Lung adenocarcinoma

Case contributed by Dr Henry Knipe

Presentation

Cough.

Patient Data

Age: 60 years
Gender: Female
CT

Mixed ground glass and solid nodule in the left upper lobe peripherally, measuring approximately 3 cm. No other pulmonary nodule. No enlarged hilar or paratracheal nodes. 

Nuclear medicine

Left upper lobe ground glass / solid nodule demonstrates low avidity. No avid hilar or mediastinal lymph nodes. 

Pathology

MACROSCOPIC DESCRIPTION: "Left upper lobe": The specimen consists of left upper lobe 175x115x65 mm. On the pleural surface, there is an area of distortion 37x45 mm. The hilar resection margin is inked blue and the visceral pleura green. The cut surface reveals an irregularly shaped but relatively well circumscribed cream solid nodule abutting the pleura and lying 40 mm away from the bronchial resection margin. The mass measures 35x25x32 mm. The remainder of the lung is homogeneous tan without further lesions.

MICROSCOPIC DESCRIPTION: Sections of the lung show features of a moderately differentiated adenocarcinoma. The total tumour size is 35mm with the invasive component measuring 30 mm and the lepidic component 5 mm (in-situ, non-mucinous type). The invasive tumour forms acinar structures (100%). The tumour cells have enlarged nuclei, prominent nucleoli and moderate amounts of eosinophilic cytoplasm. The tumour extends close to but not through the elastic layer of the visceral pleura. No evidence of lymphovascular invasion is seen. The tumour is completely excised. The bronchial and vascular margins are clear. 2 normal hilar lymph nodes are present. The remaining lung parenchyma is unremarkable.

Case Discussion

Ground glass nodule is a typical appearance of lung adenocarcinoma, and can demonstrate variable solid components. Adenocarcinoma is also frequently either non-avid or demonstrates low avidity on PET-CT. The patient was treated with complete resection via an upper lobectomy. 

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Case information

rID: 48177
Case created: 23rd Sep 2016
Last edited: 14th Oct 2016
Systems: Chest, Oncology
Inclusion in quiz mode: Included

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