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Small Cell Lung Carcinoma: Eight Types of Extension and Spread on Computed Tomography

Kazawa, Nobukata MD*; Kitaichi, Masanori MD, PhD†; Hiraoka, Masahiro MD, PhD*; Togashi, Kaori MD, PhD*; Mio, Naoshi MD, PhD‡; Mishima, Michiaki MD, PhD‡; Wada, Hiromi MD§

Journal of Computer Assisted Tomography: July/August 2006 - Volume 30 - Issue 4 - pp 653-661
Thoracic Imaging: Original Article

Objective: The aim of this study was to classify the types of tumor extension and spread of small cell lung carcinoma (SCLC) and to recognize the unusual types of spread pattern of SCLC on computed tomography (CT) including multidetector row CT (MDCT) using contrast-enhanced material.

Materials and Methods: Sixty-eight cases (53 men and 15 women aged 54-83 years old) of pathologically proven SCLC were examined mainly by contrast-enhanced CT scan. In surgically treated 7 cases, CT-pathologic correlations were performed.

Results: Eight types of extension and spread were recognized by the examinations of chest CT. The type of central mass + mediastinal extension (n = 20 [29.4%]) was the most common manifestation. The types of central perihilar mass (n = 12 [17.6%]), peripheral mass + mediastinal extension (n = 14 [20.6%]), and peripheral mass (n = 7 [10.3%]) were frequently observed. The primary site of SCLC was in peripheral lung tissue in 21 of 68 cases (30.9%) in this study. Unusual CT manifestations, such as the types of lymphangitic spread (n = 6 [8.8%]), pleural dissemination (n = 4 [5.9%]), lobar replacement (n = 3 [4.4%]), pneumonialike air-space infiltrative spread (n = 2 [2.9%]) were recognized in our study. Stenosis of trachea and main bronchus caused by peribronchial extension were commonly noted. In the advanced cases with mediastinal extension, we observed the extension of SCLC to superior vena cava (n = 22), main pulmonary artery (n = 18), pulmonary vein (n = 11), and thoracic aortic wall (n = 7). Peri-and intracardial invasions were also observed in 9 cases.

Conclusions: Computed tomography including MDCT analysis revealed 8 types of extension and spread of SCLC including unusual forms in 68 SCLC cases. Peribronchial extension and great vessel wall involvement, such as superior vena cava, main pulmonary artery, and peri-/intra-cardial extension, were commonly observed in advanced stage.

From the *Departments of Radiology, †Anatomic Pathology, ‡Respiratory Medicine, and §Thoracic Surgery, Kyoto University Hospital, Shogoin Kawaharamachi 54 Sakyo, Kyoto-City, Kyoto Prefecture Japan.

Received for publication January 22, 2006; accepted March 1, 2006.

Reprints: Nobukata Kazawa, Departments of Radiology, Kyoto University Hospital, Shogoin Kawaharamachi 54 Sakyo, Kyoto-City, Kyoto Prefecture 606-8507 Japan (e-mail: nk1207@kuhp.kyoto-u.ac.jp).

© 2006 Lippincott Williams & Wilkins, Inc.