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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Tissue embedding

Cutting sections from paraffin blocks

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H&E stainer

Automated

immunostainer

Diagnosis!

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Bronchial brushing

Bronchial biopsy

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Synaptophysin

Practical considerationsin 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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Sampling for lung

tumour bank

After a few hours in formalin….

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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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SCC lung

SCC lung

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Adenocarcinoma

Mucinous adenocarcinoma

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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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SCC –keratin pearls

Less well-differentiated SCC

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Adenocarcinoma

Papillary adenocarcinoma

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Small cell carcinoma

The Pathology Report (3)

• Summary

– diagnosis

• Pathological Stage

• SNOMED code

– Cancer registry

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Staging of lung cancer

• Non-small cell carcinomas: TNM system

– T = tumour

– N = lymph nodes

– M = metastases

• Small cell carcinoma: limited vs. extensive

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