Pulmonary Adenomatosis Versus Bronchiolar Carcinoma

¹ Thoracic Surgeon, Central Washington Tuberculosis Hospital.

1. Lack of accurate knowledge in the histogenesis has resulted in a wide variety of divergent names given to the so-called alveolar cell tumors of lung, which are primary lung tumors of unique histopathologic features, and which may someday prove to be not a rare disease.

2. Of the two most commonly used names, "bronchiolar carcinoma" is opposed by those who reject bronchiolar origin of the tumor, while "pulmonary adenomatosis" is opposed by those who claim the term implies a benign process and is misleading. As yet no satisfactory name has been agreed upon.

3. Whether pulmonary adenomatosis is a benign lesion, a pre-cancerous lesion, or a definitely malignant lesion, is by no means a settled matter. Could it be that we have here a disease of transition nature bordering between benignancy and malignancy, which, if thoroughly understood could open the door to the mystery of malignant changes of cells?

4. The controversy between alveolar origin and bronchiolar origin of the tumor is still raging, but the issue is probably merely of academic interest, as both alveolar lining cells and bronchiolar lining cells may, perhaps, in themselves, be of same origin.

5. Multicentricity of origin of pulmonary adenomatosis has to be ruled out first before unicentricity theory can be established, if the growth could be regarded as essentially a relentless alveolar proliferation of histologically-benign epithelial cells in the beginning.

6. Clinically, pulmonary adenomatosis is perhaps even more hopeless and fatal than the more malignant bronchogenic carcinoma due to its frequent multifoci of growths and its tendency to early bilateral involvement, which renders surgical treatment less effective.

7. Importance of early clinical diagnosis is emphasized, if patient is to be saved. Disease can be easily confused with pulmonary tuberculosis, especially if bilateral involvement with cavitation.

8. Two cases presented: one diagnosed as "pulmonary adenomatosis" from surgical specimen, the other as "bronchiolar carcinoma" from autopsy specimen—both diagnoses by the same pathologist.