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Bronchioloalveolar carcinoma

INTRODUCTION

Bronchioloalveolar carcinoma (BAC) is 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 World Health Organization (WHO) classification of lung tumors, BAC is considered a subset of adenocarcinoma [1].

BAC is divided into mucinous, nonmucinous, and mixed subtypes. 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].

The clinical presentation and treatment of pure BAC and mixed adenocarcinoma with a BAC component will be reviewed here. The presentation and treatment of other forms of NSCLC are 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".)

EPIDEMIOLOGY AND RISK FACTORS

Incidence — Over the last several decades, the proportion of lung cancers classified as adenocarcinoma has steadily increased and now represents approximately one-half of all cases [3].

The incidence of the BAC subset is uncertain. In the United States, estimates of the incidence of BAC have varied from as high as 24 percent in a single institution series [3] to less than 5 percent in a large series based upon the Surveillance, Epidemiology and End Results (SEER) database [4]. These differences probably reflect variation in the application of pathologic criteria for the diagnosis of BAC. (See 'Histologic features' below.)

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Last literature review version 18.2: May 2010
This topic last updated: October 6, 2009
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