[The bronchial alveolar carcinoma as a solitary coin lesion]

Bronchiolo-alveolar carcinoma is a well-differentiated adenocarcinoma which starts as a peripheral solitary nodule and gradually spreads via the bronchi to give rise to a disseminated, diffusely infiltrative tumor. A series of 17 cases presenting with solitary nodules is reported. A long interval before operation did not adversely affect prognosis, provided the nodule remained relatively small and there were no lymph node metastases. Radical cure by resection was possible only with solitary nodules, but not with multinodular or infiltrative tumors. Prognosis was worse if lymph nodes were involved but not if there was intrapulmonary lymphatic invasion without spread to lymph nodes. Large solitary nodules shortened survival, especially if the radiographic diameter was greater than 5 cm. On the other hand, in four cases where evaluation was possible, the rate of growth had no effect on prognosis. Patients with positive cytology had shorter life expectancy since the tumor had already spread to the bronchi. Unexpectedly, cellular signs of malignancy had no influence on prognosis. Invasion of blood vessels, however, was a poor prognostic sign and was not observed in early cases or in patients with prolonged survival.