Patient Data
Size and density increase of the nodule involving superior segment of the right lower lobe since prior imaging - measures ~8.2 mm. No new nodules.
Clear pleural spaces.
Right paratracheal, subcarinal and bilateral hilar nodes measuring up to 9 mm in short axis.
Dual-lead cardiac device with lead tips within the right atrium and right ventricle.
Unremarkable appearance of the imaged upper abdominal viscera. No suspicious focal osseous lesions.
Macroscopy: "Right lower lobe". A wedge of lung 70 x 30 x 20mm, with a stapled margin 70mm. There is a solitary pale firm intraparenchymal nodule 8mm diameter. No other focal lesions.
Microscopy: The sections taken from the macroscopically described lesion show an invasive tumor, composed of multiple acini and small numbers of papillae (approximately 20%), lined by pleomorphic epithelial cells. The tumor cells have moderate amounts of cytoplasm, ovoid nuclei, nuclear hyperchromasia, and prominent nucleoli. Atypical mitoses are frequent. There is focal luminal necrosis. There is accompanying desmoplastic stroma. No lymphovascular or perineural invasion is seen. Non-neoplastic lung parenchyma shows emphysematous changes. Away from this, lung parenchyma shows emphysematous changes. A single focus of adenocarcinoma in situ (2.5 mm) is seen, clear of the pleura and bronchial resection margin. Six hilar and one intrapulmonary lymph nodes show no evidence of metastatic malignancy (0/7).
Conclusion: Right lower lobe wedge resection:
- Histological type: Acinar-predominant adenocarcinoma
- Histological grade: Moderately differentiated
- Tumor size: 8 mm in maximal dimension
- Visceral pleural invasion: Not identified
- Lymphovascular invasion: Not identified
- Perineural invasion: Not identified
- Surgical margin status: Not involved
- Bronchial resection margin: Not involved
- Vascular resection margin: Not involved
- In situ carcinoma Present, single focus (2.4 mm)
- LYMPH NODES: Hilar, intrapulmonary, stations 7 and 9
- Lymph node status Not involved (total of 9 lymph nodes, 0/9)
pT1a N0 (AJCC 8th Edition)
Case Discussion
Solitary pulmonary nodule that has increased on imaging follow-up. Resection confirmed acinar-predominant lung adenocarcinoma.