Lung adenocarcinoma with rapid progression and fatal outcome through spread through air spaces: an autopsy case report
Year: 2026
Type: article
Study design: Case Report
Abstract: Background: 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. Case Description: 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. Conclusions: 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.
Institution: Niigata University
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223954654