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Transcript of Lung Cancer Pathology - ocw.usu.ac.idocw.usu.ac.id/.../rts_146_slide_lung_cancer_  · PDF...

  • 5/24/2011

    1

    Lung Cancer Pathology

    Role of the Pathologist in Lung Cancer

    • Tissue diagnosis

    • Staging prior to possible resection

    • Multidisciplinary meeting

    • Reporting of resected tumours

    • Research

  • 5/24/2011

    2

    How do we diagnose lung cancer?

    • Clinical features

    • Medical imaging

    • Tissue diagnosis - pathology

    Specimens for tissue diagnosis

    • Sputum cytology

    • Bronchoscopy – bronchial washings,

    brushings and biopsy (bronchial or

    transbronchial)

    • Cytology of pleural fluid

    • FNA under CT guidance (for peripheral

    tumours) +/- core biopsy

    • Biopsies of metastases

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    3

    What happens in the path lab?

    • Fixation

    • Macroscopic description & block selection

    • Tissue processing into paraffin

    • Embedding

    • Cutting of paraffin blocks

    • Staining

    • Cover slipping

    • Examination under the microscope and generation of pathology report

    Tissue processing

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    4

    Tissue embedding

    Cutting sections from paraffin blocks

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    5

    H&E stainer

    Automated

    immunostainer

    Diagnosis!

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    6

    Bronchial brushing

    Bronchial biopsy

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    7

    Synaptophysin

    Practical considerations in lung cancer diagnosis

    • Non-small cell vs. small cell carcinoma

    – Treatment implications

    • Central / hilar vs. peripheral

    – Diagnostic implications

    • Staging

    – Metastases present in 70% at diagnosis

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    8

    Surgically resected lung cancer

    • Wedge resection

    • Segmentectomy

    • Lobectomy

    • Pneumonectomy

    Lobectomy

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    9

    Sampling for lung

    tumour bank

    After a few hours in formalin….

  • 5/24/2011

    10

    The Pathology Report (1)

    • History

    • Macroscopic – Site of tumour

    – Dimensions of tumour

    – Invasion of adjacent structures

    – Uninvolved lung

    – List of sections taken

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    11

    SCC lung

    SCC lung

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    12

    Adenocarcinoma

    Mucinous adenocarcinoma

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    13

    Adenocarcinoma

    and emphysema

    The Pathology Report (2)

    • Microscopic

    – Type of tumour and how well differentiated

    – Completeness of resection

    – Invasion of adjacent structures

    – ? Pleural invasion

    – ? Vascular, lymphatic or perineural invasion

    – Lymph nodes

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    14

    SCC –keratin pearls

    Less well-differentiated SCC

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    15

    Adenocarcinoma

    Papillary adenocarcinoma

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    16

    Small cell carcinoma

    The Pathology Report (3)

    • Summary

    – diagnosis

    • Pathological Stage

    • SNOMED code

    – Cancer registry

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    17

    Staging of lung cancer

    • Non-small cell carcinomas: TNM system

    – T = tumour

    – N = lymph nodes

    – M = metastases

    • Small cell carcinoma: limited vs. extensive

    Australian Doctors Orchestra