Pathology · Lung Pathology (Obstructive, Restrictive, Tumors, Infections)

A 65-year-old non-smoker woman is found to have a peripheral lung adenocarcinoma growing along existing alveolar walls without destroying the architecture (non-invasive growth pattern). This pattern is termed:

  • A Lepidic growth pattern adenocarcinoma (formerly bronchioloalveolar carcinoma)
  • B Micropapillary adenocarcinoma
  • C Solid adenocarcinoma with mucin production
  • D Acinar adenocarcinoma with central fibrosis
Correct answer: A. Lepidic growth pattern adenocarcinoma (formerly bronchioloalveolar carcinoma)

Explanation

The lepidic growth pattern describes tumor cells growing along pre-existing alveolar walls (pneumocyte scaffold) without stromal, vascular, or pleural invasion. This corresponds to the previously termed 'non-mucinous bronchioloalveolar carcinoma.' When confined entirely to lepidic growth in a lesion ≤3 cm with no invasion, it is called adenocarcinoma in situ (AIS) with near-100% cure rate. Minimally invasive adenocarcinoma has ≤5 mm invasion. Lepidic-predominant invasive adenocarcinoma carries a better prognosis than acinar, papillary, micropapillary, or solid subtypes. This pattern is more common in non-smokers and EGFR/KRAS-mutated tumors.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

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