Lung wedge resection and lobectomy

Author: Mikael Häggström

Comprehensiveness

On this resource, the following formatting is used for comprehensiveness:

• Minimal depth
• (Moderate depth)
• ((Comprehensive))

Grossing

File:Gross pathology of surgical margin sampling in lobectomy.jpg

Surgical margin sampling of a lobectomy for intraoperative consultation.

Perform the following:

• Measure the specimen in 3 dimensions.
• Describe pleural surface, including color, and any presence of granularity, adhesions, retraction, or tumor.
• Palpate for any tumors.
• Ink the surgical margin and cut it away just below any sutures or staples. If the margin is substantially stapled (and their removal would be either too tissue-damaging or otherwise inconvenient), ink and use another section of the tissue underneath it for frozen sectioning.

• In intraoperative consultations use a section that is presumably closest to a tumor for frozen sectioning, with the tissue enface, for radicality. This is generally enough to report intraoperatively to the surgeon, unless otherwise requested.

• ((Sample the entire surgical margin for standard processing.))
• Cut open the bronchi of the specimen with a pair of scissors, as far as they can fit within the lumina. Attempt to cut so as to be able to take a section that includes both any tumor and nearest bronchus. Describe the cut surface, including color and consistency, and any focal lesions.
• Turn the specimen to the side with least cuts so far, and serially section it.
• For any found lung tumor:

• Measure tumor size as a maximum diameter (or 3 dimensions)
• Determine location: Which lobe if applicable, and if it is peripheral, central or hilar.
• Margin length to pleura and hilum/surgical margin.
• Any involvement of major bronchi or blood vessels.

• Describe any lymph nodes, including location, range of sizes and appearance of cut surface.

Gross report

((A. Labeled - ___. The specimen is received fresh for intraoperative consultation and consists of)) a wedge-shaped piece of lung which measures __ cm and has a staple line along one aspect measuring __ cm in length. The stapled surgical margin is inked black. The visceral pleura is mottled tan-pink and slightly puckered in the center. Cut sections show a tan, soft, tumor measuring __ cm in greatest dimension, located __ cm from the visceral pleura and __ cm from the surgical margin. The remaining parenchyma is pink and spongy. (Representative sections are submitted for microscopic examination in __ cassettes.)

• Squamous cell carcinoma involving a subsegmental bronchus with distal chronic obstructive pneumonia. The tumor is seen as a rounded nodule, approximately 2 cm in diameter, proximal to a more irregular focus of chronic obstructive pneumonia with fibrosis.
  Squamous cell carcinoma involving a subsegmental bronchus with distal chronic obstructive pneumonia. The tumor is seen as a rounded nodule, approximately 2 cm in diameter, proximal to a more irregular focus of chronic obstructive pneumonia with fibrosis.

Microscopic evaluation

Look mainly for carcinoma. Further information: Lung tumor

Microscopy report

Lung synoptic reports contain information (number and station) on all lymph nodes received per accession. For example, if Parts A-D are mediastinal nodes (8 in total) and Part E is a lobectomy containing 2 additional peribronchial nodes, the synoptic report for Part E should document all 10 nodes, for example:

A. Lymph node, station 1:
Negative for carcinoma. (0/1, 2 etc)

B. Lymph node, station 2:
Negative for carcinoma. (0/1, 2 etc)

C. Lobectomy, RLL: Adenocarcinoma

Size:

Histologic type

Margins

  See also: General notes on reporting

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