Adenocarcinoma of lung
Previous bowel cancer & bowel resection with radiotherapy
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CXR shows is a round opacity lesion locate on right lower lobe, projecting through the right hilum (hilum overlay sign).
2 case question available
Patient went on & had a right lower lobe lobectomy.
A right lower lobectomy specimen with a single staple line towards the apex of the lobe, 75mm long. On the costal surface, 35mm inferior to the apex, there is pleural puckering over an area of approximately 20mm diameter. Beneath this, there is a relatively well circumscribed, lobulated, firm tumour composed of variegated cream, yellow and grey tissue with a maximal cut face dimension of 35mm. Immediately surrounding lung parenchyma has an indurated texture and is discoloured yellow ?obstructive/lipoid pneumonia. The tumour appears clear of the bronchial resection margin by approximately 12mm. Tumour abuts, but does not invade through pleura on the costal surface. There is no clearly demonstrable communication with the bronchus. The surrounding lung is unremarkable.
Sections show a moderately differentiated adenocarcinoma, part of the tumour consisting of papillary structures with fibrovascular cores and lined by atypical pseudostratified columnar cells, part formed by gland-like structures and part showing a lepidic growth pattern. There are areas of tumour necrosis and focal lymphovascular invasion is seen. The tumour is abutting the pleura but no invasion through the visceral pleura is identified. The tumour comes close to the segmental bronchus but no invasion into the bronchus is identified. The bronchial resection margins are clear. There are prominent collections of intra-alveolar macrophages in lung tissue surrounding the tumour, consistent with an obstructive lipoid pneumonia. The two peribronchial lymph nodes are free of tumour invasion and show prominent anthraco-silicosis.
FINAL DIAGNOSIS: moderately differentiated adenocarcinoma, with lymphovascular invasion, in subpleural location. The appearance is consistent with a primary lung origin.
Features here are of a solitary lung lesion at the right hilum proven to be adenocarcinoma after biopsy.