Pulmonary Pathology II Case Studies


CASE 6: Adenocarcinoma


Clinical History:

A 47-year-old school teacher, a non-smoker, was admitted for inguinal herniorrhaphy. A pre-operative routine chest x-ray revealed a 3 cm nodule in the right upper lobe which was not present on an x-ray taken two years prior. No evidence of mediastinal adenopathy was found on CT scan. A right upper lobectomy was performed.
  1. Describe the histopathology of this lesion.

    2. This lesion shows sheets and cords of large cells with glandular formation, and mucin production. The cells have abundant pink to grey, somewhat bubbly cytoplasm. The nuclei are oval to angulated and have prominent nucleoli. Mitoses are easy to find, but not numerous. Areas of necrosis can be seen.

  2. What is the diagnosis? Where are these lesions usually located?

    3. This is an adenocarcinoma. They are more often peripheral than central.

  3. This lesion was enclosed within the lung and all of the hilar and mediastinal nodes sampled were free of tumor. What stage is this tumor? What is the prognosis for this woman?

    4. This is a stage T2 N0 M0 tumor (a T1 tumor of the lung is <3 cm). Five year survival is still only about 30%, despite the small size and absence of positive lymph node involvement.