with peripheral ground-glass opacity in the upper lobe of the left lung. The mass abuts the pleura. (b) Photomicrograph of a histologic specimen (original magnification, x40; hematoxylin-eosin stain) shows a replacement-type growth pattern characteristic of bronchioloalveolar carcinoma in the periphery of the tumor.

 

Figure 7B
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  		Figure 7b.  Adenocarcinoma with mixed acinar and bronchioloalveolar carcinoma in a 50-year-old woman. (a) Thin-section CT image obtained at the level of the aortic arch shows a 28-mm well-defined mixed ground-glass opacity lesion with peripheral ground-glass opacity in the upper lobe of the left lung. The mass abuts the pleura. (b) Photomicrograph of a histologic specimen (original magnification, x40; hematoxylin-eosin stain) shows a replacement-type growth pattern characteristic of bronchioloalveolar carcinoma in the periphery of the tumor.

 

Figure 8A
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  		Figure 8a.  Adenocarcinoma in a 56-year-old man. (a) Thin-section CT image obtained at the level of the aortopulmonary window shows a 14-mm nodular ground-glass opacity with no solid component in the upper lobe of the right lung. (b) Photomicrograph of a histologic specimen (original magnification, x40; hematoxylin-eosin stain) shows adenocarcinoma with dense sclerosis.

 

Figure 8B
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  		Figure 8b.  Adenocarcinoma in a 56-year-old man. (a) Thin-section CT image obtained at the level of the aortopulmonary window shows a 14-mm nodular ground-glass opacity with no solid component in the upper lobe of the right lung. (b) Photomicrograph of a histologic specimen (original magnification, x40; hematoxylin-eosin stain) shows adenocarcinoma with dense sclerosis.

 

Figure 9A
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  		Figure 9a.  Focal interstitial fibrosis in a 40-year-old woman. (a) Thin-section CT image at the level of the superior segmental bronchus shows a 25-mm well-defined nodular ground-glass opacity with no solid component in the lower lobe of the left lung. (b) Photomicrograph of a histologic specimen (original magnification, x40; hematoxylin-eosin stain) shows the lesion (arrow) with alveolar septal thickening and fibrosis and with intraalveolar infiltration by inflammatory cells. (c) High-power photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows fibrosis of the alveolar wall, with intraalveolar lymphocytes and denuded pneumocytes (arrows).

 

Figure 9B
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  		Figure 9b.  Focal interstitial fibrosis in a 40-year-old woman. (a) Thin-section CT image at the level of the superior segmental bronchus shows a 25-mm well-defined nodular ground-glass opacity with no solid component in the lower lobe of the left lung. (b) Photomicrograph of a histologic specimen (original magnification, x40; hematoxylin-eosin stain) shows the lesion (arrow) with alveolar septal thickening and fibrosis and with intraalveolar infiltration by inflammatory cells. (c) High-power photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows fibrosis of the alveolar wall, with intraalveolar lymphocytes and denuded pneumocytes (arrows).

 

Figure 9C
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  		Figure 9c.  Focal interstitial fibrosis in a 40-year-old woman. (a) Thin-section CT image at the level of the superior segmental bronchus shows a 25-mm well-defined nodular ground-glass opacity with no solid component in the lower lobe of the left lung. (b) Photomicrograph of a histologic specimen (original magnification, x40; hematoxylin-eosin stain) shows the lesion (arrow) with alveolar septal thickening and fibrosis and with intraalveolar infiltration by inflammatory cells. (c) High-power photomicrograph (original magnification, x200; hematoxylin-eosin stain) shows fibrosis of the alveolar wall, with intraalveolar lymphocytes and denuded pneumocytes (arrows).

 

Figure 10A
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  		Figure 10a.  Aspergillosis in a 52-year-old woman with a chronic cough. (a) Thin-section CT image at the level of the main pulmonary artery shows a 23-mm poorly defined nodular ground-glass opacity in the upper lobe of the left lung. The lesion includes several peripheral solid portions (arrows) and a subtle ground-glass opacity (arrowhead). (b) Photomicrograph of a histologic specimen (original magnification, x100; hematoxylin-eosin stain) shows an aspergillus colony (arrows) and a surrounding area of intraalveolar hemorrhage (arrowheads). (c) High-power photomicrograph (original magnification, x1000; hematoxylin-eosin stain) shows fungal hyphae.

 

Figure 10B
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  		Figure 10b.  Aspergillosis in a 52-year-old woman with a chronic cough. (a) Thin-section CT image at the level of the main pulmonary artery shows a 23-mm poorly defined nodular ground-glass opacity in the upper lobe of the left lung. The lesion includes several peripheral solid portions (arrows) and a subtle ground-glass opacity (arrowhead). (b) Photomicrograph of a histologic specimen (original magnification, x100; hematoxylin-eosin stain) shows an aspergillus colony (arrows) and a surrounding area of intraalveolar hemorrhage (arrowheads). (c) High-power photomicrograph (original magnification, x1000; hematoxylin-eosin stain) shows fungal hyphae.

 

Figure 10C
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  		Figure 10c.  Aspergillosis in a 52-year-old woman with a chronic cough. (a) Thin-section CT image at the level of the main pulmonary artery shows a 23-mm poorly defined nodular ground-glass opacity in the upper lobe of the left lung. The lesion includes several peripheral solid portions (arrows) and a subtle ground-glass opacity (arrowhead). (b) Photomicrograph of a histologic specimen (original magnification, x100; hematoxylin-eosin stain) shows an aspergillus colony (arrows) and a surrounding area of intraalveolar hemorrhage (arrowheads). (c) High-power photomicrograph (original magnification, x1000; hematoxylin-eosin stain) shows fungal hyphae.

 

Figure 11A
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  		Figure 11a.  Eosinophilic pneumonia in a 36-year-old man with peripheral blood eosinophilia. (a) Thin-section CT image at the level of the aortic arch shows an ill-defined area of nodular ground-glass opacity in the upper lobe of the right lung. (b) Thin-section CT image at the level of the upper lobar bronchus in the left lung shows a similar nodular ground-glass opacity.

 

Figure 11B
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  		Figure 11b.  Eosinophilic pneumonia in a 36-year-old man with peripheral blood eosinophilia. (a) Thin-section CT image at the level of the aortic arch shows an ill-defined area of nodular ground-glass opacity in the upper lobe of the right lung. (b) Thin-section CT image at the level of the upper lobar bronchus in the left lung shows a similar nodular ground-glass opacity.

 

Figure 12
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  		Figure 12.  Bronchiolitis obliterans with organizing pneumonia in a 46-year-old woman. Axial CT image at the level of the aortic arch shows multiple bilateral areas of ill-defined nodular ground-glass opacity, some of which contain solid components (arrows).

 

Figure 13
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  		Figure 13.  Catamenial hemoptysis syndrome in a 24-year-old woman with recurrent monthly hemoptysis during menstruation. Axial CT image at the level of the diaphragmatic dome shows multiple areas of ill-defined nodular ground-glass opacity (arrows), features representative of bleeding. The patient underwent a bronchoscopic examination, and endometrial tissue was found at bronchial lavage.

 

Figure 14A
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  		Figure 14a.  Pseudonodule in a 56-year-old woman who underwent a previous percutaneous lung biopsy. (a) Thin-section CT image obtained at the level of the aortic arch shows a 9-mm well-defined nodular ground-glass opacity (arrow) in the right upper lobe. (b) Axial image obtained during CT-guided percutaneous transthoracic biopsy with the patient in the supine position shows the biopsy needle (arrow), which has been inserted near the nodule. (c) Axial CT image, obtained after the biopsy, shows a poorly defined pseudonodule represented by ground-glass opacity (arrow) along the biopsy tract. The pathologic diagnosis, obtained after a wedge resection, was focal interstitial fibrosis.

 

Figure 14B
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  		Figure 14b.  Pseudonodule in a 56-year-old woman who underwent a previous percutaneous lung biopsy. (a) Thin-section CT image obtained at the level of the aortic arch shows a 9-mm well-defined nodular ground-glass opacity (arrow) in the right upper lobe. (b) Axial image obtained during CT-guided percutaneous transthoracic biopsy with the patient in the supine position shows the biopsy needle (arrow), which has been inserted near the nodule. (c) Axial CT image, obtained after the biopsy, shows a poorly defined pseudonodule represented by ground-glass opacity (arrow) along the biopsy tract. The pathologic diagnosis, obtained after a wedge resection, was focal interstitial fibrosis.

 

Figure 14C
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  		Figure 14c.  Pseudonodule in a 56-year-old woman who underwent a previous percutaneous lung biopsy. (a) Thin-section CT image obtained at the level of the aortic arch shows a 9-mm well-defined nodular ground-glass opacity (arrow) in the right upper lobe. (b) Axial image obtained during CT-guided percutaneous transthoracic biopsy with the patient in the supine position shows the biopsy needle (arrow), which has been inserted near the nodule. (c) Axial CT image, obtained after the biopsy, shows a poorly defined pseudonodule represented by ground-glass opacity (arrow) along the biopsy tract. The pathologic diagnosis, obtained after a wedge resection, was focal interstitial fibrosis.

 

Figure 15A
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  		Figure 15a.  Resolution of nodular ground-glass opacity over time helps determine the benignity of a lesion in a 50-year-old man. (a) Initial thin-section CT image at the level of the inferior pulmonary vein shows a 12-mm poorly defined nodular ground-glass opacity in the right lower lobe. (b) Follow-up CT image obtained approximately 2 months later shows that the lesion in a has resolved.

 

Figure 15B
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  		Figure 15b.  Resolution of nodular ground-glass opacity over time helps determine the benignity of a lesion in a 50-year-old man. (a) Initial thin-section CT image at the level of the inferior pulmonary vein shows a 12-mm poorly defined nodular ground-glass opacity in the right lower lobe. (b) Follow-up CT image obtained approximately 2 months later shows that the lesion in a has resolved.

 

Figure 16A
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  		Figure 16a.  Persistent nodular ground-glass opacity in a 69-year-old man. (a) Thin-section CT image obtained at the level of the left brachiocephalic vein shows a 14-mm poorly defined round nodular ground-glass opacity in the upper lobe of the left lung. (b) Follow-up thin-section CT image obtained 4 months later shows the persistence and stable appearance of the lesion. The pathologic diagnosis, obtained after a wedge resection, was focal interstitial fibrosis.

 

Figure 16B
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  		Figure 16b.  Persistent nodular ground-glass opacity in a 69-year-old man. (a) Thin-section CT image obtained at the level of the left brachiocephalic vein shows a 14-mm poorly defined round nodular ground-glass opacity in the upper lobe of the left lung. (b) Follow-up thin-section CT image obtained 4 months later shows the persistence and stable appearance of the lesion. The pathologic diagnosis, obtained after a wedge resection, was focal interstitial fibrosis.

 

Figure 17A
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  		Figure 17a.  Persistent nodular ground-glass opacity in an 80-year-old man with adenocarcinoma. (a) Initial thick-section CT image obtained at the level of the right inferior pulmonary vein shows a subtle nodule (arrow) in the middle lobe of the right lung. (b) Follow-up CT image obtained 12 months later shows an increase in the lesion size and an additional subtle internal solid component (arrow). (c) Follow-up thin-section CT image obtained at 16 months shows an increase in the size of the solid component within the lesion (arrow). Adenocarcinoma was found at histopathologic analysis of an excised specimen.

 

Figure 17B
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  		Figure 17b.  Persistent nodular ground-glass opacity in an 80-year-old man with adenocarcinoma. (a) Initial thick-section CT image obtained at the level of the right inferior pulmonary vein shows a subtle nodule (arrow) in the middle lobe of the right lung. (b) Follow-up CT image obtained 12 months later shows an increase in the lesion size and an additional subtle internal solid component (arrow). (c) Follow-up thin-section CT image obtained at 16 months shows an increase in the size of the solid component within the lesion (arrow). Adenocarcinoma was found at histopathologic analysis of an excised specimen.

 

Figure 17C
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  		Figure 17c.  Persistent nodular ground-glass opacity in an 80-year-old man with adenocarcinoma. (a) Initial thick-section CT image obtained at the level of the right inferior pulmonary vein shows a subtle nodule (arrow) in the middle lobe of the right lung. (b) Follow-up CT image obtained 12 months later shows an increase in the lesion size and an additional subtle internal solid component (arrow). (c) Follow-up thin-section CT image obtained at 16 months shows an increase in the size of the solid component within the lesion (arrow). Adenocarcinoma was found at histopathologic analysis of an excised specimen.

 




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