Online consultation case: Basic information: Female, 71 years old, from Henan. Disease description: Three years ago, it was discovered during a CT scan during a physical examination. She has been under observation and usually feels nothing. My father was a lung cancer patient.

Online consultation case:

Basic information:

Female, 71 years old Henan native

Disease description:

Three years ago, during a physical examination, CT scan found that had been under observation and usually felt nothing. My father was a lung cancer patient.

Hospital departments visited:

Department of Thoracic Surgery, a hospital in Henan Province

Hope for help:

Diagnostic condition

Picture display:

Lesion 1: Very light ground glass nodule;

Lesion 2: Light ground glass nodule with vacuole sign

Lesion 3: Tiny light ground glass opacity

Lesion 4: Tiny ground glass nodule

Lesion 5: Tiny ground glass nodule

Lesion 6: Very light ground glass opacity

Lesion 7: Light grinding with small vacuole sign in the left lower lobe , but the density is too low, and it cannot be said that it is definitely a tumor.

Lesion 8: Lightly ground in the lower right

Lesion 9: Very light subpleural micro-ground glass nodules in the lower left

Lesion 10: The density in the lower left adjacent pleura is slightly higher and more elongated. lesions, chronic inflammation is also possible

Lesions 11: Tiny ground glass nodules in the right lower lobe

Lesions 12-13: 2 light ground glass tiny nodules in the right lower pole

Lesions 14: Right lower lobe with small vacuole sign Light ground glass nodules, with blood vessels running along them

Lesion 15: Tiny ground glass nodules in the lower right

Lesions 16-21: Light ground glass nodules in both lungs, tiny, but with clear outline

Lesion 22: Light ground glass nodules in the left lower lobe Ground-glass micronodules

Lesions 23-28: Tiny light ground-glass nodules in both lungs, with clear outlines and lower density on the left side

Lesions 29-30: Tiny ground-glass nodules in both lower lobes

Lesion 31: Left lower lobe Microscopic ground-glass nodule in the dorsal segment

Lesion 32: Microscopic ground-glass nodule in the dorsal segment of the right lower lobe

Lesion 33: Ground-glass nodule in the right upper lobe, with blood vessels entering, but the lesion appears scattered and has unclear outline, so it is not necessarily a tumor range, but since there are many cases of AAH in both lungs, it still needs to be considered.

The following is lesion 34, which is also the main lesion:

The lesion appears, the edge is slightly blurred, the density in the middle is higher, and there are blood vessels running in the adjacent area

There are solid components in the lesion, and blood vessels are also seen

The lesion seems to be lobulated

High The density component is more obvious, but the contractility of the high-density area is not strong.

The lesions have spiculation signs and lobulation signs, and the solid component is in the middle

The lesions have obvious lobes, obvious spiculations, and the solid component is obvious, but the contraction force of the solid part is not It is obvious

The lesion has obvious shrinkage at this level

The ground glass density at the edge is uneven

The density of the lesion is uneven

Main lesion impression: This is a lesion that appears as a typical invasive adenocarcinoma on imaging. The entire lesion has a mixed ground glass density and a spiculation sign. Blood vessels are adjacent to or enter, blood vessels pass through the lesion, there is a solid component in the middle, there is a lobulation sign, and the contractility of some layers is obvious (the solid component has weak contractility). It's inappropriate to keep this thing.

Lesion 35: Ground glass nodule in the left upper lobe, considered more likely to be carcinoma in situ

Lesion 36: Solid nodule in the right upper lobe, close to the pleura, more likely to be benign

Image impression:

The patient has both lungs There are multiple nodules, as many as 36, and there may be smaller ones that cannot be definitely identified. Most of them are nodules in the tumor category, among which the main lesion is more risky. It should be dealt with as soon as possible. Other small lesions are still very small or very low-density, so there is currently no major risk, and there is no benefit from more surgical resections. It is recommended to follow up on time after surgery.

Review of images:

Among the images that my friend sent me, the earliest one of the main lesions was in December 2020. He said that it had been discovered for 3 years, which means that it was there earlier and there was no obvious progress. Let’s look at the end of 2022:

The density was not low at that time. Why is it that the possibility of invasive adenocarcinoma is high, but it still takes so long and the progress is not so obvious? My idea is that the actual components are probably mainly acinar subtypes, with no obvious solid or micropapillary subtypes. Moreover, tumors develop relatively slowly in the early stages, and those with ground glass components are more likely to cause these findings. The year is still a relatively inert stage. But it is extremely unstable to leave such a lesion alone. Let’s take a step back and say that the lesion is located on the side and can be resected in a wedge shape first. Even if it is benign, it is reassuring, the trauma is not big, and the recovery is quick. And if it is actually malignant as I judged, then waiting too long will affect the prognosis. Who knows when this kind of disease will start to accelerate? What if it doesn't grow and enters the blood first? This comes at great risk.

My opinion:

I took screenshots of December 2020 and May this year for you. The pictures don’t seem to have progressed much, but this lesion is a mixed ground glass nodule. The proportion of solid components is not low, and the surface is There are branching burrs and blood vessels entering, so the possibility of malignancy is very high. The reason for the slow change is that the tumor may develop slowly in the early stage, and the components with high density are not just high-risk subtypes. Moreover, the location is good, so we can remove it in a wedge shape first and put away the inappropriate ones. If you wait until it is transferred, it will be too late! Even if it is really benign, wedge resection will not have much impact, and the operation only takes a few minutes. It’s better to open it!