Invasive lung adenocarcinoma
Lung nodule for follow-up. PET negative.
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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.
MICROSCOPIC DESCRIPTION: 1. One lymph node is identified with no evidence of tumour. 2. Sections of the lung show features of a moderately differentiated adenocarcinoma. The tumour forms acinar (50%) and papillary structures (50%). The tumour cells have enlarged nuclei, prominent nucleoli and moderate amounts of eosinophilic cytoplasm. The tumour does not involve the visceral pleura. No evidence of lymphovascular invasion is seen. The tumour is completely excised. The bronchial and vascular margins are clear. One normal intraparenchymal lymph node is present. The remaining lung parenchyma is unremarkable. The tumour cells are CK7 and TTF-1 positive. CK20 is negative. 3. One lymph node is identified with no evidence of tumour. 4. Three lymph nodes are identified with no evidence of tumour.
DIAGNOSIS: 1. Intersegmental frozen: One lymph node identified with no evidence of tumour. 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. Tumour completely excised with clear parenchymal margin. One normal intraparenchymal lymph node identified. 3. Intersegmental lymph node: One lymph node identified with no evidence of tumour. 4. Station 8: Three lymph nodes identified with no evidence of tumour.