Adenocarcinoma of the lung: lepidic predominant

Case contributed by A.Prof Frank Gaillard

Presentation

Cough

Patient Data

Age: 70 years
Gender: Female

A region of what appears to be atelectasis is seen in the lingular segment of the left upper lobe. It appears smaller than the corresponding lesion seen on CT however this may be due to relatively low density of the periphery of the lesion. Comparison with previous chest x-rays would be helpful to confirm that the lesion is not smaller in size.

Elsewhere the lungs and pleural spaces are clear. The cardiomediastinal contours are normal.

 

An irregularly shaped somewhat spiculated mass measuring 2.4 x 2.8cm is identified in the lingular segment of the left upper lobe. There is a linear tail which appears to be a atelectasis extending to the pleural surface. There is no associated pleural thickening. Centrally within the mass are multiple focal radiolucencies suggesting this may represent an adenocarcinoma.

There is a 1cm subtle rounded area of groundglass opacity in a subpleural position postero-laterally in the left lower lobe. If the larger lesion proves to be an adenocarcinoma, this could represent either in situ disease at all well differentiated adenocarcinoma.

A minor region of atelectasis in the apical segment of the right lower lobe is unchanged. A non-specific opacity inferiorly and anteriorly in the right upper lobe may represent scarring.

In extensive changes of emphysema are seen.

There no enlarged hilar or mediastinal lymph nodes.

No suspicious bone lesions are seen.

Conclusion:

  • at the lingular segment left upper lobe mass has the appearance of a carcinoma, probably adenocarcinoma
  • small groundglass focus in the right lower lobe could also represent adenocarcinoma either in situ or low grade
  • there our bronchi passing into the lingular segment mass. It would be amenable to bronchoscopic biopsy

 

Case Discussion

This patient went on to have a left upper lobectomy. 

Histology

MICROSCOPIC DESCRIPTION:

Sections from the tumour show adenocarcinoma with a predominantly lepidic growth (60%) and a lesser component of acinar growth (40%). Tumour cells are cuboidal to columnar with large hyperchromatic pleomorphic, small nucleoli and clumped chromatin. The stroma appears desmoplastic and contains a dense mononuclear inflamamtory cell infiltrate. There is a large central scar area. Lymphovascular and perineural invasion are not identified. Tumour is close to the pleura. but does not appear to invade the pleura. The sections of the hilar margin structures are clear of tumour. Lung parenchyma away from the tumour is unremarkable. There is some mild subpleural fibrosis and emphysema in one of the sections. Two lymph nodes show no evidence of metastatic carcinoma. 

DIAGNOSIS:

  1. Left upper lobectomy: * Lepidic predominant adenocarcinoma. - Lepidic component 60%, acinar component 40%. - Size - 22mm. - No pleural invasion. - No lymphovascular invasion. - No perineural invasion. - Well clear of margins. - 2 lymph nodes with no evidence of metastatic carcinoma (0/2).
  2. Station 5, 8, 10, 11: lymph nodes with no evidence of metastatic carcinoma 
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Case information

rID: 28820
Case created: 14th Apr 2014
Last edited: 1st Oct 2017
System: Chest
Inclusion in quiz mode: Included

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