The patient underwent surgical wedge resection:
Macroscopy: A. Labelled "Right middle lobe wedge - frozen section". A wedge 54x24mm. On sectioning, there is a well-defined cream/grey firm lesion 15x14x10mm. This appears to abut the green inked stapled margin. The remainder of parenchyma is tan/red.
B. Labelled "Completion right middle lobectomy". Completion right middle lobectomy weighing 31 g (post-fixation) measuring 63 x 62 x 30 mm. Pleura appears grey/pale tan with areas of adherent haemorrhage. On sectioning, parenchyma appears pale tan and mildly haemorrhagic. No lesions are identified. Stapled resection margins inked green, blue and yellow which measure 65, 55 and 18 mm respectively. Bronchovascular resection margins are clear.
C. Labelled "Right lung level 4R lymph node". One potential lymph node measuring 2 mm which is surrounded by fatty tissue.
D. Labelled "R lymph node level 10". 2 pieces of potential lymph node 3 and 4 mm.
E. Labelled "Right lung station 11R lymph node", 1 potential lymph node 3 mm.
Microscopy: A. Paraffin sections confirm the frozen section diagnosis and show solid cellular tumour beneath the pleural surface. Tumour is composed of large nests of cells with a collagenous stromal reaction. The tumour cells have fairly uniform, round to oval nuclei with granular chromatin and a small to moderate amount of cytoplasm. Occasional rosette formation is evident. Mitotic figures are seen, with a mean of 1 per 10 HPF (or 2 sq mm). There is no tumour necrosis. Tumour extends into the elastic lamina of the visceral pleura, but no tumour is present on the pleural surface. No lymphovascular or perineural invasion is seen. Tumour is present at the painted margin (after removal of staples).
Tumour cells show positive immunoperoxidase staining for low molecular cytokeratin (Cam 5.2), TTF-1, chromogranin and synaptophysin. Ki67 shows a proliferative index of approximately 10%.
B. Sections show lung tissue within normal limits. A small benign intraparenchymal lymph node is present. There is no malignancy.
C. The biopsy consists of fibroadipose connective tissue. There is no lymph node. There is no malignancy.
D. Sections show lymph node with no malignancy.
E. Sections show lymph node with no malignancy.
Conclusion: A,B. Right middle lobe lung wedge resection with completion lobectomy specimens: Typical carcinoid tumour, 15 mm in size.
- mean mitotic rate 1 per 2 sq mm, no tumour necrosis
- invasion of visceral pleura (PL1)
- no lymphovascular invasion identified
- resection margins clear
- one benign intraparenchymal lymph node
- pT2
C. Right lung level 4R lymph node, biopsy: Benign connective tissue only.
D. Right level 10 lymph node, biopsy: Benign lymph node.
E. Right 11 R lymph node, biopsy: Benign lymph node.