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Bronchioloalveolar carcinoma, including adenocarcinoma in situ

Howard J West, MD
Section Editors
Rogerio C Lilenbaum, MD, FACP
James R Jett, MD
Deputy Editor
Sadhna R Vora, MD


The term bronchioloalveolar carcinoma (BAC) was originally applied to a subtype of adenocarcinoma of the lung that is distinguished by its peripheral location, well-differentiated cytology, growth along intact alveolar septa (the so-called "lepidic" growth pattern), and tendency for both aerogenous and lymphatic spread.

In the 2004 World Health Organization (WHO) classification of lung tumors, BAC was considered a subset of adenocarcinoma and is divided into mucinous, nonmucinous, and mixed subtypes [1]. This distinction is based upon histologic criteria, and is supported by immunohistochemical and molecular biology differences. Distinguishing mucinous from nonmucinous subtypes of BAC has significant therapeutic and prognostic implications [2].

In 2011, a multidisciplinary expert panel representing the International Association for the Study of Lung Cancer (IASLC), the American Thoracic Society (ATS), and the European Respiratory Society (ERS) proposed a major revision of the classification of adenocarcinomas that reclassified what had been called BAC into newly defined histologic subgroups and recommended discontinuation of the term BAC [3]. The proposed revisions are briefly presented in the relevant sections below and discussed in detail elsewhere. (See "Pathology of lung malignancies", section on 'Comparison of the 2015 and 2004 WHO classification of adenocarcinoma'.)

Currently, the term BAC continues to be used operationally by some pathologists and many clinicians to describe not only the noninvasive “pure” form but also some cases of mixed adenocarcinoma with a BAC component that share clinical characteristics. As the new classification of lung adenocarcinoma becomes variably applied, the term “lepidic predominant adenocarcinoma” is followed in many cases by the clarification, “the entity formerly known as BAC,” or similar duplication of terminology during this transitional period.

The treatment of other forms of non-small cell lung cancer (NSCLC) is discussed elsewhere. (See "Overview of the treatment of advanced non-small cell lung cancer" and "Overview of the initial evaluation, treatment and prognosis of lung cancer".)


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Literature review current through: Sep 2016. | This topic last updated: Sep 16, 2014.
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