[A case of multicentric bronchio-alveolar cell carcinomas with mild improvement during clinical course]

It is very important for clinicians to recognize that some lung cancers, especially among the bronchiolo-alveolar cell carcinomas (BAC), rarely show mild improvement in opacity during the clinical course. We would like to present a 63-year-old woman who demonstrated very unusual exacerbation and improvement in lung opacity during 7 years of follows up. The abnormal chest shadows pointed out in an initial screening checkup and in a following chest CT presented 4 nodules in both lung fields; 2 of them appeared to have cavities. One of these nodules showed a definitely reduced size in a chest CT taken after one year of follow up study. We therefore determined it was probably not malignant of this time. But, after seven years the patient revisited our institute complaining of bronchorrhea. The chest CT taken immediately revealed increased size of each nodule and progression to pulmonary consolidation of the right lower lobe. A transebroncheal biopsy led to a diagnosis of bronchiolo-alveolar cell carcinoma pathologically. The incidence of BAC has recently shown a remarkable increase and radiological images of these tumors are various. It is important, therefore, to consider the possibility of BAC for differential diagnose of cases presenting abnormal pulmonary shadows.