Here we have a lung lobectomy removed for a biopsy-proven Ad | Figure 1

Here we have a lung lobectomy removed for a biopsy-proven Adenocarcinoma.

This is the most common form of lung cancer and is seen in both smokers and non-smokers.

The first picture shows the medial aspect of the lung, where we can see the grouping of stapled bronchi, arteries, and veins. These all represent a surgical margin and must be assessed microscopically to ensure no tumor cells are present. If there ARE tumor cells at the margin, that means there are likely tumor cells still inside the patient at that site, an obvious problem when addressing reoccurrence.

Second pic is the opposing side, showing a small bulge in the visceral pleura, which I have inked over in blue. Ink is important in helping the pathologist visualize true margins and important diagnostic surfaces (such as the visceral pleura in this case) under the microscope.

Lastly, we have the cut surface of the tumor. Classic appearance of lung adenocarcinoma — yellow-white, firm, and ill-defined. The blue arrow points to the pleural surface and you can see that the mass appears to push on but not actually involve the pleura. The white arrow shows a vessel which looks potentially involved by the tumor.

Since we don’t have invasion of the visceral pleura (at least grossly), the T stage of this tumor will be mostly based on size. At 3.5 cm in greatest dimension, without invasion of the pleura or the main bronchus, this tumor will be staged as a T2a.

Final TNM staging must take into account the status of the region lymph nodes (N) and any scans for distant metastases (M).

Common presentation

Here is a 67-year-old female with biopsy-proven endometrial adenocarcinoma, by far the most common type of uterine cancer.

This cancer develops in the lining of the uterus, the endometrium, and can vary greatly in severity.

The first strange thing I came across was the cut surface of a subserosal (just beneath the serosa, the most outer layer of the uterus) fibroid. This is seen in the first picture and, cut surfaces which usually look whorled and fibrous, are now showing unusual cystic spaces and a central white discoloration.

Moving to the 2nd picture, here we have a cross-section of the uterus showing all ‘layers’ (endometrium, myometrium, and serosa from top to bottom). The tumor began at the black arrow and has not only invaded into the underlying muscle (myometrium), but has actually invaded into and almost completely involves what once was a intra-mural (within the muscle) fibroid (green arrow)!! While this finding doesn’t change the patient’s stage (invasion into the outer half of the myometrium puts her at T1b), this is a unique finding and one that likely forecasts how aggressive this tumor will behave. As expected, the first, strange finding was proven microscopically to be a result of tumor involvement. If this mass were to INVOLVE the serosa itself (via direct extension or local metastasis), it would bump the patients stage to a T3a.

#Pleura and portions of #Lung tissue removed for metastatic #Melanoma.

First pic shows the pleura which is extensively involved by hyperpigmented #Metastases (blue arrows). You can see the stark difference in colors between the dark nodules and the adjacent, uninvolved pleura. 2nd pic just a close-up of one of these areas. 3rd pic shows 2 lung wedge resections which show involvement by metastatic melanoma. The blue arrows point to hyperpigmented nodules that formed on the outside of the lung and the black arrow points to a large (2.5cm) mass within the lung itself which also came back on final pathology as metastatic melanoma.