Patient Question: Disease:How to treat early lung adenocarcinoma after surgery Description:Because of multiple ground glass nodules in both lungs, we could only address the largest nodule on the left side first. The surgical records and gross pathological findings are reported as follows.
Surgical records:On intraoperative exploration, there were no obvious adhesions in the pleura, no obvious pleural fluid, no obvious nodules on the lung surface, and incomplete oblique fissure differentiation. The exact lesion was not reached in the hand. The final decision was made to directly resect the upper lobe of the left lung. After careful search, a mass was found in the posterior segment of the left upper lobe of the lung, near the root of the upper lobe of the lung, with a small parenchymal sector, about 0,5 CM. flattened. The material was sent for intraoperative frozen pathology and reported as (left upper lobe lung mass) alveolar epithelial heterogeneous hyperplasia with cancerous tendency, to be determined by paraffin and immunohistochemistry. Gross pathology.
What is seen by the naked eye: left upper lobe of the lung (with dissected mass), about 13*12*4 cm, the lesion has been removed by frozen nucleus, 2 pieces of lung tissue were taken at the incision. One piece of bronchial dissection was taken. Multiple groups of lymph nodes (9) L5 bean grain large piece taken in full. l7 bean grain large to peanut rice large piece taken in full. l8 bean grain large piece taken in full. l9 bean grain large piece taken in full. l10 bean grain large and bean grain large piece taken in full. l11 bean grain large and peanut rice large piece taken in full. l12 bean grain large piece taken in full. l13 bean grain large and bean grain large piece taken in full. l14 bean grain large piece taken in full. l15 bean grain large piece taken in full. l16 bean grain large piece taken in full. l17 bean grain large piece taken in full. l18 bean grain large piece taken in full.
Microscopic findings: A. The cancer cells were growing along the alveolar wall with disproportionate nuclear plasma ratio and large deep stained nuclei.
B. Lung tissue C. Tracheal wall tissue with heavy heterogeneous hyperplasia on local alveoli L. Lymph node lymphoid tissue hyperplasia Immunohistochemistry.
A:CK5/6(-) CK7(+) CD56(-) TTF-1(+) P63(-) EGFR(+) synaptophysin(-) D2-40(-) CD34(-) Diagnostic opinion.
A. (Left upper lobe lung mass) Adenocarcinoma. Lepidic growth pattern is predominant. EGFR,K-ras and ALK gene mutation testing is recommended to guide treatment.
B. Lung tissue C. Tracheal wall tissue, local alveolar hyperplasia with heavy heterogeneity. Lymph node lymphatic tissue hyperplasia Hope to provide help:I hope Professor Gu can give advice on how to follow up the treatment? Because the surgeon said it is carcinoma in situ. There is no need for chemotherapy. Close observation of the right node is sufficient. What do you suggest? Thanks a lot.
Hospital Department Attended:The First Hospital of China Medical University Thoracic Surgery Treatment Status:Time:2014-05-042014-05-18 Hospital Department:The First Hospital of China Medical University Thoracic Surgery Treatment Process:Lung adenocarcinoma surgery Doctor requested regular follow-up Medication Status:Drug Name:Schweitzer Umethazine Instructions for taking:One tablet per day Patient Question.
Thank you, Professor Gu, for your reply. Does immunotherapy mean genetic testing first and then targeted therapy?
I regret that I didn’t go to you for the surgery, but I heard that you can locate the needle. My mom was diagnosed with multiple ground glass nodules in both lungs, but the left upper lobe is the largest with 1 or 2 cm. the right lung has multiple small ground glass nodules. The right lung has multiple small ground glass nodules, so the left lung had to be addressed first. The right side was said to be under observation at that time. Unexpectedly, during the surgery, the surgeon could not feel the lesion at all and had to decide to remove the upper lobe of the left lung directly. After careful searching, a mass was found in the posterior segment of the upper lobe of the left lung, near the root of the upper lobe, with a small parenchymal sector, about 0,5 CM.
Now the most confusing thing was the nodule in the right side of the lung, which was multiple. I am sending you the images of the 12 ground glass nodules (the largest is 0.9*0.6) found by the imaging doctor. Can you give me a diagnosis of benign or malignant? Is it possible to continue the surgery with so many nodules? Some doctors in my area said that it is not possible to do it. They want to do targeted therapy directly. I beg for your help.
Pulmonary plain 3D-CT: what is seen on examination (2014, 6, 19) The scan shows thoracic symmetry, bronchial truncation in the upper lobe of the left lung with visible metal anastomosis shadow, a ground glass nodule visible in the apical segment (thin IM88) posterior segment (thin IM97) and middle lobe (161) dorsal segment (thin IM132) of the right lower lobe, and an outer basal segment of the right lower lobe (thin IM235), a small nodule was seen in the upper lobe of the right lung, a restricted area of lung tissue translucency enhancement was seen in the right lung, a speckled calcification was seen in the right lung, and a restricted stripe was seen in the lower lobe of the left lung; strips of liquid density shadow was seen in the left thorax. The lung hilum was not large bilaterally, and the mediastinum was centered, and no enlarged lymph nodes were seen within it. The heart was normal in size, and a curved liquid density shadow was seen in the pericardium, and no abnormalities were seen in the soft tissues of the chest wall. A small lamellar hypodense shadow was seen in the upper right anterior lobe of the liver.
Conclusion of examination.
Postoperative changes in the upper lobe of the left lung and left pleural effusion.
Multiple nodules in the right lung are closely followed and observed.
Old lesions in both lungs. Limited emphysema in the right lung.
Small amount of pericardial effusion.
Hypodense foci in the upper right anterior lobe of the liver, please combine with clinical.
Examining Hospital: The First Hospital of China Medical University The First Hospital of Dalian Medical University Cardiothoracic Surgery Department Chun-dong Gu replied.
Immunotherapy is not targeted therapy! Also, have you done the gene mutation test for EGFR?
Patient question.
1. We did not do the genetic testing. If immunotherapy is also required to do this test?
2. Professor Gu, please help me to see the pictures of the ground glass nodules in the right lung. Are these nodules (the largest is 0.9*0.6) malignant? Is it possible to do another surgery? The patient had surgery on May 8 this year to remove the upper lobe of the left lung, how long will it take to operate again on the right side?
3. If surgery is not possible, do you think it is better to use targeted therapy or immunotherapy? Can it be cured? After the left lobe of the lung was removed, the surgeon said it was cured and no chemotherapy was needed. No drugs were prescribed.
Reply from Chun-dong Gu, Department of Cardiothoracic Surgery, The First Affiliated Hospital of Dalian Medical University.
I commend you for the quality and care with which the medical records were prepared! Your question is very general, to answer you.
1, molecular targeted therapy requires genetic testing, immunotherapy does not. We suggest that you go to the pathology department and use the surgical specimen to do the EGFR gene mutation detection to provide a reference basis for the next step of treatment.
2, there are multiple GGO lesions in the right lung, most of these lesions are inert in general, in the current situation, we suggest you observe temporarily, but pay attention to the changes in the size and density of the lesions, especially the GGO lesion in the right upper lung near the lung margin.
3, Do not dwell on the surgery of the left lung, I also see a small GGO in the left upper lung in addition to the main lesion.
4, In the current condition, chemotherapy is not recommended.