LungCancer(2003) 42,319—326 Patterns of recurrence of bronchioloalveolar cell carcinoma after surgical resection: a radiological, histological, and immunohistochemical study Michele Gaeta a , Alfredo Blandino a , Stefano Pergolizzi a , Silvio Mazziotti a, * , Rosario Caruso b , Mario Barone c , Stefano Cascinu d a Institute of Radiological Science, Policlinico Universitario, Via Consolare Pompea, 45, 98168, Messina 98100, Italy b Institute of Pathology, Policlinico Universitario, Messina 98100, Italy c Institute of Thoracic Surgery, Policlinico Universitario, Messina 98100, Italy d Institute of Medical Oncology, Policlinico Universitario, Messina 98100, Italy Received17March2003;receivedinrevisedform2June2003;accepted10June2003 KEYWORDS 2-Integrin; Gelatinase A; CT; MRI; Lung Summary Purpose: Bronchioloalveolar carcinoma (BAC) is a subtype of lung adeno- carcinomawhoseincidenceisraising.Bronchioloalveolarcarcinomahasatendencyto involvediffuselythelung.Noagreementexistsaboutwhetherdiffusebronchioloalve- olarcarcinomahasamulticentricorunicentricorigin.Thepurposeofthisworkisto evaluate the correlation between intrapulmonary spread of bronchioloalveolar car- cinoma and its histologic and immunohistochemical characteristics. Design: Surgical specimens of 20 bronchioloalveolar carcinomas with radiologically proved evolution from focal to diffuse disease were retrieved and reviewed. Patterns of pulmonary spread were defined on the basis of CT and MR imaging examinations. Immunohisto- chemical studies were performed to investigate the expression of gelatinase A and 2-integrin. Correlation between immunohistochemical results and patterns of pul- monary spread was evaluated. Statistical evaluation was performed by using Fisher ExactTest. Results: Threehistologicalsubtypesofbronchioloalveolarcarcinomawere found:mucinous(11cases),non-mucinous(3cases),andmixedadenocarcinomawith prominentbronchioloalveolarpattern(6cases).Threepatternsofpulmonaryspread weredepictedradiologically:parenchymalopacification(11cases),multiplenodules (7cases)andmixedpattern(2cases).Elevenoutof12mucin-producingversusnone outof8non-mucinproducingcancersdevelopedparenchymalopacification.Thedif- ference was statistically significant (P < 0.028). A statistically significant difference wasalsofoundbetweenthedevelopmentofparenchymalopacificationandthelevel of 2-integrin: 11 out of 13 tumors with negative 2-integrin versus none out of 7 with positive 2-integrin immunoreactivity (P > 0.033). Conclusions: Diffuse bron- chioloalveolarcarcinomamaydevelopfromapriorfocalcancer.Mucinoussubtypeis the most prone to develop diffuse disease with parenchymal opacification, probably representing aerogenous spread. Low levels of 2-integrin receptors were found in bronchioloalveolar carcinoma which developed parenchymal opacification. ©2003ElsevierIrelandLtd.Allrightsreserved. * Corresponding author. Tel.: +39-090-2212941; fax: +39-090-2937427. E-mail address: smazziotti@unime.it (S. Mazziotti). 0169-5002/$ — see front matter © 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/S0169-5002(03)00362-3