CT features of lung metastases from pancreatic adenocarcinoma: Correlation with histopathologic findings - 26/05/21
Highlights |
• | Lung metastases from pancreatic ductal adenocarcinoma display a misleading alveolar pattern on CT in 22% of patients. |
• | The alveolar pattern includes 4 distinctive subtypes including ground glass opacity, nodule with a halo sign, air-space nodule and consolidation. |
• | The alveolar pattern of lung metastases from pancreatic ductal adenocarcinoma is associated to a lepidic growth at histopathologic analysis. |
Abstract |
Purpose |
The purpose of this study was to evaluate the prevalence of an atypical, alveolar presentation of pulmonary metastases from pancreatic adenocarcinoma (PDAC) on computed tomography (CT) and to correlate CT features with those obtained at histopathologic analysis.
Material and methods |
A total of 76 patients with lung metastases from PDAC over a 10-year period (2009–2019) in a French university hospital were retrospectively included. There were 34 men and 42 women with a mean age of 67.6±11.3 (SD) years (range: 38–89 years). CT features of PDAC were classified according to their presentations as usual metastatic pattern or atypical alveolar pattern; the atypical alveolar pattern corresponding to either ground glass nodules or opacities, solid nodules with a halo sign, “air-space” nodules with air bronchogram, or parenchymal consolidation. Imaging-histopathologic correlation was performed when tissue samples were available.
Results |
Pulmonary metastases were synchronous in 36 patients (36/76; 47%) and metachronous in 40 patients (40/76; 53%). A predominant alveolar presentation on CT was observed in 17 patients (17/76, 22%). Nodules with halo sign were the predominant alveolar pattern in 7 patients (7/17; 41%), air-space nodules were predominant in 4 patients (4/17; 24%) whereas pure ground glass nodules and consolidations were observed as predominant features in 3 patients (3/17; 18%) each. For 5 patients who had histopathological confirmation, alveolar metastases of PDAC were characterized by columnar tumor cells lining the alveolar wall, which was not seen in other radiological presentations, whereas there were no differences regarding mucin secretion between pulmonary metastases with alveolar presentation and those with typical pattern.
Conclusions |
Lung metastases from PDAC may present with a so-called “alveolar” pattern on CT. This misleading CT features is found in 22% of patients with lung metastases from PDAC and is due to lepidic growth of the metastatic cells.
Le texte complet de cet article est disponible en PDF.Keywords : Pancreatic carcinoma adenocarcinoma, Pancreatic neoplasms, Lung neoplasms, Tomography X-ray computed, .
Abbreviations : CK7, CK20, CT, IQR, PACS, PDAC, SD, TTF1
Plan
Vol 102 - N° 6
P. 371-377 - juin 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.