Adenocarcinoma of lung

Patient went on & had a right lower lobe lobectomy.

Histology

MACROSCOPIC DESCRIPTION

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 tumor 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 tumor appears clear of the bronchial resection margin by approximately 12mm.  Tumor  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.  

MICROSCOPIC DESCRIPTION

Sections show a  moderately differentiated  adenocarcinoma, part of the tumor 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 tumor  necrosis and  focal lymphovascular  invasion  is seen. The tumor is abutting the pleura but no invasion  through the visceral pleura is identified.   The tumor  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  tumor,  consistent  with an  obstructive lipoid pneumonia.   The two  peribronchial  lymph nodes are  free of tumor 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.