Oncology (General Cancer)/Left lung resection pathology report
I had a PetScan in December 2013 that showed increased size and changes of a lung nodule with SUV of 15.7. Followed up with vats procedure to have a left lung resection. Doctors are saying it was only inflammation of unknown etiology. Below is my final pathology report. Please give me your opinion. I am concerned because in one part of path report it states some cells stained positive for CD56, Synaptophysin and Chromogranin.
Final Pathologic Diagnosis
A. LUNG, LEFT UPPER LOBE, WEDGE RESECTION
--Caseating Granulomatous Inflammation, Etiology Unknown (See Comment #1)
--Carcinoid Tumorlet, 0.2cm in Greatest Dimension, Incidental finding (See comment #2)
--Granulomatous Inflammation Focally Extends to the Staple-Line Margin (A5)
--Special Stains for Acid Fast Bacteria and Fungus are Negative
1. Special stains are negative for causative organisms. The differential diagnosis would include infectious etiologies, including mycobacterial, viral or fungal, and less likely sarcoidosis. Clinical correlation is recommended.
2. Reactive neuroendocrine cell hyperplasia is often seen in association with underlying lung conditions, such as fibrosis, chronic or granulomatous inflammation and others. The small size, lack of mitotic activity, association with granulomatous inflammation and low grade cytologic features suggest a benign reactive etiology of the carcinoid tumorlet. Though a reactive, hyperplastic process is favored, clinical follow-up is recommended due to the presence of focal cartilage invasion, an uncommon finding in reactive processes.
A. Left Upper Lobe Wedge Biopsy
A. Sections of the nodule show well-formed granulomas lined by plump histiocytes, lymphocytes and numerous multinucleated giant cells with central caseating necrosis. Focal giant cells show asteroid-body-like inclusion.
Special stains for Acid Fast Bacteria (AFB) and GMS for fungus are negative. Centrally with the nodule, a small peribronchial lesion is present, showing nests of small cells with round to oval nuclei, salt and pepper chromatin and small amounts of amphophilic cytoplasm. No mitotic figures are identified. A focal nest of the lesion is seen infiltrating into the edge of adjacent cartilage. Immunohistochemical stains reveal the proliferation to be diffusely positive for CD56, Synaptophysin and Chromogranin, indicating neuroendocrine origin. The cells are negative for CK7, p63, Napsin A, TTF-1, S-100 and CK5/6. The granulomatous inflammation extends to within 3 cell layers of the inked pleural surface, causing focal puckering as well as focally to the green-inked margin underlying the staple line. A small unremarkable subpleural lymph node is present, lying immediately adjacent to, but not involved by the granumlomatous nodule.
Basically, what you have is a reactive process, and there doesn't seem to be any evidence of malignancy. I don't know what you are reacting to; caseating granulomas are usually caused by infections, allergic problems, or foreign body reactions. In your case, the pathologist couldn't find evidence to support any of these things, although "sarcoid" is a good bet. basically, though, the lack of mitotic activity in the carcinoid-like cells suggest a benign process. Hope this helps.