Lung cancer associated with cystic airspaces: Characteristic morphological features on CT in a series of 11 cases

Purpose: To familiarize the reader with the entity 'lung cancer associated with cystic airspaces' (LC-CAS) and create an awareness about the potential for slow progressive development of cancer within these nonaggressive appearing cystic airspaces (CAS) encountered in routine radiology practice. Material and methods: Morphological appearances of (n = 11) LC-CAS detected during routine radiological reporting of chest CT scans were studied. Patient demographics, clinical history, characteristics of LC-CAS including location, size, wall thickening, diffuse nodularity, eccentric nodule, ground glass change, emphysema and pathology results were collected from the hospital's internal database. Results: Patients with LC-CAS (9F/2M) were between 49 and 77 years (mean 63.18 years). All patients (n = 11) had a history of smoking. LC-CAS had a characteristic multicystic bubbly appearance. Average size of CAS at initial detection of LC was 2.52 cm (range 1.3-4 cm). Lesions were located in the RLL (n = 4), RML (n = 2), RUL (n = 1), LLL (n = 1) and LUL (n = 3) with no lobar predilection and were more commonly peripheral (n = 7) than central (n = 4). Ground glass change (n = 2), extrinsic nodules (n = 4), diffuse wall nodularity (n = 3) and intrinsic nodules (n = 2) were observed and prompted biopsy. Lesions ranged between T1a to T4. Most cancers were T1a NO (n = 5). Adenocarcinomas formed the majority of cases (n = 9). Conclusion: LC-CAS present as new development of diffuse nodularity, eccentric nodules or ground glass change associated with CAS. These are more commonly adenocarcinomas on histology. Recognition of CAS and appropriate malignancy workup when suspicious features are observed is essential to enable early detection of lung cancer.