Pulmonary Pathology Online
Examination of Lobectomy or Pneumonectomy Specimens for Neoplastic or Non-Neoplastic Lesions
Examination of lobectomy or pneumonectomy specimens for neoplasia:
- To determine the histological type of a lung tumour which is easier on large specimen than on biopsy material.
Examination of lobectomy specimens for non-neoplastic diseases:
- Cysts (congenital or acquired, secondary to emphysema or inflammation) and inflammatory lesions such as bronchiectasis, bullae and sequestrations.
- Sometimes for localized areas of consolidation and organizing pneumonia, inflammatory pseudotumour, Wegener’s granulomatosis and rheumatoid nodule.
An approach to histopathological reporting of lobectomy specimens:
The report should contain the following information:
Histological type and degree of differentiation:
(i) Squamous cell carcinoma ;
(ii) Adenocarcinoma ;
(iii) Large cell carcinoma ;
(iv) Giant cell carcinoma,
Features important for staging: Involvement of bronchial resection margin; involvement of pleura; vascular invasion; involvement of lymph nodes .
Features in the lung away from the neoplasm: Squamous metaplasia, dysplasia, or in situ malignancy in bronchial epithelium ; Obstructive pneumonitis with the features of endogenous lipid pneumonia ; Sarcoid-like granulomas in the lung and lymph nodes ; Asbestos bodies.
Preexisting lung disease: Emphysema ; Desmoplasia ; Non-fibrotic changes in the alveoli (hyaline membrane formation ; interstitial inflammation, hyperplasia of alveolar lining cells).
Important features in specific tumour:
Carcinoid tumour: High mitotic rate and necrosis are associated with aggressive behaviour (atypical carcinoid); nuclear pleomorphism alone is not a reliable indicator; Spindle cell morphology ; oncocytic change, and melanin pigment ;
Adenoid cystic carcinoma: Spread in the walls of airways, and involvement of perineural spaces.
(II) Non-neoplastic lesions:
- Cystic and cavitating lesions:
Contents of cavity:
Pus in lung abscess; aspirated foreign material; caseous material in tuberculosis; mycetoma - usually aspergilloma ;
Respiratory, squamous, enteric, mucinous ; squamous epithelium in re-epithelialization of a cavity ;
Granulation tissue with fibrosis ;
Bronchial seromucous glands and cartilage in bronchogenic cyst;
Pancreatic tissue and mucous glands in enteric cysts ;
Multiple cysts lined by respiratory epithelium in adenomatoid malformations;
Focal granulomatous malformation with scattered giant cells in mycetoma;
Necrotizing granulomas with caseation necrosis in mycobacterial infection;
Mycetoma formation associated with other diseases such as tuberculosis, emphysema with bulla formation and late stage sarcoidosis with fibrosis.
- Inflammatory lesions:
Lumen of bronchi and bronchioles:
Pus in cystic fibrosis ;
Mucus plugging in allergic bronchopulmonary aspergillosis ;
Fungal hyphae within mucus in allergic bronchopulmonary aspergillosis and as mycetoma in complicated bronchiectasis ;
Bacterial colonies (botryomycosis) ;
Eosinophils in allergic bronchopulmonary aspergillosis.
Mucinous metaplasia in cystic fibrosis ;
Squamous metaplasia in bronchiectasis and non-specific inflammatory conditions ;
Ulceration and replacement by granulation tissue in bronchiectasis and allergic bronchopulmonary aspergillosis.
Non-specific inflammation with fibrosis in bronchiectasis ;
Follicular lymphoid aggregates in follicular bronchiectasis ;
Granulomatous inflammation with numerous histiocytes , scattered giant cells, and eosinophils in allergic bronchopulmonary aspergillosis/ bronchocentric granulomatosis.
Non-specific inflammation and fibrosis with organizing pneumonia in bronchiectasis ;
Mucus plugging in obstructive pneumonitis ;
Carcinoid tumorlets associated with bronchiectasis ;
Necrotizing granulomas with caseation necrosis in mycobacterial infection ;
Coagulative fibrinoid necrosis in the centre of a rheumatoid nodule ;
Vasculitis in Wegener’s granulomatosis ;
Vascular infiltration with atypical lymphoid cells in angiocentric lymphoma.
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