Bronchioloalveolar carcinoma

Classification according to ICD-10
C34	Malignant new growth of the bronchi and lungs
ICD-10 online (WHO version 2019)

The bronchioloalveoläre carcinoma (BAC) is a tumor of the lung. The bronchioloalveolar carcinoma is counted among the bronchial carcinomas to the adenocarcinomas . This carcinoma differs from other bronchial carcinomas in that it often grows relatively slowly, does not grow invasively, and rarely forms metastases outside the lungs. It has an overall better prognosis than the other bronchial carcinomas. Outdated terms for the BAK are alveolar cell carcinoma or malignant pulmonary adenomatosis . Occasionally, different variations of the name, as found broncho alveolar carcinoma or bronchioles alveolar carcinoma.

pathology

In bronchioloalveolar carcinoma, there are usually well-differentiated tumor cells that line the alveolar walls in a single layer like wallpaper. The tumor grows non-invasively and the lung structure is preserved. In addition to these pure BAK, there are also adenocarcinomas, some of which grow invasively and some of which have a bronchioloalveolar growth pattern (mixed adenocarcinoma with BAK content). Some studies suggest that the prognosis of these mixed adenocarcinomas becomes more unfavorable the larger the invasive, solid part is in relation to the BAK part. A further distinction is made between a mucinous (mucous-forming) BAK and a non-mucinous BAK. As a rule, the mucinous form is assigned a somewhat poorer prognosis.

In recent years there have been increased efforts to reclassify all lung tumors. It was suggested that the term “bronchioloalveolar carcinoma” should be completely dispensed with and that terms such as “adenocarcinoma in situ” (AIS) or “minimally invasive adenocarcinoma” (MIA) should be used instead (as of June 2012).

Epidemiology

Approx. The bronchioloalveolar carcinoma accounts for 5% of all bronchial carcinomas. It is striking that compared to the other types of lung cancer, a relatively large number of non-smokers and women develop this tumor. Most patients are over 60 years old. The average age is around 66 years, around 6% are younger than 50 years. The frequency in East Asia appears to be increased.

diagnosis

In most cases, the first diagnosis shows a single (solitary) pulmonary nodule on the X-ray. Sometimes the X-ray resembles a pneumonia (diffuse growth) or there are several foci already at the beginning distributed over the lungs (multilocular or multifocal). Miliar form is a special form of multilocular BAK, in which countless small foci are distributed over both lungs. In computed tomography picture is often recognizes a "ground glass lesion", sometimes the so-called " Cheerio sign to see." A histological examination is possible if, for example, tumor material has been obtained by a transthoracic biopsy . In many cases, the tumor is discovered accidentally in asymptomatic patients. In advanced cases, cough, sputum (mucinous form), weight loss ( cachexia ) and increasing difficulty in breathing may occur.

therapy

As with other non-small cell lung cancers, surgical removal of the tumor will be sought in the initial stages. It is questionable whether a limited operation (wedge or segment resection) can be preferred to flap removal (standard lobectomy ) in the case of very small tumors . Several clinical studies are ongoing (as of May 2008).

During the discussion about the benefits of lung cancer screening using CT, the question arose repeatedly in recent years whether some lung tumors found by chance might grow so slowly that a patient hardly benefits from a therapy. It is controversial whether some of the very small (5 mm diameter) bronchioloalveolar carcinomas could represent such "indolent lung cancers" ( indolent tumor ).

In advanced stages, chemotherapy , (repeated) resection (sometimes with laser) of multiple foci by wedge resections (controversial), radiation or, as a last resort, lung transplantation are possible .

Studies on the use of erlotinib and gefitinib as primary medication and in combination therapy are also being carried out. There is evidence that these drugs (tyrosine kinase inhibitors) have a relatively high response rate (improvement in symptoms, regression of the radiological findings) if there is a mutation in the area of ​​the EGFR receptor. The likelihood of such a mutation appears to be increased for bronchioloalveolar carcinomas and mixed adenocarcinomas compared to other forms of lung cancer.

forecast

Five years after diagnosis, around 40–50% of patients are still alive. After surgical removal in the initial stage, the five-year survival rate is sometimes over 80%. In advanced stages, when the tumor has spread to several lobes and causing symptoms, the prognosis is poor.

literature

• SA Yousem, MB. Beasley: Bronchioloalveolar carcinoma: a review of current concepts and evolving issues. In: Arch Pathol Lab Med , 2007 Jul, 131 (7), pp. 1027-1032, PMID 17616987
• KS Lee, Y Kim, J Han, EJ Ko, CK Park, SL. Primack: Bronchioloalveolar carcinoma: clinical, histopathologic, and radiologic findings . In: Radiographics , 1997 Nov-Dec, 17 (6), pp. 1345-1357, PMID 9397450
• Rusch VW, Tsuchiya R, Tsuboi M, Pass HI, Grunenwald D, Goldstraw P: Surgery for bronchioloalveolar carcinoma and “very early” adenocarcinoma: an evolving standard of care? In: J Thorac Oncol . , 2006 Nov, 1 (9 Suppl), pp. 27-31, PMID 17409998

Individual evidence

1. ↑ Y Sakao, H Miyamoto, M Sakuraba, T Oh, K Shiomi, S Sonobe, H. Izumi: Prognostic significance of a histologic subtype in small adenocarcinoma of the lung: the impact of nonbronchioloalveolar carcinoma components. In: Ann Thorac Surg . , 2007 Jan, 83 (1), pp. 209-214, PMID 17184664
2. ↑ SM Lee et al .: A new classification of adenocarcinoma: what the radiologists need to know. . (PDF; 1.97 MB) In: Diagnostic and Interventional Radiology . May 2012. doi : 10.4261 / 1305-3825.DIR.5778-12.1 .
3. ↑ L. Xu et al .: Adenocarcinomas with prominent lepidic spread: retrospective review applying new classification of the American Thoracic Society. . In: Am J Surg Pathol . February 2012. PMID 22198010 .
4. ↑ PB O'Donovan: The radiologic appearance of lung cancer . In: Oncology (New York) . September 11, 1997, pp. 1387-1402. PMID 9306427 .
5. ↑ D. Aktuerk, M. Lutz, D. Rosewarne, H. Luckraz: Cheerios in the lung: a rare but characteristic radiographic sign . In: QJM: An International Journal of Medicine . 108, September 2015, pp. 743-744. doi : 10.1093 / qjmed / hcv044 . PMID 25660601 .
6. ↑ M. Svoboda, P Fabian, O Slabý, M Stanková, R Lakomý, R Nemecek, R. Vyzula: EGFR tyrosine kinase inhibitors as a targeted therapy for bronchioloalveolar carcinoma of the lung: a case report of a clinically prompt and intensive response and literature review . In: Klin Onkol. , 23 (4), pp. 224-230, PMID 20806820
7. ↑ Joel W. Neal: Histology Matters: Individualizing Treatment in Non-Small Cell Lung Cancer ( English ) In: Oncologist , Vol. 15, No. 1 . Pp. 3-5. January 19, 2010. Retrieved January 14, 2011.
8. ↑ K. Inamura, H Ninomiya, Y Ishikawa, O. Matsubara: Is the epidermal growth factor receptor status in lung cancers reflected in clinicopathologic features? In: Arch Pathol Lab Med. , 2010, 134 (1), pp. 66-72, PMID 20073607

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