Central Lung Adenocarcinoma: A Case Series of Four Patients with Radiological and Clinical Insights

Background: Lung adenocarcinoma, the most common subtype of non-small cell lung cancer (NSCLC), typically originates in the peripheral regions of the lung.?,? However, a subset of these tumors may present centrally, involving the bronchial tree and hilar structures, mimicking radiologic patterns of other central malignancies such as squamous cell carcinoma.? Central adenocarcinomas are underrecognized and may present at advanced stages due to delayed symptom onset and diagnostic challenges.? Objective: To describe the clinical, radiologic, and staging characteristics of central bronchogenic adenocarcinoma in four patients, and to highlight the importance of identifying atypical central presentations of a typically peripheral tumor. Methods: This prospective case series includes four patients diagnosed with centrally located lung adenocarcinoma at East Point College of Medical Sciences and Research Center over a 12-month period from January 2024. Detailed clinical history, chest CT findings, and histopathological results were reviewed and analyzed. Results: All four patients presented with central masses involving the main or lobar bronchi and perihilar regions. CT imaging revealed features such as bronchial obstruction, lobar collapse, lymphangitis carcinomatosis, mediastinal lymphadenopathy, vascular encasement, and in two cases, metastatic disease.? All four patients underwent bronchoscopic biopsy. Histopathological evaluation confirmed adenocarcinoma (non- mucinous) in all cases, despite radiologic features resembling squamous cell carcinoma.? The central tumor location contributed to advanced-stage diagnosis in these patients. Conclusion: This case series highlights an emerging and clinically significant shift in the anatomical presentation of lung adenocarcinoma. Recognizing central bronchogenic adenocarcinomas on imaging is crucial for timely diagnosis and appropriate management.? Radiologists and clinicians should maintain a high index of suspicion for adenocarcinoma even in centrally located masses and confirm the diagnosis histologically to guide optimal therapy.