CTICasesInvasive Adenocarcinoma with Coexisting Atypical Adenomatous Hyperplasia
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Imaging findings
CT revealed multiple pulmonary nodules clustered in the right upper lobe, including several ground glass nodules and one mixed solid and ground glass lesion. The mixed lesion demonstrated classic features of adenocarcinoma with a ground glass component, a solid component, and an air bronchogram.
Key takeaways
This is a classic teaching case illustrating the spectrum of adenocarcinoma development, where atypical adenomatous hyperplasia (AAH) is considered a precursor to adenocarcinoma in situ and invasive adenocarcinoma. Multiple synchronous lesions, including ground glass nodules (AAH) and mixed solid-ground glass lesions (invasive adenocarcinoma), can coexist in the same lobe. The 'bubbly' appearance and traction bronchiectasis often seen in adenocarcinomas may be due to lipidic growth causing a ball-valve phenomenon in airways or fibrosis causing distortion and pulling apart of small airways.
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