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It is considered as a variant of pulmonary adenocarcinoma, accounting for about 5% of lung cancers. It is often multifocal, grossly appearing as a pneumonic consolidation. A characteristic feature is its growth along alveolar septa (lepidic growth pattern), without destroying the underlying alveolar architecture. Two subtypes are recognized: the cuboidal non-mucinous type and the mucinous type.

Cytologic diagnostic features (sputum and bronchial washing)

Cytologic diagnostic features (FNA and bronchial brushing)

The bronchioloalveolar carcinoma can be hardly distinguished from classic adenocarcinoma on cytologic preparations. Some cases may strictly resemble a papillary thyroid carcinoma, because of the presence of psammoma bodies, occasional nuclear grooves and pseudoinclusions, optically clear nuclei. Clinical history is helpful to exclude a metastasis.


Bronchioloalveolar carcinoma:

Bronchioloalveolar carcinoma. Somewhat cohesive fragment of tumor with tightly packed, minimally pleomorphic nuclei. Also note a few cytoplasmic mucin vacuoles.
Bronchioloalveolar carcinoma. Loosely cohesive tissue fragments with hyperchromatic crowded nuclei mixed with numerous alveolar macrophages.
Bronchioloalveolar carcinoma. Neoplastic epithelium appearing as a cohesive three-dimensional ball-like structure. Note the monotonous appearance of the neoplastic cells.
Bronchioloalveolar carcinoma. Small tissue fragment showing peripherally protruding nuclei (knobby outline) giving the cells a so-called “hobnail” appearance. Note also a benign multinucleated histiocyte on the left.
Bronchioloalveolar carcinoma. A loosely cohesive tissue fragment with monotonous nuclei, vesicular chromatin, and small but prominent nucleoli. Note the deceptive benign appearance of the fragment.



FNA of BAC – TTF-1
FNA of BAC – TTF-1
FNA of BAC – TTF-1