CTICasesAdenocarcinoma In Situ Presenting as Ground-Glass Nodules
Imaging findings
Starting in 2016, pure ground-glass nodules were noted, and follow-up years later shows the dominant nodule and a second smaller nodule have each grown slightly over four years, without a solid component. CT-guided biopsy, PET, and subsequent lobectomy were performed; histology shows lepidic growth of atypical cells along the interalveolar septa consistent with adenocarcinoma in situ, with additional similar foci found separate from the dominant nodule.
Key takeaways
Slowly growing pure ground-glass nodules with lepidic growth represent adenocarcinoma in situ, and the pathologic distinction between atypical adenomatous hyperplasia and adenocarcinoma in situ is variable, especially on percutaneous biopsy. A nodule of this size and behavior (initially about 6 mm, no solid component, doubling time of years) could reasonably have been followed rather than resected, as Fleischner criteria would suggest no follow-up at that size.
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