Invasive lung adenocarcinoma

Case contributed by Melbourne Uni Radiology Masters


Lung nodule for follow-up. PET negative.

Patient Data

Age: 54-year-old
Gender: Female

CT Chest

CT Chest

Lobulated ground glass nodule within the posterior basal segment of the right lower lobe is unchanged in size and density compared with the prior study. Normal vessels and attenuated bronchi traverse the lesion. No solid component present. Unfortunately automated segmentation for volumetric assessment was unsuccessful due to the ground glass nature of this nodule.

A few subtle areas of ill-defined, small and non-specific ground glass opacity elsewhere, tiny pulmonary nodules and atelectasis/scarring in the lingula and middle lobe are of doubtful clinical significance.

No overt lymphadenopathy.

Small volume pericardial and right pleural fluid has developed.

Conclusion: Stable well-defined right lower lobe lobulated ground glass nodule. This remains suspicious for a low grade adenomatous lesion. Further follow-up in 3-6 months suggested.

Case Discussion


MICROSCOPIC DESCRIPTION: 1. One lymph node is identified with no evidence of tumor. 2. Sections of the lung show features of a moderately differentiated adenocarcinoma. The tumor forms acinar (50%) and papillary structures (50%). The tumor cells have enlarged nuclei, prominent nucleoli and moderate amounts of eosinophilic cytoplasm. The tumor does not involve the visceral pleura. No evidence of lymphovascular invasion is seen. The tumor is completely excised. The bronchial and vascular margins are clear. One normal intraparenchymal lymph node is present. The remaining lung parenchyma is unremarkable. The tumor cells are CK7 and TTF-1 positive. CK20 is negative. 3. One lymph node is identified with no evidence of tumor. 4. Three lymph nodes are identified with no evidence of tumor.

DIAGNOSIS: 1. Intersegmental frozen: One lymph node identified with no evidence of tumor. 2. Post basal segment right lower lobe: Moderately differentiated adenocarcinoma. 20mm in maximum dimension. No evidence of pleural invasion. No evidence of lymphovascular invasion. Bronchial resection margin uninvolved. Tumor completely excised with clear parenchymal margin. One normal intraparenchymal lymph node identified. 3. Intersegmental lymph node: One lymph node identified with no evidence of tumor. 4. Station 8: Three lymph nodes identified with no evidence of tumor.

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Case information

rID: 39243
Published: 27th Aug 2015
Last edited: 14th Aug 2019
System: Chest
Tag: rmh
Inclusion in quiz mode: Included

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