CTICasesLepidic-Pattern Pulmonary Metastases from Cholangiocarcinoma (Biliary Tract Cancer)
Imaging findings
A patient with biopsy-proven pulmonary metastatic biliary tract (cholangiocarcinoma) disease had serial CTs spanning several years showing numerous target-like lesions with solid centers and surrounding ground-glass halos, along with some larger areas of mixed ground-glass and solid opacity spanning multiple lobules. On the most recent study, the lesions had grown dramatically and become confluent, with the ground-glass component enlarging out of proportion to the solid component, an appearance attributed to lepidic growth of tumor cells along alveolar walls.
Key takeaways
Well-differentiated metastatic adenocarcinomas, including cholangiocarcinoma and pancreatic adenocarcinoma, can occasionally grow in a lepidic fashion along intact alveolar walls, producing halo or target-like ground-glass-predominant lesions that progressively enlarge and coalesce over time rather than forming purely solid nodules; recognizing this growth pattern, distinct from hemorrhagic metastases (which would be expected to evolve differently over serial imaging), helps explain an unusual but reproducible pattern of slow, indolent pulmonary metastatic progression.
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