Macroscopy: Labelled "Right upper and middle lobe of lung". Perihilar soft tissue is present over a bare area on the medial aspect 55 x 46 mm (inked green). Bronchial and vascular resection margins amputated, resulting surfaces inked blue. Parenchymal staple lines amputated, resulting surfaces inked black. There is a moderately firm lobulated yellow lesion in the lobe, which abuts the does not appear to cross the fissure into the lobe. The lesion has central areas of yellow necrosis. Peritumoral parenchymal changes seen with areas of grey mottling of the parenchyma distal to the tumour site within the lobe.
Microscopy: The sections taken from the macroscopically described tumour show an invasive tumour, composed of irregular fused glands with cribriform formation, papillary structures and numerous nests of atypical epithelial cells. The tumour cells have moderate to abundant pale to eosinophilic cytoplasm, moderate nuclear pleomorphism, irregular nuclear membranes and prominent nucleoli. There is frequent atypical mitosis. Stromal retraction artefact is present. There are foci of necrosis, fibrosis with accompanying active chronic inflammation including foamy macrophages and multinucleated giant cells surrounding cholesterol clefts. Vascular wall changes and atypical stromal cells are seen. These features are in keeping with the treatment effect. There is extensive lymphovascular invasion, including within bronchovascular bundles of an adjacent lobe. No discrete tumour nodule is seen in adjacent lobe. No perineural invasion is seen. Residual tumour cells are seen within peritumoral changes described macroscopically. Estimated tumour size is 43 mm. The tumour is clear of resection margins. Four hilar lymph nodes show sclerosis with chronic inflammation including histiocytes, in keeping with treatment effect. One of the lymph nodes shows a small focus of intravascular adenocarcinoma, 0.05 mm in size.
Conclusion: Right upper and middle lobe of lung:
- Histological type Adenocarcinoma, acinar predominant
- Tumour size 47 mm in maximal dimension
- Visceral pleural invasion Not identified
- Lymphovascular invasion Extensive, into the adjacent lobe
- Perineural invasion Not identified
- Bronchial resection margin Not involved
- Vascular resection margin Not involved
- Response to neoadjuvant therapy >10% residual viable tumour
- Hilar lymph nodes Positive (1/4), treatment effect present