病理报告案例sample lung pathology reports

Specimen: Lung, right lower lobe 
 
Gross Description: Submitted fresh and designated “right lower lobe lung” is a 19.5 x 13 x 6 cm lobe of the lung. The pleural surface is glistening. There is a puckered area on the surface of the lung. There is some firmness of the pulmonary tissue beneath it. The bronchial and vascular margins of resection appear negative for tumor. Numerous small peribronchial lymph nodes are identified, which are anthracotically pigmented and measure up to 0.7 cm in diameter. Subtending the previously described puckered area is an 8 x 5 x 4 cm rubbery to firm homogeneous tan tissue mass, which has a prominent gray surface. The mass is somewhat ill defined and extends almost imperceptibly into the contiguous lung tissue. Focally there is almost a myxoid character to the tissue. This mass extends up to, but did not appear to penetrate the visceral pleura. A second nodule is identified approximately 4 cm from the margin of resection and appears to be intraparenchymal. This nodule is 1 cm in diameter, is well-circumscribed and on cut surface has a sclerotic mottled yellow tan appearance. 
 
Microscopic: 
Histologic Type: Adenocarcinoma, acinar type with bronchioloalveolar features Histologic Grade: G2: Moderately differentiated Extent of Invasion: >3 cm in greatest dimension invades the visceral pleura Margins: Margins uninvolved by tumor. Distance of tumor from closest margin: 8 cm. Blood/Lymphatic Vessel Invasion: Absent Regional Lymph Nodes: N0: No regional lymph node metastasis. Comment: Separate 1.0 cm carcinoid tumor 4 cm from closest margin. 
 
Final Diagnosis: 
Lung (right lower lobectomy): 8.0 cm moderately differentiated acinar type adenocarcinoma, bronchial and vascular margins of resection negative for tumor, peribronchial lymph nodes negative for tumor, separate 1.0 cm well differentiated neuroendocrine carcinoma (carcinoid tumor). 
 

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案例二
Specimen:
1. Subcarinal lymph node
2. Right upper lobe mass

Final Diagnosis:
1. Subcarinal lymph node, excisional biopsy: Fragments of benign lymph node with
anthracotic pigment.
2. Lung, right upper lobe wedge resection: Bronchoalveolar carcinoma measuring 2 cm
in diameter. The margin of resection is free of tumor by more than 0.5 cm. One
intraparenchymal benign lymph node.
Specimen:
1. Left upper lobe wedge
2. Additional wedge, left upper lobe

Final Diagnosis:
1. Lung, left upper lobe (wedge biopsy): Well differentiated bronchogenic
adenocarcinoma, nuclear grade 1, acinar type, 1 cm in greatest diameter. No
unequivocal lymphovascular invasion seen. Pleural surface is clear of tumor.
2. Lung, left upper lobe (wedge re-excision): No residual adenocarcinoma seen.
Emphysematous change.
Clinical History: Right lower lobe lung tumor and mediastinal adenopathy.

Specimen:
1. Biopsy right lower lobe
2. Right paratracheal node
3. Subcarinal node
4. Left paratracheal node

Final Diagnosis:
Right lower lobe lung biopsy showing no diagnostic abnormalities. Sections from the
lymph nodes show metastatic adenocarcinoma and metastatic small cell neuroendocrine
carcinoma in each node. By immunohistochemistry, the adenocarcinoma stains with
CK20 and CK7 and the small cell carcinoma stains with synaptophysin and TTF. In
addition, chromogranin is negative, AAT is non-contributory and PSA is equivocal.
These findings most likely represent a metastatic “combined small cell carcinoma” from
lung.
病历
History: The patient was hospitalized with cough and greenish sputum. CT scan
demonstrated multiple lung masses, one in the right upper lobe segment and the other in
the left lower lobe posteriorly, each measuring 4 x 5 cm. He underwent aggressive
pulmonary toilet with parenteral antibiotics, high flow nebulizer treatments and then
underwent a fiberoptic bronchoscopy. The bronchoscopy note demonstrated extrinsic
compression of the right upper lobe sub segment as well as the left lower lobe posterior
segment without an obvious endobronchial lesion and transbronchial biopsies in the right
upper lobe demonstrating a large cell carcinoma.

Studies: CT scan from March 3, 2007 shows a 5.2 cm. mass in the right upper lobe with
spiculated borders and tenting of the adjacent pleura. There is also a 5.1 cm. mass in the
left lower lobe, spiculated, non specific, though a neoplastic process could not be
excluded. No significant mediastinal adenopathy. The images from the upper abdomen
show mild filling of the distal esophagus but no other abnormalities. Pathology report
from the right upper lobe biopsy showed large cell carcinoma.

Impression:
1. Bilateral synchronous lung cancers (greater than 5.0 cm) right upper lobe and visceral
parietal pleural involvement along the paraspinal region (left lower lung). No
obvious mediastinal disease.
2. Chronic renal insufficiency
3. History of congestive heart failure, no compensated
4. COPD undergoing pulmonary toilet prior to fiberoptic bronchoscopy

Disposition: We discussed with the patient his situation and felt that given his disease is
confined to the chest that a trial of radiation therapy with low dose weekly Taxol and
Carboplatin had at least a 50-70% likelihood of controlling the global disease.
Reference:https://seer.cancer.gov/tools/mphrules/training_adv/lung_cases.pdf
X-ray (PA)
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.

CT: LUNG AXIAL HI RES XC lung window
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:

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).
Station 5, 8, 10, 11: lymph nodes with no evidence of metastatic carcinoma
Ref: https://radiopaedia.org/cases/adenocarcinoma-of-the-lung-lepidic-predominant
Adenocarcinoma of the lung: lepidic predominant 肺腺癌(贴壁型)案例

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