Left Upper Lobectomy Specimen: Carcinoma
The specimen is received fresh labeled “left upper lobe” and consists of a 380 g, 22.0 x 19.0 x 3.5 cm, intact lung lobectomy specimen. The overlying pleura displays an indurated and radially puckered area located along the medial aspect of the lobe located 4.0 cm from the stapled bronchial margin which measures 1.5 x 0.5 x 0.3 cm. The vascular margin is also stapled and measures 0.5 cm in greatest diameter. There is an exposed area of roughened lung parenchyma along the hilar margin. The remaining pleura is red-brown to red-blue and multifocally fibrotic.
Serial sectioning reveals a 2.5 x 2.0 x 1.5 cm poorly delineated firm tan-white to tan-gray lesion with irregular borders that comes to within 0.1 cm of the nearest inked pleural margin (inked in blue), 3.5 centimeters from the bronchial margin and 4.5 cm from the vascular margin. The remainder of the lobe reveals diffuse anthracotic pigmentation among a red-brown vascular soft parenchyma.
Lodged within the hilar margin are 3 possible ovoid, soft, red-brown lymph nodes ranging from 0.5-3.0 cm in greatest dimension.
Representative sections are submitted in cassettes A1-A11:
- A1: Bronchial margin
- A2: Vascular margin
- A3-A6: Representative sections of tumor
- A7: Fibrotic pleura
- A8: Lung parenchyma, uninvolved
- A9-A11: Lymph nodes, one in each cassette, bisected
Right Upper Lobe Apical Wedge Resection: Pneumothorax
The specimen is received fresh labeled “right upper lobe apical wedge resection” and consists of a 12 g, 7.0 x 3.5 x 2.0 cm lung wedge with a stapled curvilinear marin of resection. The tan-purple pleural surface is focally hemorrhagic, moderately congested, focally covered by tan-yellow, plaque-like material measuring 1.2 cm in greatest dimension, and covered by multifocal string-like fibrous adhesions. The stapled margin is removed and the new margin and entire external surface is inked in black. Serial sectioning perpendicular to the margin of resection reveals a tan-red, diffusely hemorrhagic, spongy cut surface that lacks any grossly discrete lesions. Representative sections are submitted in cassette A1-A3.
Pneumonectomy: Malignant Neoplasm of Right Upper Lobe
The specimen is received fresh labeled “right lung” and consists of a 203 g, 25.0 x 16.0 x 4.0 cm, right pneumonectomy specimen. The hilar margin of resection is received stapled. The hilar bronchial margin measures 2.0 cm in greatest diameter and does not appear to be involved by any mass lesions. The hilar vessels range from 0.3 – 1.2 cm in greatest diameter and do not appear to be grossly involved by thrombi or mass lesions. Within the hilum are 3 possible firm black lymph nodes ranging from 0.6-1.0 cm in greatest dimension.
There is a radially puckered indurated area along the pleural surface of the right upper lobe which measures 2.0 x 2.0 cm and is inked in black. The remainder of the pleural surface is tan-pink and diffusely anthracotic. Sectioning reveals a 2.5 x 2.5 x 1.5 cm well-circumscribed, firm, gray-yellow mass with poorly delineated borders which is located 1.0 cm from the bronchial margin and comes to within 0.1 cm of the overlying inked indurated pleural surface. The remainder of the parenchyma is tan-pink spongy diffusely anthracotic but is otherwise unremarkable.
Representative sections are submitted as follows:
- A1-A2: Hilar margin
- A3-A6: Mass, entirely submitted, showing relationship to overlying inked pleural surface
- A7: Grossly uninvolved upper lobe
- A8: Grossly uninvolved middle lobe
- A9: Grossly uninvolved lower lobe
ALINA MAYSTERCHUK 