Macroscopy: Labelled "Left upper lobe of the lung". Left upper lobe weighing 204 g measuring 153 x 125 x 55 mm. Pleura appears dark brown/tan with scattered black pigment, with focal puckering at the posterior aspect. Hilar margins are clear with mucus plugs seen within vessels on sectioning. In the posterior aspect of the lobe, there is a firm pale cream/tan lesion which abuts the pleura measuring 16 x 14 x 10 mm. The lesion is 10 mm from the hilum, and blood appears to invade into vasculature or airway. The remainder of parenchyma appears tan with a spongy texture. There is a focal area of subpleural haemorrhage. No further lesions are identified. Inked blue hilum, black stapled margin and yellow at the area of puckering pleural surface.
Microscopy: Sections show a 16 mm invasive adenocarcinoma that is entire of the acinar (cribriform) pattern. No convincing micropapillary or other patterns are identified. The tumour infiltrates within a desmoplastic inflamed stroma. The entire tumour is strongly positive for CK 7 and TTF-1. The tumour is subpleural in a location with a focal invasion of the visceral pleura identified. Focal lymphovascular space invasion is identified. No perineural invasion is seen. Some free-floating adenocarcinoma tumour fragments are present in the pulmonary parenchyma surrounding the tumour. The tumour is clear of the bronchovascular hilar resection margin and trimmed stapled margin.
Metastatic adenocarcinoma is identified in one of 5 peribronchial lymph nodes.
The background pulmonary parenchyma shows focal atypical adenomatous hyperplasia, emphysematous change and prominent alveolar macrophages.
Conclusion:
- specimen type: Left upper lobectomy.
- histological tumour type: Adenocarcinoma
- histological grade: Moderately differentiated - acinar pattern
- tumour location: Subpleural
- tumour size: 16 mm
- visceral pleural invasion: Present, PL1 tumour focally invades beyond the elastic layer of the visceral pleura but is not exposed on the pleural surface.
- lymphovascular invasion: Present
- perineural invasion: Absent
- Surgical margins status
- bronchial resection margin: Clear
- vascular resection margin: Clear
- other margins: Stapled hilar margin macroscopically clear.
- direct invasion of adjacent structures: Absent.
- in situ carcinoma: Not identified
- lymph nodes within the main resection specimen:
- Number of lymph nodes: 5
- Number of involved lymph nodes: 1
- Separately received lymph nodes:
- Number of lymph nodes: 6
- Number of involved lymph nodes: 0
- other coexistent pathological abnormalities: Focal atypical adenomatous hyperplasia. Emphysematous change
Pathological staging (AJCC 8th addition): pT2a N1 MX