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Lung Cancer Pathology

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Lung Cancer Pathology. Dr.Erich Fl gel. Fresenius Kabi Austria. Infections Oncology ... Bronchoscopy bronchial washings, brushings and biopsy (bronchial or ... – PowerPoint PPT presentation

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Title: Lung Cancer Pathology


1
Lung Cancer Pathology
  • Dr.Erich Flögel
  • Fresenius Kabi Austria
  • Infections Oncology

2
Role of the Pathologist in Lung Cancer
  • Tissue diagnosis
  • Staging prior to possible resection
  • Multidisciplinary meeting
  • Reporting of resected tumours
  • Research

3
How do we diagnose lung cancer?
  • Clinical features
  • Medical imaging
  • Tissue diagnosis - pathology

4
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

5
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

6
Tissue processing
7
Tissue embedding
8
Cutting sections from paraffin blocks
9
HE stainer
Automated immunostainer
10
Diagnosis!
11
Bronchial brushing
12
Bronchial biopsy
13
Synaptophysin
14
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

15
Surgically resected lung cancer
  • Wedge resection
  • Segmentectomy
  • Lobectomy
  • Pneumonectomy

16
Lobectomy
17
Sampling for lung tumour bank
18
After a few hours in formalin.
19
The Pathology Report (1)
  • History
  • Macroscopic
  • Site of tumour
  • Dimensions of tumour
  • Invasion of adjacent structures
  • Uninvolved lung
  • List of sections taken

20
(No Transcript)
21
SCC lung
22
SCC lung
23
Adenocarcinoma
24
Mucinous adenocarcinoma
25
Adenocarcinoma and emphysema
26
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

27
SCC keratin pearls
28
Less well-differentiated SCC
29
Adenocarcinoma
30
Papillary adenocarcinoma
31
Small cell carcinoma
32
The Pathology Report (3)
  • Summary
  • diagnosis
  • Pathological Stage
  • SNOMED code
  • Cancer registry

33
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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