Vascular manifestations of small solitary pulmonary masses. Angiographic-pathologic correlations and clinical significance.
OBJECTIVE
By performing pulmonary specimen angiographies, the authors attempted to determine the pathologic correlations of the vascular-related radiologic manifestations within, at the edge of, and adjacent to the small solitary pulmonary masses, and to evaluate their usefulness in differentiating small bronchogenic carcinomas from tuberculomas.


METHODS
A total of 29 resected lobe specimens with 1.5- to 3.5-cm solitary pulmonary masses, including 24 carcinomas and 5 tuberculomas, were studied prospectively with preoperative radiographs, postoperative specimen arteriographies (in 19 carcinomas and 5 tuberculomas), and venographies (in 5 carcinomas), 10- to 15 micrograms-thick whole-mount sections, and 5-micrograms-thick slices for the examination of angiographic-pathologic correlation. Another series of chest radiographs and conventional tomographs of 100 patients with 1- to 3-cm peripheral pulmonary masses, including 60 carcinomas and 40 tuberculomas, were reviewed retrospectively and analyzed with the chi-square test.


RESULTS
Specimen angiographies showed the intralesion avascularity, small arterial speculation, and lobulation or notch at the mass margin with arterial compression, as well as vascular convergence to the mass, in both carcinoma and tuberculoma groups. The irregular arterial wall (79.2%) and venous dilation distal to the mass (100%) were found in the carcinoma group only. Microscopically, arterial or venous fibrous hyperplasia was observed in both carcinomas and tuberculomas, whereas the arterial erosion by tumor tissue and tumor emboli within the vessels were found in carcinomas only. The retrospective review of the 100 patients showed that two radiologic signs of the vascular convergence to the mass and the vascular dilation distal to the mass occurred at similar frequencies (12%-13%) between the carcinoma and tuberculoma groups.


CONCLUSIONS
In addition to compression of vessels by tumor and vessel occlusion by tumor embolus, pulmonary vascular fibrotic hyperplasia can cause intramass avascularity. Small vessels running vertically into or from the mass margin can construct the spiculation sign of the tuberculomas. Any evidence of pulmonary vascular irregularity will indicate a bronchogenic carcinoma. The vascular convergence to the mass and the vascular dilation distal to the mass are not specific radiologic signs for small solitary bronchogenic carcinomas.
Yang
X
X
Department of Clinical Radiology, Kuopio University Hospital, Finland.
Yan
H
H
Liu
H
H
Xie
Y
Y
Hu
M
M
Soimakallio
S
S
D000230:Adenocarcinoma / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology; D000792:Angiography; D001808:Blood Vessels / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D006801:Humans; D008175:Lung Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology; D011446:Prospective Studies; D012189:Retrospective Studies; D014375:Tuberculoma / Q000000981:diagnostic imaging* / Q000473:pathology; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging* / Q000473:pathology; D014652:Vascular Diseases / Q000000981:diagnostic imaging* / Q000473:pathology