Due to emphasis on early screening for lung cancer, the detection rate of multiple ground glass opacities (GGOs) on computed tomography (CT) image increases in recent years, and research on multifocal adenocarcinomas presented by GGOs has been thriving. It is more common in women and non-smokers and has excellent prognosis both in patients with natural history and after surgery. These clinical features suggest that it is likely to be a distinct disease entity. From the perspective of molecular genetics, lesions in the same individual are likely to have distinct clonal features. Therefore, genetic heterogeneity is the most prominent feature of multifocal pulmonary adenocarcinomas with GGOs. The genetic heterogeneity is expected to assist the diagnosis of multifocal pulmonary adenocarcinoma and intrapulmonary metastasis, and also suggests that genetic testing of the GGO lesions is of great therapeutic significance. Some GGO lesions may harvest the similar clonal feature, which provide new evidence for the theory of spread through air spaces (STAS).
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Adenocarcinoma ; diagnostic imaging ; genetics ; pathology ; Adenocarcinoma of Lung ; Humans ; Lung Neoplasms ; diagnostic imaging ; genetics ; pathology ; Retrospective Studies ; Solitary Pulmonary Nodule ; diagnostic imaging ; genetics ; pathology ; Tomography, X-Ray Computed

The International Agency for Research on Cancer (IARC) published the World Health Organization (WHO) classification of thoracic tumors (5th edition) in May 2021, only six years after the 4th edition of WHO Classification. With the application of low-dose spiral computed tomography (CT) as an early screening method for lung tumors in recent years, lung adenocarcinoma has become the main type of disease in many hospital surgical treatments. The WHO classification serves as the authoritative guide for pathological diagnosis, and any slight change in the classification is at the heart of pathologists, clinicians and patients. Adenocarcinoma in situ is a newly added type of adenocarcinoma diagnosis in the 4th edition of the WHO classification, and it is also the focus of clinical treatment and research at home and abroad in recent years. Because its catalog position has been adjusted in the 5th edition of the WHO classification, there has been a huge controversy and discussion among clinicians and patients that "adenocarcinoma in situ was excluded from the category of malignant tumors". This article will briefly explain the origin of the diagnosis of lung adenocarcinoma in situ, the adjustment of the new classification catalog, and whether adenocarcinoma in situ is benign or malignant.
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Adenocarcinoma in Situ/pathology* ; Adenocarcinoma of Lung/diagnostic imaging* ; Humans ; Lung Neoplasms/pathology* ; Neoplasm Staging

Objective: To explore the application value of diffusion kurtosis imaging (DKI) in the differential diagnosis of rectal tumors and evaluating the prognostic factors associated with rectal adenocarcinoma. Methods: A total of 105 patients with rectal tumors admitted in the First Affiliated Hospital of Zhengzhou University from December 2018 to August 2020 were retrospectively analyzed. All patients underwent high-resolution magnetic resonance DKI scanning. The mean diffusivity (MD), mean kurtosis (MK) and apparent diffusion coefficient (ADC) were measured and the relationship of these parameters with pathological types and prognostic factors of rectal tumor were analyzed. The diagnostic efficacy of MD, MK, and ADC for positive circumferential resection margin (CRM) and extramural venous invasion (EMVI) of rectal adenocarcinoma was evaluated by the receiver operating characteristic (ROC) curve. Results: MD and ADC were only related to pathological type. The MD and ADC were (2.091±0.390)×10(-3) and (1.478±0.265)×10(-3) mm(2)/s in mucinous adenocarcinoma, higher than (1.136±0.182)×10(-3) and (0.767±0.077)×10(-3) mm(2)/s in unspecified adenocarcinoma and (1.617±0.697)×10(-3) and (0.940±0.179)×10(-3) mm(2)/s in tubulo-villous adenoma. The MD and ADC in unspecified adenocarcinoma were lower than those in tubule-villous adenoma (P<0.05). Nevertheless, MK was associated with pathological type, N stage, CRM and EMVI. The MK was 0.566±0.110 in mucinous adenocarcinoma, lower than 0.982±0.135 in unspecified adenocarcinoma and 0.827±0.121 in tubulo-villous adenoma. The MK in unspecified adenocarcinoma was higher than that in intubulo-villous adenoma. The MK was 0.984±0.107 in pN1-2, higher than 0.881±0.146 in pN0. The MK was 0.990±0.142 in positive CRM, higher than 0.862±0.114 in negative CRM. The MK was 0.996±0.140 in positive EMVI, higher than 0.832±0.100 in negative EMVI (P<0.05). The ROC curves showed that the AUCs of MD, MK and ADC in diagnosing positive CRM were 0.459, 0.653 and 0.408, respectively; with MK=1.006 as the optimal diagnostic threshold, the diagnostic sensitivity and specificity were 51.9% and 81.0%, respectively. The AUCs of MD, MK and ADC values in diagnosing positive EMVI were 0.510, 0.662 and 0.388, respectively; with MK=1.010 as the optimal diagnostic threshold, the diagnostic sensitivity and specificity were 50.9% and 87.5%, respectively. Conclusions: DKI quantitative parameter is helpful for discriminating rectal tubulo-villous adenoma, unspecified adenocarcinoma, and mucinous adenocarcinoma, and is helpful for predicting the prognosis of patients with rectal adenocarcinoma. High MK is associated with positive CRM and EMVI.
Humans ; Adenocarcinoma/diagnostic imaging* ; Adenocarcinoma, Mucinous/diagnostic imaging* ; Adenoma, Villous/diagnostic imaging* ; Diffusion Magnetic Resonance Imaging/methods* ; Prognosis ; Rectal Neoplasms/pathology* ; Retrospective Studies ; Sensitivity and Specificity

OBJECTIVETo explore the CT features of ground-glass nodules (GGN) including preinvasive lesions [atypical adenomatous hyperplasia (AAH) and adenocarcinoma in situ (AIS)], minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC).

METHODSNinety-seven GGN lesions confirmed by operation pathology were included in this study. The lesions were divided into three groups: preinvasive lesion group (24 cases), MIA group (39 cases), IAC group (34 cases). The lesion size, 3-dimensional ratio, 2-dimensional ratio in axial images, lesion density, shape, speculation, lobulation, air-containing space and pleural indentation on the preoperative CT images in the three groups were analyzed and compared with pathological results. The data were statistically analyzed using SPSS 17.0.

RESULTSAll preinvasive lesions presented as pure GGN on CT image, most showed round-like shape, clear and smooth border. MIA presented as pure GGN or mixed GGN on CT image, most showed round-like shape, with a clear and smooth border. IAC most presented as mixed GGN on CT image, often showed irregular shape. Speculation, lobulation, air-containing space and pleural indentation displayed gradually increasing from preinvasive lesions to MIA and IAC. There were statistically significant differences in lesion size, CT density, shape, air-containing space, speculation, pleural indentation and long diameter of solid component between the MIA and IAC groups (P < 0.05 for all). There were statistically significant differences in CT density values and long diameters of solid component of the lesions between the preinvasive lesion group and MIA group (P < 0.05). The AUC of solid component of the preinvasive lesion group and MIA group was 0.705, and that of the MIA and IAC groups was 0.814.

CONCLUSIONComprehensive analysis of the CT image features of GGNs, especially the solid component in the lesions, may help to the preoperative and differential diagnosis of preinvasive lesions, MIA and IAC.

Adenocarcinoma ; diagnostic imaging ; pathology ; Adult ; Aged ; Diagnosis, Differential ; Female ; Humans ; Hyperplasia ; Lung ; diagnostic imaging ; pathology ; Lung Neoplasms ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Neoplasm Invasiveness ; Precancerous Conditions ; diagnostic imaging ; pathology ; Solitary Pulmonary Nodule ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed

BACKGROUND: At present, more and more studies predict invasive adenocarcinoma (IAC) through three-dimensional features of pulmonary nodules, but few studies have confirmed that three-dimensional features have more advantages in diagnosing IAC than traditional two-dimensional features of pulmonary nodules. This study analyzed the differences of chest computed tomography (CT) features between IAC and minimally invasive adenocarcinoma (MIA) from three-dimensional and two-dimensional levels, and compared the ability of diagnosing IAC. The non-invasive adenocarcinoma group includes precursor glandular lesions (PGL) and minimally invasive adenocarcinoma (MIA). METHODS: The clinical data of 1,045 patients with ground glass opacity (GGO) from January to December 2019 were collected. Then the correlation between preoperative CT image characteristics and pathological results were analyzed retrospectively. The independent influencing factors for the identification of IAC were screened out according to two-dimensional and three-dimensional classification by multivariate Logistic regression and the cut-off point for the identification of IAC was found out through the receiver operating characteristic (ROC) curve. At last, the ability of diagnosing IAC was evaluated by Yoden index. RESULTS: The diameter of nodule, the diameter of solid component, the diameter of mediastinal window nodule in two-dimensional factors, and the volume of nodule, the volume of solid part and the average CT value in three-dimensional factors were independent risk factors for the diagnosis of IAC. These factors were arranged by Yoden index: solid partial volume (0.601)>nodule volume (0.536)>solid component diameter (0.525)>nodule diameter (0.518)>mediastinal window nodule diameter (0.488)>proportion of solid component volume (0.471)>1-tumor disappearance ratio (TDR) (0.468)>consolidation tumor ratio (CTR) (0.394)>average CT value (0.380). CONCLUSIONS The CT features of three-dimensional are better than two-dimensional in the diagnosis of IAC, and the size of solid components is better than the overall size of nodules.
Humans ; Lung Neoplasms/pathology* ; Retrospective Studies ; Neoplasm Invasiveness ; Multiple Pulmonary Nodules/diagnostic imaging* ; Adenocarcinoma/pathology*

The accurate judgement of the upper and lower borders of the adenocarcinoma of esophagogastric junction (AEG) by radiology can facilitate the decisions on surgical approach and staging criteria. X-ray double contrast radiography, CT and MRI are the common modalities. The accuracy of X-ray double contrast radiography in determining the invasion length of esophagus and the central point of gastric infiltration can be improved by standardized pretreatment, combination of multiple contrast methods such as double contrast and flow-coating procedure, and combination of multi-angle observations such as conventional frontal, left /right anterior oblique and supine right posterior oblique position. Abdominal enhanced CT is the imaging method recommended by clinical guidelines for the radiological examination of AEG. The relative position of the central point of the tumor from 2 cm line can be determined through the combination of measurement and formula calculation on multi-planar reconstructed CT images. The "three-layer four-type" classification can provide reference for the selection of abdominothoracic incision. The direct demonstration of the tumor extension can be achieved through the CT curved planar reconstruction by drawing lines along esophagus to stomach. The combination of multiple sequences of MRI is helpful to determine the extension of the lesions. In the future, more radiological studies are needed to establish criteria with high accuracy, repeatability and convenient operation,and to assist clinical evaluation of AEG invasion.
Adenocarcinoma ; classification ; diagnostic imaging ; pathology ; surgery ; Contrast Media ; Esophageal Neoplasms ; classification ; diagnostic imaging ; pathology ; surgery ; Esophagogastric Junction ; diagnostic imaging ; pathology ; surgery ; Humans ; Magnetic Resonance Imaging ; Neoplasm Invasiveness ; Neoplasm Staging ; Stomach Neoplasms ; classification ; diagnostic imaging ; pathology ; surgery ; Tomography, X-Ray Computed

OBJECTIVETo compare the difference in CT manifestations between primary colorectal mucinous adenocarcinoma and signet ring cell carcinoma in order to improve radiologic diagnosis.

METHODSClinicopathological data and CT findings of 109 patients with colorectal mucinous adenocarcinoma and 46 patients with primary colorectal signet-ring cell carcinoma confirmed by surgery and pathology from March 2008 to February 2015 in the Tumor Hospital of Yunnan Province were retrospectively collected. Differences in age, gender, tumor location, length and thickness of the involved intestinal wall, thickening pattern of the intestinal wall, lesion density, calcification, contrast-enhanced form, peri-intestinal invasion, occurrence of intestinal obstruction and metastasis of other organs were compared between the two groups.

RESULTSAmong 109 patients with colorectal mucinous adenocarcinoma, 68 were men and 41 were women with a mean age of (56.8±15.4) years. Among 46 patients with primary colorectal signet-ring cell carcinoma, 26 were men and 20 were women with a mean age of (42.9±15.6) years. Compared with mucinous adenocarcinoma group, signet-ring cell carcinoma group showed more concentric bowel-wall thickening[93.5%(43/46) vs. 81.6%(89/109), χ=9.19, P=0.030], higher lesion density [(42.0±3.0) Hu vs. (28.5±1.5) Hu, t=37.30, P=0.000], more marked enhancement [54.3%(25/46) vs. 12.8%(14/109), χ=35.21, P=0.000], less vast-low-density region in enhanced CT imaging[2.2%(1/46) vs. 45.0%(49/109), χ=73.31, P=0.000] and more severe peri-intestinal invasion [41.3% (19/46) vs. 17.4%(19/109), χ=10.25, P=0.006]. Calcification was found in 18.3%(20/109) of mucinous adenocarcinoma cases, but was not found in signet-ring cell carcinoma cases (χ=9.69, P=0.002). Target ring sign in contrast-enhanced scan was observed in 15.2%(7/46) of signet-ring cell carcinoma cases, while in none of mucinous adenocarcinoma cases (χ=17.37, P=0.000). There were no statistically significant differences in lesion location, length and thickness of the involved intestinal wall, occurrence of intestinal obstruction, lymph node metastasis, liver or peritoneum metastasis between two groups(all P>0.05).

CONCLUSIONSSignet-ring cell carcinoma is often found in younger patients, whose CT manifestation is characterized by the target ring sign in contrast-enhanced scan, while primary colorectal mucinous adenocarcinoma is often in older patients, whose CT manifestation is characterized by calcification in unenhanced scan and low density region in enhanced CT show.

Adenocarcinoma, Mucinous ; diagnostic imaging ; pathology ; Adult ; Age Factors ; Aged ; Calcinosis ; diagnostic imaging ; pathology ; Carcinoma, Signet Ring Cell ; diagnostic imaging ; pathology ; China ; Colorectal Neoplasms ; diagnostic imaging ; pathology ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Tomography, X-Ray Computed ; methods

OBJECTIVETo evaluate the high resolution CT (HRCT) features of cyst-like lung adenocarcinoma, explore the correlation between HRCT image features and histopathological characteristics, and observe the pathological basis of air-containing space.

METHODSHRCT and histopathologic findings of cyst-like lung adenocarcinoma in 86 patients were investigated retrospectively. The image features of both tumor and air-containing space were analyzed. All surgically resected specimens were reviewed. The pathological analysis included histologic subtype, differentiation degree, and the pathological basis of air-containing space formation. The correlation between HRCT image features and histopathologic grades was analyzed.

RESULTSOn HRCT, intratumoral necrosis was detected in 17 cases (19.8%), air-containing space with septa in 40 cases (46.5%), wall nodule in the air-containing space in 16 cases (18.6%), mixed thick and thin walls of air-containing space in 49 cases (57.0%). Air-containing space and its wall were observed in 63 cases on histological specimens, among which destruction of the alveolar wall by tumor cells might be the pathological basis of air-containing space in 42 (66.7%) cases. Differences of tumor attenuation (P = 0.030), intratumoral necrosis (P = 0.003) and proportion of thin-wall in air-containing space (P = 0.014) among different histopathologic grades were significant. The proportion of thin-wall in air-containing space was negatively correlated with histological grade (r = 0.267, P = 0.015). Differences of tumor contour (P = 0.002), tumor attenuation (P = 0.006), intratumoral necrosis (P < 0.001), septa in air-containing space (P = 0.016) and proportion of thin-wall in the air-containing space (P = 0.005) among different differentiation degrees were significant. The proportion of thin-wall in air-containing space was positively correlated with differentiation degree (r = 0.266, P = 0.013).

CONCLUSIONSOn HRCT, cyst-like lung adenocarcinoma may manifest as an air-containing space with septa and mixed thin and thick walls, whereas wall nodule of air-containing space and intratumoral necrosis are not common. There is a certain correlation of HRCT manifestation with pathological subtype grading and tumor differentiation. Analysis of HRCT image features is helpful in prediction of the histopathologic grading and histological differentiation degree of the tumors. Destruction of the alveolar structure by tumor cells may be the main pathological basis of air-containing space formation in cyst-liked lung adenocarcinoma.

Adenocarcinoma ; complications ; diagnostic imaging ; pathology ; Adult ; Aged ; Aged, 80 and over ; Cysts ; complications ; diagnostic imaging ; pathology ; Female ; Humans ; Lung Diseases ; complications ; diagnostic imaging ; pathology ; Lung Neoplasms ; complications ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed ; methods

OBJECTIVE: Indocyanine green with near-infrared fluorescence imaging (NIR-ICG) is a new tracer modality in the limelight used for lymphatic mapping. The advantage of this method is to provide real-time image during surgery. To use ICG for image guided lymph node dissection, a surgeon needs to know initial appearing time and duration. METHODS: A 52-year-old woman undertook surgery diagnosed with endometrial cancer. She had no past medical history and her body mass index was 25.3 kg/m2. Preoperative magnetic resonance imaging examination revealed 2.7 cm sized cancerous mass in the endometrial cavity with superficial myometrial invasion without lymph node enlargement. Four mL (1.25 mg/mL) of ICG solution was prepared for injection. For each site, 1 mL of solution was injected superficially, 2-3 mm into the cervical submucosa and another 1 mL was injected deep, 1-2 cm into the stroma of the cervix. We recorded video with 30° 10 mm scope equipped with a specific lens and light source emitting both visible and NIR light (KARL STORZ GmbH & Co. KG, Tuttlingen, Germany). RESULTS: Pelvic lymph node was visualized from around 5 minutes. ICG was dispersed into organs after hysterectomy (53 minutes after ICG injection), yet we could clearly identify sentinel lymph node (SLN). Pathology revealed endometriod adenocarcinoma grade I, myometrial invasion with less than half of myometrium and no lymph node metastasis. CONCLUSION: Cervical injection of ICG provides good visualization of SLN from 5 minutes to over an hour. Our film gives an idea about time management to make a plan for surgery and not to miss SNLs.
Adenocarcinoma/diagnostic imaging/*pathology ; Coloring Agents/*therapeutic use ; Endometrial Neoplasms/diagnostic imaging/*pathology ; Female ; Humans ; Indocyanine Green/*therapeutic use ; Lymphatic Metastasis/diagnostic imaging ; Middle Aged ; Optical Imaging/methods ; Sentinel Lymph Node/*diagnostic imaging ; Time-Lapse Imaging/methods

Objective To investigate the correlations of diffusion weighted imaging (DWI) with pathological grading,typing and clinical staging of cervical adenocarcinoma. Methods The data of 95 patients with cervical adenocarcinoma from May 2011 to February 2018 in Cancer Hospital Chinese Academy of Medical Sciences were collected for retrospective analysis.Before treatment,conventional MRI and DWI (b=0,800 s/mm²) were performed,and the apparent diffusion coefficient (ADC) value of cervical adenocarcinoma was measured.The ADC values were compared among different pathological grades,types,and clinical stages. Results The mean ADC value was (1.00±0.25)×10^-3 mm²/s in the poorly differentiation group,(1.09±0.25)×10^-3 mm²/s in the moderately differentiation group,and (1.22±0.20)×10^-3 mm²/s in the well differentiation group,which showed significant difference between the poorly and well differentiation groups (P=0.002).The mean ADC values were (1.04±0.24) ×10^-3 mm²/s and (1.21±0.26)×10^-3 mm²/s in the endocervical adenocarcinoma (usual type) group and mucinous carcinoma group,respectively,which showed significant difference (P=0.005). Conclusions The worse differentiation of cervical adenocarcinoma corresponded to the lower ADC value.The ADC value of mucinous carcinoma was higher than that of endocervical adenocarcinoma (usual type).
Adenocarcinoma/pathology* ; Diffusion Magnetic Resonance Imaging/methods* ; Female ; Humans ; Magnetic Resonance Imaging/methods* ; Retrospective Studies ; Uterine Cervical Neoplasms/diagnostic imaging*