The patient underwent a CT-guided core-biopsy and further lobectomy:
Macroscopy: A. Labelled "Right lung lower lobe". Specimen description: Intact lobectomy. Size: 164 x 110 x 40 mm, 150g
- inking: Parenchymal - green, Pleura - blue, Bronchial/vascular - Black (4mm stapled margin amputated before inking)
- pleural surface: Smooth, glistening tan-violaceous, focal puckering over the medial basal segment
- tumour location: Peripheral, basal medial segment.
- tumour size: 33 x 30 x 12 mm
- tumour appearance: Cream-grey, lobulated/infiltrative, firm
- relationship to pleura: Retraction of pleura, possible invasion.
- distance from bronchial margin: 70 mm
- post-obstructive pneumonia: Absent
- remaining lung parenchyma: Red/brown and spongy
- lymph nodes: 4 perihilar lymph nodes.
B. Labelled "Station 7 lymph node (right pleural)". A violaceous fatty tissue fragment 35 x 17 x 4 mm, containing a single elongate lymph node, 30 mm. LS ×4.
C. Labelled "Station 9 lymph node right pleural". A fragment of fatty tissue 20 x 10 x 3 mm, containing 2 dark brown lymph nodes 15 x 8 x 3 mm and 5 x 3 x 1 mm, and a small amount of attached fat. Largest node bisected. All in.
D. Labelled "Station 11 lymph node (right pleural)". 4 fragments of dark brown, ragged tissue ranging from 3-10 mm. Fragments processed whole.
Microscopy: A. The sections taken from the macroscopically described tumour show an invasive adenocarcinoma. The tumour has predominantly lepidic pattern with admixed papillary (20%) and acinar (10%) patterns. The tumour cells show moderate nuclear pleomorphism, nuclear hyperchromasia and small nucleoli. No lymphovascular or perineural invasion is identified. There is a focal extension through the elastic layer of visceral pleural. The tumour is clear of resection margins. Non-neoplastic lung show small foci of organising pneumonia. Three hilar lymph nodes show sinus histiocytosis with no evidence of metastatic malignancy (0/3).
B. The sections show a lymph node with sinus histiocytosis. There is no evidence of metastatic malignancy (0/1).
C. The sections show 2 lymph nodes with sinus histiocytosis. There is no evidence of metastatic malignancy (0/2).
D. The sections show lymphoid tissue with sinus histiocytosis. There is no evidence of malignancy.
Conclusion: A. Right lower lobe, resection:
- histological type Moderately differentiated, lepidic predominant adenocarcinoma pT2a N0
- tumour size 33 mm in maximal dimension
- visceral pleural invasion Focally into visceral pleura (PL1)
- lymphovascular invasion Not identified
- perineural invasion Not identified
- bronchial resection margin Not involved
- vascular resection margin Not involved
- hilar lymph nodes involvement Absent (0/3)
B. Station 7 lymph node right pleural, excision: No metastatic malignancy in 1 lymph node (0/1).
C. Station 9 lymph node right pleural, excision: No metastatic malignancy in 2 lymph nodes (0/2).
D. Lesion 11 lymph node right pleural, excision: No metastatic malignancy.