SPECIMEN

A. LUNG - 1. Needle biopsy left uper lung lobe mass -

B. LUNG - 2. Left upper lung lobe - FS for Margen's
C. LYMPH NODE(S) - 3. Level 10 lymph node
D. LYMPH NODE(S) - 4. Level 7 lymph node
E. LYMPH NODE(S) - 5. Level 8 nodes
F. LYMPH NODE(S) - 6. Level 9 nodes

CLINICAL INFORMATION
Left lung mass.

GROSS DESCRIPTION
The specimens are received in six containers, each labeled with the patient's na

Part A is received fresh for frozen section diagnosis labeled "needle biopsy left upper lung lobe" and
consists of seven cylindrical portions of tan-white tissue ranging from 0.1 x 0.1 cm up to 0.5 x 0.1 cm.
The specimen is submitted in toto for frozen section diagnosis as (FSA 1). The frozen section residue is
submitted as (A 1).

Frozen section diagnosis:

FSA 1 - Needle biopsy left upper lobe - "positive for non-small-cell carcinoma."

Part B is received fresh for frozen section diagnosis labeled "left upper lobe" and consists of a 125 gm, 12
x 8 x 4 cm lobe of lung including a 0.5 cm length of exposed bronchus. The mildly anthracotic pleura has
a 1 cm retracted area over a palpable mass near the hilum. The bronchial margin is taken en face and
submitted for frozen section diagnosis as (FSB1). Sections show a well-defined 2.5 x 2.5 x 2 cm firm tan-
white subpleural mass, which corresponds to the pleural retraction and is located approximately 1 cm
from the bronchial margin. The mass grossly communicates with the bronchus. The remainder of the
specimen consists of spongy light-grey parenchyma without additional nodules or areas of consolidation.
A 0.5 cm peribronchial lymph node is dissected from the specimen. The frozen section residue and
representative sections are submitted as (B1 )-(B7).

SLIDE KEY
B1 - Bronchial margin en face for frozen section
B2 - Vascular margin en face
B3 - Tumor with inked pleura
B5-B5 - Tumor
B6 - Uninvolved parenchyma
B7 - One lymph node bisected

FS81 - Left
Examined by
.. - .. - ..
Frozen section diagnosis:
nchial margin - "Negative for carcinoma."

Part C is received fresh labeled "level 10 lymph nodes" are four anthracotic tan tissue fragments ranging
from 0.3 cm-0.8 cm. The specimen is submitted in toto as (C1).

Part 0 is received fresh labeled "level 7 lymph nodes" and consists of two 0.8 cm and 1.9 cm portions of
tan tissue. The specimen contains two 1.7 cm and 0.6 cm anthracotic lymph nodes. Poles were bisected
and the specimen is submitted in its entirety with one lymph node per cassette as (01) and (02).

Part E is received fresh labeled "level 8 lymph nodes" and consists of a 1.5 cm portion of adipose tissue,
which contains a 1 cm anthracotic lymph node. The lymph node is bisected and submitted in its entirety
as (E1).

Part F is received fresh labeled "level 9 lymph nodes" and consists of a 1.4 cm portion of adipose tissue,
which contains a 0.7 cm anthracotic lymph node. The lymph node is bisected and submitted in its entirety
as (F1).
MICROSCOPIC DESCRIPTION
SURGICAL PATHOLOGY CANCER CASE SUMMARY, LUNG

LUNG: Resection.
SPECIMEN TYPE: Left upper lobe lobectomy.
TUMOR SITE: Left upper lobe.
TUMOR SIZE: 2.5 x 2.5 x 2 cm.
HISTOLOGIC TYPE: Adenocarcinoma.
HISTOLOGIC GRADE: The tumor shows solid nests of cells as well as areas where the tumor lines
glandular spaces. The majority of the tumor is solid. There is a focally marked pleomorphism in the
tumor cells with large high irregular and lobated nuclei. Mitotic figures are fairly abundant. The tumor is
situated within desmoplastic stroma, which is moderately inflamed.
EXTENT OF INVASION: The tumor comes close to the visceral epithelial cell surface and, therefore, and
elastin stain was performed with an appropriate control. The tumor comes close to, but does not invade
through the elastin fibers.

T1, tumor 3 cm or less in greatest dimension, surrounded by lung and visceral pleura.
MARGINS: Margins uninvolved by tumor.
Distance of tumor from closest margin: 1 cm.
ATERIAL, VENOUS/LYMPHATIC VESSEL INVASION: Absent.
REGIONAL LYMPH NODES: NO, no regional lymph node metastasis.
A total of 9 lymph nodes are examined, none of which are positive (0/9).
LOBECTOMY LYMPH NODES:
Number examined: 1.
Number positive: O.
LEVEL 10 LYMPH NODES:
Number examined: 4.
Number positive: O.
LEVEL 7 LYMPH NODES:
Number examined: 2.
Number positive: O.
LEVEL 8 LYMPH NODE:
Number examined: 1
Number positive: O.
LEVEL 9 LYMPH NODE:
Number examined: 1
Number positive: O.
DISTANT METASTASIS: MX, cannot be assessed.
_ A G E : IA (T1 NO MX).

FINAL DIAGNOSIS
LUNG, LEFT UPPER LOBE, BIOPSY
Moderately differentiated invasive adenocarcinoma.

LUNG, LEFT UPPER LOBE, LOBECTOMY

Invasive, moderately differentiated adenocarcinoma.
Tumor measures 2.5 cm in greatest dimension.
No evidence of vascular invasion.
1 lymph node negative for metastatic carcinoma (0/1).

LEVEL 10 LYMPH NODES, DISECTION

4 lymph nodes negative for metastatic carcinoma (0/4).

LEVEL 7 LYMPH NODES, DISECTION

2 lymph nodes negative for metastatic carcinoma (0/2).

LEVEL 8 LYMPH NODE, BIOPSY

1 lymph node negative for metastatic carcinoma (0/1).

LEVEL 9 LYMPH NODES, BIOPSY

1 lymph node negative for metastatic carcinoma (0/1).

CPT CODE(S): 88309X1, 88307X2, 88305X3, 88331X2, 88313