Korean J Radiol.  2006 Jun;7(2):80-86. 10.3348/kjr.2006.7.2.80.

CT Findings of Atypical Adenomatous Hyperplasia in the Lung

• Park CM
• Goo JM
• Lee HJ
• Lee CH
• Kim HC
• Chung DH
• Im JG

• KMID: 1782180
• DOI: http://doi.org/10.3348/kjr.2006.7.2.80

Abstract

OBJECTIVE
The aim of this study was to analyze the computed tomographic (CT) findings of atypical adenomatous hyperplasia (AAH) in the lung. MATERIALS AND METHODS: The CT findings of AAHs in eight patients were retrospectively reviewed. The CT findings of each AAH lesion were evaluated for multiplicity, location, shape, size and internal density of the lesion, the interface between the normal lung and the lesion, the internal features within the lesion and any change of the lesion on the follow-up CT scans (range: 33 to 540 days; average: 145.3 days). RESULTS: The eight patients consisted of three men and five women (age range: 43-71 years). Six of eight patients were asymptomatic. Four of them (50%) had synchronous malignancies in the lung: adenocarcinoma of the lung (n = 3), and metastatic squamous cell carcinoma from the uterus (n = 1). We could identify and evaluate eleven AAH nodules in seven patients on the CT scans. Three patients had multiple AAHs. Seven of the 11 lesions (64%) were located in the upper lobe. All the AAHs showed a well-defined oval or round shape and pure ground-glass opacity (GGO) without any solid component (size: 3.9x3 mm to 19x17 mm; internal attenuation: -467 to -785 HU). All the AAHs showed no change of their size and internal density on the follow-up CT scans. CONCLUSION: Atypical adenomatous hyperplasia is often associated with malignancy. This tumor is shown on CT as persistent well-defined oval or round nodular GGOs without solid components, and it does not change on the follow-up CT.

Keyword

Lung, CT; Lung, diseases; Ground-glass opacity; Atypical adenomatous hyperplasia

MeSH Terms

*Tomography, X-Ray Computed
Retrospective Studies
Pulmonary Alveoli/pathology
Precancerous Conditions/pathology/*radiography
Middle Aged
Male
Lung Neoplasms/epidemiology/radiography
Lung/*pathology/*radiography
Hyperplasia
Humans
Female
Epithelial Cells/pathology
Aged
Adult
Adenocarcinoma/pathology/radiography

Figure

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  Fig. 1 A 71-year-old woman with adenocarcinoma in the right upper lobe and atypical adenomatous hyperplasia in the left lower lobe. A. The transverse thin section CT scan shows an 11.7×9 mm well-defined round nodule (arrowheads) with pure ground-glass opacity in the left lower lobe and a 30×27 mm mixed ground-glass opacity lesion (arrow) in the right upper lobe. Note the solid portion of the right upper lobe lesion. B. Photomicrograph of the left lower lobe superior segmentectomy specimen (H & E staining,×40) shows atypical epithelial cell proliferation along the thickened alveolar septa, which is consistent with atypical adenomatous hyperplasia.

• 

  Fig. 2 A 53-year-old woman with a single atypical adenomatous hyperplasia in the right lower lobe. A. Transverse thin section CT scan shows an 11.2×10 mm well defined round nodule with pure ground-glass opacity in the right lower lobe. Note the pulmonary vessel penetrates the ground-glass opacity lesion without any vascular compromise. B. Photomicrograph (H & E staining, ×10) shows that the boundary between the atypical adenomatous hyperplasia and the underlying lung parenchyma is distinct. Note the pulmonary vessel penetrating the AAH lesion (black arrow). C. High power photomicrograph (H & E staining, ×100) shows atypical epithelial cell proliferation along the thickened alveolar septa, which is consistent with atypical adenomatous hyperplasia.

• 

  Fig. 3 A 59-year-old woman with disseminated nodular ground-glass opacitys in the bilateral lungs. Wedge resections for the right upper lobe and the right lower lobe were conducted for making the diagnosis for these lesions. A, B. Transverse thin section CT shows numerous round nodular ground-glass opacitys smaller than 10 mm in the bilateral lungs, and especially in the bilateral upper lobes. On the wedge resection specimen, these lesions, including a 9×9 mm sized well-defined round ground-glass opacity (arrow), were diagnosed as multiple atypical adenomatous hyperplasias. C. The irregular ground-glass opacity lesion (arrow) was confirmed as bronchioloalveolar carcinoma on the pathologic specimen.

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