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What Do The VATS Procedure Findings Suggestive Of?
Question: I had a recent VATS procedure that resulted in 3 findings: pulmonary hamartoma (good), uninvolved lung with mild emphysema (not sure why as I've never smoked), and atypical adenomatous hyperplasia ( most concerning). The lobe resection was 6x3x2 cm with 8 cm in length stapled resection margin inked. I am unclear whether the AAH is contained in that margin and also if it is a definite precursor to adenocarcinoma which so much of the literature states. I would like to understand this report more fully so that I know how to proceed for further follow-up. Should I be flowed by a pulmonologist as well as the surgeon and what other tests/procedures are indicated?
Brief Answer:
Get done k ras and p53 protien expression.
Detailed Answer:
Hello dear, thanks for your question on HCM.
I can understand your situation and problem.
Yes, you are right about AAH (Atypical Adenomatous Hyperplasia). It is known precursor of adenocarcinoma of lung. In your report, the most worrisome thing is presence of AAH. It can turn into adenocarcinoma and can recur.
The possibility of malignant transformation is more if
1.The Grade of AAH is high
2. Expression of p53 and k ras are high.
So you need to get done p53 and k ras level.
Also let me the grade of the AAH. It must be written in your histopathology report.
You need to consult oncologist and pulmonologist for this.
And on follow up you need to get done repeat CT thorax with contrast to know if any new growth is there or not.
Hope I have solved your query.
I will be happy to help you further.
Wish you good health.
Thanks.
Get done k ras and p53 protien expression.
Detailed Answer:
Hello dear, thanks for your question on HCM.
I can understand your situation and problem.
Yes, you are right about AAH (Atypical Adenomatous Hyperplasia). It is known precursor of adenocarcinoma of lung. In your report, the most worrisome thing is presence of AAH. It can turn into adenocarcinoma and can recur.
The possibility of malignant transformation is more if
1.The Grade of AAH is high
2. Expression of p53 and k ras are high.
So you need to get done p53 and k ras level.
Also let me the grade of the AAH. It must be written in your histopathology report.
You need to consult oncologist and pulmonologist for this.
And on follow up you need to get done repeat CT thorax with contrast to know if any new growth is there or not.
Hope I have solved your query.
I will be happy to help you further.
Wish you good health.
Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your clarification. I have reviewed the report in detail but find no description of the grade of the AAH. I have asked for further information and am still waiting.
I also have no knowledge of Kras and p53 protein expression workups. Can these be done after the fact from the specimen?
Because your answers are time limited here, could you provide me with some descriptive parameters of what I would be looking for determine was high grade AAH and high Kras and p53 expression would be.
Thank you
I also have no knowledge of Kras and p53 protein expression workups. Can these be done after the fact from the specimen?
Because your answers are time limited here, could you provide me with some descriptive parameters of what I would be looking for determine was high grade AAH and high Kras and p53 expression would be.
Thank you
Brief Answer:
You need to get done Immunohistochemisry and PCR.
Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
I can understand your concern.
You can ask me directly on bit.ly/askdrkaushalbhavsar even after completion of time period. So no need to worry for this.
You need to get done Immunohistochemisry for p53 overexpession. It is newer histological technique in which specific stains are used to detect p53 expression in specimen.
For k ras, we need to look for mutations. So polymerase chain reaction (PCR) should be done from given specimen.
About severity of grading, this is purely histological criteria. It is actually based on appearance and characteristics of atypical cells in given specimen.
Following things to be seen in specimen to decide grading.
1. Size of the cell
2. Borders and margin of the cell
3. Nucleus and its contents.
4. Cytoplasm and its contents.
5. Nucleocytoplasmic ratio
6. Invading vessels or lymphatic or not
May I know few things.
1. Where are you working?
2. What were your symptoms and CT report that ended for VATS surgery?
3. Have you consulted oncologist?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wish you good health.
Thanks.
You need to get done Immunohistochemisry and PCR.
Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
I can understand your concern.
You can ask me directly on bit.ly/askdrkaushalbhavsar even after completion of time period. So no need to worry for this.
You need to get done Immunohistochemisry for p53 overexpession. It is newer histological technique in which specific stains are used to detect p53 expression in specimen.
For k ras, we need to look for mutations. So polymerase chain reaction (PCR) should be done from given specimen.
About severity of grading, this is purely histological criteria. It is actually based on appearance and characteristics of atypical cells in given specimen.
Following things to be seen in specimen to decide grading.
1. Size of the cell
2. Borders and margin of the cell
3. Nucleus and its contents.
4. Cytoplasm and its contents.
5. Nucleocytoplasmic ratio
6. Invading vessels or lymphatic or not
May I know few things.
1. Where are you working?
2. What were your symptoms and CT report that ended for VATS surgery?
3. Have you consulted oncologist?
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further.
Wish you good health.
Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you once again. To answer your questions:
1. I am a high school guidance counselor and have no known exposure to work toxins.
2. I am/was asymptomatic. The hamartoma showed up on a routine chest X-Ray.Due to the incidence of lung cancer in my family (father who was a heavy smoker) it was recommended that it be removed. I take good care of my physical health. Am at a good weight, work out 4-5 times a week (aerobic and strength training), and eat healthily.
3. I do have an oncologist with whom I will be meeting (not the doctor who treated me) which is why I want to be as informed with my questions. The reason I have an oncologist is unrelated to this; I had atypical lobular hyperplasia in breast tissue that was removed 8 years ago (no recurrence) and am on Evista as prophylactic.
I have contacted surgeon for follow-up tests; still waiting.
Questions:
1.The VATS procedure was done on 2/11/15 so I am concerned that tissue may not still be available. Are these specimens saved for any length of time? Can all the immunohistory and PCR be done on the old specimen? If not available, does it require a new biopsy or other procedure (which I hope to avoid)?
2. **Can AAH be present without ever resulting in cancer? **
3. Is periodic chest CT monitoring adequate for follow-up if AAH grade is low?
4. Can AAH and ALH be connected?
5. What should i discuss as priority follow-up questions and requests for further testing with the surgeon and oncologist?
When told of AAH, I was only told that it was unrelated to the hamartoma and that they did not know why it was there. Post-op appointment only recommended chest CT to be done in XXXXXXX I am wondering if this finding should be less worrisome for me than it is and am hoping to have enough information to understand. Thank you once again.
1. I am a high school guidance counselor and have no known exposure to work toxins.
2. I am/was asymptomatic. The hamartoma showed up on a routine chest X-Ray.Due to the incidence of lung cancer in my family (father who was a heavy smoker) it was recommended that it be removed. I take good care of my physical health. Am at a good weight, work out 4-5 times a week (aerobic and strength training), and eat healthily.
3. I do have an oncologist with whom I will be meeting (not the doctor who treated me) which is why I want to be as informed with my questions. The reason I have an oncologist is unrelated to this; I had atypical lobular hyperplasia in breast tissue that was removed 8 years ago (no recurrence) and am on Evista as prophylactic.
I have contacted surgeon for follow-up tests; still waiting.
Questions:
1.The VATS procedure was done on 2/11/15 so I am concerned that tissue may not still be available. Are these specimens saved for any length of time? Can all the immunohistory and PCR be done on the old specimen? If not available, does it require a new biopsy or other procedure (which I hope to avoid)?
2. **Can AAH be present without ever resulting in cancer? **
3. Is periodic chest CT monitoring adequate for follow-up if AAH grade is low?
4. Can AAH and ALH be connected?
5. What should i discuss as priority follow-up questions and requests for further testing with the surgeon and oncologist?
When told of AAH, I was only told that it was unrelated to the hamartoma and that they did not know why it was there. Post-op appointment only recommended chest CT to be done in XXXXXXX I am wondering if this finding should be less worrisome for me than it is and am hoping to have enough information to understand. Thank you once again.
Brief Answer:
Following are your answers.
Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
Answer to your 1st question.
Yes, histopathology samples are preserved for atleast 6 months for medicolegal purpose in XXXXXXX I don't know about your place. But they are preserved for atleast 2-3 months. And Immunohistochemisry (IHC) can be done in 1-2 month old sample if preserved properly. And yes, you need tissue sample again if not preserved.
Answer to your 2nd question.
Yes, AAH can be present without developing adenocarcinoma. If grade is low then chances of adenocarcinoma are also less.
Answer to your 3rd question.
Yes, periodic chest CT are good for follow up in any grade of AAH.
Answer to your 4rth question.
AAH and ALH are not connected or associated with each other.
Answer to your 5th question.
You should discuss about screening with routine tumour markers like LDH, CEA , CA125 etc along with CT thorax on follow up.
And I can understand what patient can feel after receiving such report with positive family history of lung cancer. So no need to worry much, you can definitely ask me to clear your doubts.
I will be happy to help you further.
Wish you good health.
Thanks.
Following are your answers.
Detailed Answer:
Hello dear, thanks for your follow up question on HCM.
Answer to your 1st question.
Yes, histopathology samples are preserved for atleast 6 months for medicolegal purpose in XXXXXXX I don't know about your place. But they are preserved for atleast 2-3 months. And Immunohistochemisry (IHC) can be done in 1-2 month old sample if preserved properly. And yes, you need tissue sample again if not preserved.
Answer to your 2nd question.
Yes, AAH can be present without developing adenocarcinoma. If grade is low then chances of adenocarcinoma are also less.
Answer to your 3rd question.
Yes, periodic chest CT are good for follow up in any grade of AAH.
Answer to your 4rth question.
AAH and ALH are not connected or associated with each other.
Answer to your 5th question.
You should discuss about screening with routine tumour markers like LDH, CEA , CA125 etc along with CT thorax on follow up.
And I can understand what patient can feel after receiving such report with positive family history of lung cancer. So no need to worry much, you can definitely ask me to clear your doubts.
I will be happy to help you further.
Wish you good health.
Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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