240 Chapter 16 The second patient was diagnosed in San Raffaele Scientific Institute. After initial wedge resection of the left lower lobe, that did not reveal a gross tumor, lobectomy of the left lower lobe was performed. Gross examination showed a diffuse thickening of the pulmonary parenchyma, brownish or greyish in color, in which there was a nodular lesion of 1.1 cm palpable. Initial histologic slides (28 blocks) showed a lepidic growth on thin alveolar walls without signs of invasion, compatible with AIS (Noguchi type A10) in most of the blocks and on the palpable lesion a focus with increased elastin (Noguchi type B10). Subsequently the remaining of the lobe was extensively sampled with in total 130 tissue blocks. In 111 blocks (85%) AIS Noguchi type A was present. In three sections small foci of slight multilayering fitting with extensive epithelial proliferation317. Beside a small pneumocytoma in one slide, the sections also showed signs of emphysema, pigment depositions, focal smooth muscle hyperplasia, intimal fibrosis in pulmonary artery, minor focal lymphocytic infiltrate, focal bleeding and clamping edema. From the pT3N0 cohort of 683 patients342, 112 (16%) patients with an adenocarcinoma larger than 7 cm were selected. After analyzing the pathology reports, and reviewing the pathology slides, 87 cases were definitely invasive. Another 18 cases were excluded because of mucinous subtype, of which 10 cases had clearly invasive components. The remaining 7 cases were classified on H&E as possibly non-invasive non-mucinous adenocarcinoma and selected for this further analysis. Patient- and tumor characteristics of selected cases and their matched controls are shown in table 1. Table 1. Characteristics of the 2 completely histologically examined cases* as well as the 7 possible non-invasive cases from the T3N0 cohort and their invasive controls Case # Gender Age Hospital Resected lobe / diameter tumor slide # # tumor blocks Selection H&E staining only Diagnosis after revision on H&E, CK7, elastin staining 1* m 75 G LLL /16 cm 312 293 Possible in-situ In situ 2* f 77 H LUL / 16 cm 159 130 Possible in situ In situ 3 f 72 A LUL /whole lobe 8 6 Possible in-situ In situ 4 m 68 C RLL/20 cm 7 5 Possible in-situ In situ 5 m 65 E LLL /9.0 cm Possible in-situ In situ 6 m 76 A RUL/RML / 9.5 cm 10 7 Possible in-situ Papillary carcinoma 7 f 70 B LUL /12.0 cm 10 5 Possible in-situ Invasive, lepidic predominant + acinar 8 f 63 D RML /7.1 cm 9 5 Possible in-situ Papillary carcinoma 9 m 57 F LUL /11.0 cm 8 5 Possible in-situ Micropapillary 10 m 76 A Pneumonectomy Left /9.0 cm 12 6 Invasive control Invasive, solid 11 m 80 B LLL /8.0 cm 7 4 Invasive control Invasive, acinar 12 m 60 C Pneumonectomy Right/8.5 cm 8 4 Invasive control Invasive, solid
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