Lung adenocarcinoma with rapid progression and fatal outcome through spread through air spaces: an autopsy case report.
- 1Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medicine, Dentistry and Health Sciences, Niigata, Japan.
- 2Department of Cardiovascular Medicine, Niigata University Graduate School of Medicine, Dentistry and Health Sciences, Niigata, Japan.
- 3Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medicine, Dentistry and Health Sciences, Niigata, Japan.
Abstract
Spread through air spaces (STAS), defined as tumor cell dissemination into alveolar spaces, is a prognostic factor for early-stage non-small cell lung cancer and is typically identified in surgical specimens from patients with early-stage disease. We describe a rare autopsy case of rapid progression with STAS in a patient with recurrent lung adenocarcinoma. A 70-year-old man with stage IA lung adenocarcinoma previously treated with stereotactic radiotherapy and multiple comorbidities, including chronic heart failure due to the dilated phase of hypertrophic cardiomyopathy, ventricular tachycardia treated with amiodarone, and diabetes mellitus, was admitted because of progressive dyspnea and respiratory failure. Computed tomography (CT) revealed bilateral ground-glass opacities with increased consolidation at the site of prior irradiation. Given the elevated liver attenuation on CT, amiodarone-induced pulmonary toxicity and pulmonary edema were initially suspected, the drug was discontinued, and diuretic therapy was intensified. Despite additional corticosteroid therapy and antibiotics for concurrent bacteremia, respiratory failure progressed and the patient died on hospital day 37. Autopsy revealed papillary adenocarcinoma with extensive STAS, characterized by tumor cell clusters floating within the airspaces in a micropapillary pattern, spreading bilaterally. Mucin staining revealed no abundant mucin in the cytoplasm, and thyroid transcription factor-1 was positive. No evidence of amiodarone-induced pneumonitis or significant pulmonary edema was observed. To our knowledge, this is the first reported autopsy case of recurrent advanced lung adenocarcinoma with fatal respiratory failure in which extensive STAS was considered a major contributing factor. Clinicians should consider STAS as a potential mechanism of rapid deterioration in patients with known lung adenocarcinoma.
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BibTeX
@article{arinami2026lung,
title = {{Lung adenocarcinoma with rapid progression and fatal outcome through spread through air spaces: an autopsy case report.}},
author = {Jun Arinami and Yu Saida and Shintaro Yoneyama and Satoshi Watanabe and Tomoki Sekiya and Ryo Suzuki and Naohiro Yanagimura and Miyuki Sato and Koichiro Nozaki and Tomohiro Tanaka and Saori Takashima and Yusuke Tani and Kazuyuki Ozaki and Takeshi Kashimura and Takayuki Inomata and Toshiaki Kikuchi},
journal = {Translational lung cancer research},
year = {2026},
month = sep,
doi = {10.21037/tlcr-2026-0957},
url = {https://europepmc.org/article/MED/42999413},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Lung adenocarcinoma with rapid progression and fatal outcome through spread through air spaces: an autopsy case report.
AU - Jun Arinami
AU - Yu Saida
AU - Shintaro Yoneyama
AU - Satoshi Watanabe
AU - Tomoki Sekiya
AU - Ryo Suzuki
AU - Naohiro Yanagimura
AU - Miyuki Sato
AU - Koichiro Nozaki
AU - Tomohiro Tanaka
AU - Saori Takashima
AU - Yusuke Tani
AU - Kazuyuki Ozaki
AU - Takeshi Kashimura
AU - Takayuki Inomata
AU - Toshiaki Kikuchi
PY - 2026
DA - 2026/09/29
JO - Translational lung cancer research
DO - 10.21037/tlcr-2026-0957
UR - https://europepmc.org/article/MED/42999413
AB - Spread through air spaces (STAS), defined as tumor cell dissemination into alveolar spaces, is a prognostic factor for early-stage non-small cell lung cancer and is typically identified in surgical specimens from patients with early-stage disease. We describe a rare autopsy case of rapid progression with STAS in a patient with recurrent lung adenocarcinoma. A 70-year-old man with stage IA lung adenocarcinoma previously treated with stereotactic radiotherapy and multiple comorbidities, including chronic heart failure due to the dilated phase of hypertrophic cardiomyopathy, ventricular tachycardia treated with amiodarone, and diabetes mellitus, was admitted because of progressive dyspnea and respiratory failure. Computed tomography (CT) revealed bilateral ground-glass opacities with increased consolidation at the site of prior irradiation. Given the elevated liver attenuation on CT, amiodarone-induced pulmonary toxicity and pulmonary edema were initially suspected, the drug was discontinued, and diuretic therapy was intensified. Despite additional corticosteroid therapy and antibiotics for concurrent bacteremia, respiratory failure progressed and the patient died on hospital day 37. Autopsy revealed papillary adenocarcinoma with extensive STAS, characterized by tumor cell clusters floating within the airspaces in a micropapillary pattern, spreading bilaterally. Mucin staining revealed no abundant mucin in the cytoplasm, and thyroid transcription factor-1 was positive. No evidence of amiodarone-induced pneumonitis or significant pulmonary edema was observed. To our knowledge, this is the first reported autopsy case of recurrent advanced lung adenocarcinoma with fatal respiratory failure in which extensive STAS was considered a major contributing factor. Clinicians should consider STAS as a potential mechanism of rapid deterioration in patients with known lung adenocarcinoma.
SN - 2218-6751
SN - 2226-4477
ER -