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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
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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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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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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
Australian Doctors Orchestra
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