Pleomorphic carcinoma of lung: comparison of CT features and pathologic findings.
OBJECTIVE
To retrospectively evaluate computed tomographic (CT) features of pleomorphic carcinoma of the lung and to compare these features with pathologic findings.


METHODS
Ten patients (10 men, three women; mean age at diagnosis, 64.1 years; range, 43-75 years) with pleomorphic carcinoma treated from June 2000 to January 2003 were selected from two institutions. Two radiologists retrospectively reviewed CT features, which included size and location of tumor, presence of calcification, attenuation values and internal architecture of the mass, and invasion of pleura and chest wall. Attenuation values of the mass on CT scans were compared with pathologic findings in tumors in available gross specimens. Follow-up CT scans were not routinely obtained except in two patients with progressive pleural effusion and rapid growth of the tumor as seen on serial chest radiographs.


RESULTS
On unenhanced CT scans, attenuation of the tumor was similar to that of the surrounding muscle. Calcification within the tumor was visible in one patient. Invasion of chest wall was noted in two patients. Seven patients had pleural invasion. Tumors were located at the lung periphery in nine patients. On contrast material-enhanced CT scans, lesions with the longest diameter larger than 5 cm showed central low-attenuation areas with substantial enhancement in the tumor periphery; in comparison, lesions with the longest diameter smaller than 5 cm showed homogeneous enhancement. Size of two lesions with the longest diameter larger than 5 cm increased rapidly after a follow-up of shorter than 3 weeks. Low-attenuation areas on contrast-enhanced CT scans were found to correspond to areas of myxoid degeneration, necrosis, or hemorrhage in pathologic specimens.


CONCLUSIONS
Findings of this study suggest that pleomorphic carcinomas of the lung preferentially manifest as large peripheral lung neoplasms with a central low-attenuation area and frequently invade the pleura and chest wall.
Kim
Tae Hoon
TH
Department of Radiology, Yongdong Severance Hospital, Yonsei University College of Medicine, 146-92 Dogok-Dong, Kangnam-Ku, Seoul 135-720, Korea. kimydrt@yumc.yonsei.ac.kr
Kim
Sang Jin
SJ
Ryu
Young Hoon
YH
Lee
Hyun Ju
HJ
Goo
Jin Mo
JM
Im
Jung-Gi
JG
Kim
Hyung Joong
HJ
Lee
Doo Yun
DY
Cho
Sang Ho
SH
Choe
Kyu Ok
KO
D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000473:pathology; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging / Q000473:pathology; D009367:Neoplasm Staging; D015588:Observer Variation; D010994:Pleura / Q000000981:diagnostic imaging / Q000473:pathology; D012680:Sensitivity and Specificity; D035441:Thoracic Wall / Q000000981:diagnostic imaging / Q000473:pathology; D036542:Tomography, Spiral Computed