Adenocarcinoma of lung

Case contributed by Jack Ren

Presentation

Previous bowel cancer & bowel resection with radiotherapy

Patient Data

Age: 70 years
Gender: Male
X-ray

CXR shows is a round opacity lesion locate on right lower lobe, projecting through the right hilum (hilum overlay sign). 

Patient went on & had a right lower lobe lobectomy.

Histology

MACROSCOPIC DESCRIPTION

A right lower lobectomy specimen with a single staple line towards the apex of the lobe, 75mm  long. On the  costal surface,  35mm inferior  to the apex, there is pleural  puckering  over an area of approximately  20mm diameter. Beneath this,  there is a  relatively well  circumscribed,  lobulated, firm tumour composed of variegated cream,  yellow and grey tissue with a maximal cut face dimension of 35mm.  Immediately surrounding lung parenchyma has an indurated texture and is discoloured  yellow ?obstructive/lipoid pneumonia. The tumour appears clear of the bronchial resection margin by approximately 12mm.  Tumour  abuts,  but does  not invade  through  pleura on the costal surface.  There is no clearly demonstrable communication with the bronchus. The surrounding lung is  unremarkable.  

MICROSCOPIC DESCRIPTION

Sections show a  moderately differentiated  adenocarcinoma, part of the tumour consisting  of papillary  structures with  fibrovascular  cores and lined by   atypical   pseudostratified   columnar cells,   part  formed by gland-like structures and part showing a lepidic growth pattern.  There are areas of tumour  necrosis and  focal lymphovascular  invasion  is seen. The tumour is abutting the pleura but no invasion  through the visceral pleura is identified.   The tumour  comes close to  the segmental  bronchus but no invasion into the bronchus is identified.   The bronchial resection margins are clear.  There are  prominent collections of  intra-alveolar macrophages in lung  tissue  surrounding the  tumour,  consistent  with an  obstructive lipoid pneumonia.   The two  peribronchial  lymph nodes are  free of tumour invasion and show prominent anthraco-silicosis.

FINAL DIAGNOSIS: moderately  differentiated adenocarcinoma, with lymphovascular invasion, in subpleural location. The appearance is consistent with a primary lung origin.

Case Discussion

Features here are of a solitary lung lesion at the right hilum proven to be adenocarcinoma after biopsy.

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Case information

rID: 24509
Case created: 21st Aug 2013
Last edited: 25th Nov 2015
System: Chest
Inclusion in quiz mode: Included

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