lobulated nodule... - 1254808

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reag12
lobulated nodule... - 1254808

Sorry in advance for the long post, but wanted to provide as much info as I can...my mom has HCC (primary liver cancer).

On a recent CHEST CT scan (January 2013, without contrast) there was a "lobulated nodular density in right lung base adjoining the hemidiaphram" it said that this "increased in size", however the prior CT scans of the chest (November 2012 and Sept 2012 and June 2012) NEVER mentioned this. Therefore I am not sure why they said "increased in size"??? In other scans that have been done in the past such as an abdominal CT and MRI, where you are able to see the lung bases, they indicate "clear lung base" (the most recent MRI of abdomen was January 2013 and says lung base "large paraespohogeal varices and hiatal hernia. The varices are bc of my mom's liver cirrohis).

Most recently, a Pet CT scan (February 2013) said that the "nodule at right lung base is not clearly visible".
Can this possibly mean that the "lobulated nodule" disappeared? Or is it that something is making it impossible to view?

I can not comprehend bow can something not be clearly visible if there is only a 4 week difference between the CT scan and the Pet CT scan?

What does lobulated mean? Is "lobulated".a characteristic of a lung cancer or a cancer that has spread/metastasized from my mom's HCC? Are "lower chest" and "lung base" the same area? Does a CT or MRI of the "abdomen" get a good view of the lung bases as well? Is it common for lung cancer/cancer that has metastasized to occur in the lung bases or does it occur anywhere in the lungs?

The Pet CT does say, under impressions that the "other nodules that were present in the past have either minimized in size or resolved themselves".

Just as a background my mom does have a prior history of MAC lung infection (in 2003 - 10 years ago) so on her chest CT there are scattered centribronchial nodules in both upper lobes as well as " tree in bud" appearance. The "lobulated nodule" in question is in the right Lung base.

Dr West
Reply To: lobulated nodule…

Lobulated is an adjective describing the appearance of a lesion as being like a confluent collection of nodules, kind of like if bubbles connect together. It is not specific for one kind of cancer or another, but I think that it would be overwhelmingly likely that in someone with a known history of hepatocellular carcinoma (HCC), this would describe a lesion from the liver and not a separate lung cancer.

CT scans of the abdomen should typically see the lower part of the lungs; the term "lower chest" and "lung bases" would definitely be used interchangeably. Beyond that, we really can't provide any meaningful interpretation of a scan we can't see for someone we don't know. If you have specific questions about the interpretation of these scans, they need to be directed to someone who has a realistic possibility of doing something better than just wildly speculating about the answer.

In the event that a lobulated nodule is from the MAC infection a decade ago, that really shouldn't change over time now, or at least very minimally.

Good luck.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

reag12
Reply To: lobulated nodule…

Thank you Dr. West for your response.

Currently the HCC in my mom's liver has been treated via chemo embolization. Thus far, there is no active tumor. Thankfully, her HCC was found as a 9mm lesion. Could HCC metastasize quickly to the lungs???

From your experience, why would the "nodule at right lung base be not clearly visible”. Can this possibly mean that the “lobulated nodule” disappeared? Or is it that something is making it impossible to view? Nodules can appear and disappear on their own, would this also be true for a nodule that is lobulated?

Is there a difference between a lobulated nodule versus a spiculated nodule???

Dr West
Reply To: lobulated nodule…

I don't treat hepatocellular carcinoma, and right now we really don't have anyone to focus on that here on the GRACE site, so I can't offer you insights about how HCC might behave. It tends to remain localized to the liver for a long time, but cancer can do anything.

A nodule, including a lobulated one, could potentially resolve, but I really can't speculate on what is happening and what this might represent. Please don't ask us to interpret what these differences might mean -- that gets into a territory in which we can't go.

A lobulated nodule is as I described it, while a spiculated nodule has branches that extend from it, so yes, they are different. A spiculated nodule would be a more classic description for a lung nodule that represents a primary lung cancer (a cancer that originates in the lung rather than travels there from another location).

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

reag12
Reply To: lobulated nodule…

Thank you so much, Dr. West.

Does a lobulated nodule look more "popcorn" like?
What are the characteristics of a lung nodule, that is a result of a metastasize?

catdander
Reply To: lobulated nodule…

Hello reag,
I believe the description of a bubble in Dr. West's first post sounds a lot like the description of popcorn.
When a cancer metastasizes' to another part of the body the cells remain the same. So a liver cancer metastasized in the lungs would look like liver cancer in the liver. A metastasis will look and be the cells from where it came.
And as Dr. West posted above, "A spiculated nodule would be a more classic description for a lung nodule that represents a primary lung cancer (a cancer that originates in the lung rather than travels there from another location)."

This may help describe it, http://cancergrace.org/cancer-101/2010/09/15/primary-vs-metastatic-cancer/

I hope this is helpful,
Janine
forum moderator

Dr West
Reply To: lobulated nodule…

So yes, as Janine notes, "lobulated" would also appear like popcorn.

Metastatic lesions are classically pretty round with smooth margins, though they can certainly vary in appearance.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

reag12
Reply To: lobulated nodule…

Thank you catdander.

I do understand that the metastasized cancer will mimic or look like the cancer where it has spread from (liver, breast, colon, etc). However, I was reading that nodules/lesions that are a result of being metastasized have certain characteristics (example: round, solid, etc) and I was looking for more clarification on this???

reag12
Reply To: lobulated nodule…

Hi Dr. West...I must of submitted my last question as you were responding to it.

As always...thank you so much for clarifying.

reag12
Reply To: lobulated nodule…

Oh...one last thing...

Do "popcorn" shaped nodules tend to be more biegin versus malignant?

Dr West
Reply To: lobulated nodule…

I can't give stats and would say that either is very possible, depending on the context/other variables. Please speak with one of the doctors directly involved for any more information.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education