CTICasesSmall Cell Lung Carcinoma
Imaging findings
CT scans demonstrate a solid left upper lobe nodule associated with ground glass opacities which was resected and proven to be adenocarcinoma. Over a two-year follow-up period, multiple small ground glass nodules are seen throughout the lungs, along with a stable posterior right upper lobe cystic, emphysematous lesion that develops minor progressive scarring when prone. Concurrently, a small, central right upper lobe nodule undergoes rapid, dramatic interval enlargement, showing intense fluorodeoxyglucose (FDG) avidity on PET/CT. Core biopsy of this rapidly growing central mass confirms small cell neuroendocrine carcinoma.
Key takeaways
Rapid growth of a central pulmonary nodule in a patient with a history of lung adenocarcinoma should raise suspicion for small cell carcinoma or a high-grade neuroendocrine tumor. This rapid progression can represent a heterogeneous mixed tumor or a lineage plasticity event, such as small cell transformation. Clinically, small cell transformation is increasingly recognized as a resistance mechanism to targeted therapies and immunotherapies, such as osimertinib or pembrolizumab, in patients initially treated for adenocarcinoma.
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