Adenocarcinoma of the lung

Case contributed by Dr Bruno Di Muzio

Presentation

Chest pain.

Patient Data

Age: 65 years
Gender: Male
X-ray

Chest radiograph

Ill-defined opacity in the left lung upper zone may represent a pulmonary mass.  

CT

CT Chest

Large, lobulated, spiculated left upper lobe mass measuring up to 4.8 cm. The mass has a broad base with the major fissure but no radiographic penetration into the left lower lobe. No satellite nodules. No pleural deposits or effusion.

10 mm round lymph node in the AP window.  No contralateral mediastinal or hilar lymphadenopathy.  No supraclavicular lymph nodes.

Nuclear medicine

PET-CT (18F-FDG)

Avid FDG uptake in the LUL mass and in the left AP window lymph node. 

CT

CT guided lung biopsy

Left lung biopsy using 17G co-axial and 18G core-biopsy needle. 

Macroscopy: Two pale tan core biopsies 14mm & 15mm.​

Microscopy: The sections show cores of alveolar lung parenchyma with extensive involvement by adenocarcinoma. The tumour shows a predominantly lepidic architecture with atypical cuboidal to columnar epithelial cells lining thickened alveolar septae. Foci consistent with invasive acinar adenocarcinoma are seen with irregular glands surrounded by fibroblastic stroma. In addition, there are areas showing micro-papillary architecture with micropapillary budding present within alveolar spaces.

Conclusion: Adenocarcinoma with lepidic, acinar and micropapillary architecture.

Case Discussion

Typical appearances of lung carcinoma on imaging, imaging staging in keeping with a T2bN1M0 tumour further confirmed to represent an adenocarcinoma of the lung

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Case information

rID: 59871
Published: 29th May 2018
Last edited: 31st May 2018
System: Chest
Inclusion in quiz mode: Included

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