Pulmonary metastatic nodules: CT-pathologic correlation.

Abstract

To elucidate the characteristics of pulmonary metastatic nodules on high-resolution computed tomographic (HRCT) scans, a correlative computed tomographic (CT)-pathologic study was performed with five human lungs after autopsy. The relationship of metastatic nodules to pulmonary vessels was studied with HRCT scans, radiographs of the specimen, and stereomicroscopic study in 264 nodules 0.6-9.0 mm in diameter. On radiographs and stereomicroscopic images, 190 small nodules (less than 3 mm in diameter) were in contact with the pulmonary lobule on the central bronchovascular bundles (n = 33 [17.4%]), located between the central bronchovascular bundle and the perilobular structure (n = 127 [66.8%]), or attached to perilobular structures (n = 30 [15.8%]). On HRCT scans, 21 small nodules (11.1%) were located on the central bronchovascular bundle; 130 small nodules (68.4%), between the central bronchovascular bundle and the perilobular structure; and 39 small nodules (20.5%), on the perilobular structure. On radiographs and stereomicroscopic images, 43 of 74 large nodules (greater than 3 mm in diameter) (58%) compressed both bronchovascular bundles and perilobular structures. The central bronchovascular bundle was invaded in only 13 large nodules (18%).

Role of high resolution computed tomography in the clinico- radiological study of diffuse parenchymal lung diseases and in disease progression of tuberculosis

“…Ill-defined discrete nodules of varying sizes with no relationship to lobular structures and interlobular septa as per Murata et al, were seen in one case with diffuse hematogeneous metastases to lung fields. 20 Cystic lesions of varying sizes were present in patient with Langerhans Cell Histiocytosis (LCH) and Lymphangioleiomyomatosis. In LCH, relative sparing of the bases was noted on HRCT whereas a more diffuse pattern of spread was seen in Lymphangioleiomyomatosis.…”

Histoplasmosis presenting with multiple pulmonary nodules. A case mimicking radiological features of pulmonary metastasis

“…The aim of this report is to present one of such case with feeding vessel sign that occurs in pulmonary metastasis 10 in a patient with a history of previously diagnosed melanoma.…”

Multi slice computed tomography in the study of pulmonary metastases

“…In a high-resolution CT (HRCT) study by Milne and Zerhouni [44], it was present in 75% of metastatic pulmonary nodules. On the other hand, in pathological samples, Murata et al [42] showed that the mass-vessel sign was not detectable, presumably because the vessels supplying the lesions are too small to be visualised by HRCT, whereas it appears in only 27% of cases of larger metastatic lesions (with a diameter >3 mm).…”

“…This distribution occurs because the neoplastic cells reach the lungs through the bloodstream but can also cross the endothelium of the arterioles and capillaries and distribute within the perivascular tissues [41]. On pathological sections, Murata et al [42] studied the relationship between pulmonary metastases <3 mm in diameter and centrilobular structures, reporting that only about 12% of pulmonary metastases were centrilobular, with about 68% being located between the centrilobular structures and the interlobular septa and 20% at the level of the interlobular septa. Our MIP and VR reconstructions yielded comparable results, as 65% of nodules were centrilobular and 35% interlobular.…”

“…Tale distribuzione si determina poiché le cellule neoplastiche raggiungono il polmone per via ematogena, ma possono attraversare l'endotelio delle arteriole e dei capillari e distribuirsi nei tessuti perivascolari [41]. Murata et al [42] hanno studiato su sezioni anatomiche la relazione tra metastasi polmonari con diametro inferiore a 3 mm e strutture centrolobulari ed hanno riportato che solo il 12% circa delle metastasi polmonari erano centrolobulari, il 68% circa era situato tra strutture centrolobulari e setti interlobulari ed il 20% circa dei noduli erano localizzati a livello dei setti interlobulari. Considerando le ricostruzioni MIP e VR i risultati da noi ottenuti sono sostanzialmente sovrapponibili, infatti abbiamo riscontrato il 65% di noduli centrolobulari ed il 35% di noduli interlobulari.…”