Erik Thunnissen, Hans J L G Blaauwgeers, Erienne M V de Cuba, Ching Yong Yick, Douglas B Flieder1,2,3. 1. From the Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands (Drs Thunnissen, de Cuba, and Yick); 2. the Department of Pathology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (Dr Blaauwgeers); 3. and the Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (Dr Flieder).
Abstract
CONTEXT: Surgical and pathologic handling of lung physically affects lung tissue. This leads to artifacts that alter the morphologic appearance of pulmonary parenchyma. OBJECTIVE: To describe and illustrate mechanisms of ex vivo artifacts that may lead to diagnostic pitfalls. DESIGN: In this study 4 mechanisms of ex vivo artifacts and corresponding diagnostic pitfalls are described and illustrated. RESULTS: The 4 patterns of artifacts are: (1) surgical collapse, due to the removal of air and blood from pulmonary resections; (2) ex vivo contraction of bronchial and bronchiolar smooth muscle; (3) clamping edema of open lung biopsies; and (4) spreading of tissue fragments and individual cells through a knife surface. Morphologic pitfalls include diagnostic patterns of adenocarcinoma, asthma, constrictive bronchiolitis, and lymphedema. CONCLUSION: Four patterns of pulmonary ex vivo artifacts are important to recognize in order to avoid morphologic misinterpretations.
CONTEXT: Surgical and pathologic handling of lung physically affects lung tissue. This leads to artifacts that alter the morphologic appearance of pulmonary parenchyma. OBJECTIVE: To describe and illustrate mechanisms of ex vivo artifacts that may lead to diagnostic pitfalls. DESIGN: In this study 4 mechanisms of ex vivo artifacts and corresponding diagnostic pitfalls are described and illustrated. RESULTS: The 4 patterns of artifacts are: (1) surgical collapse, due to the removal of air and blood from pulmonary resections; (2) ex vivo contraction of bronchial and bronchiolar smooth muscle; (3) clamping edema of open lung biopsies; and (4) spreading of tissue fragments and individual cells through a knife surface. Morphologic pitfalls include diagnostic patterns of adenocarcinoma, asthma, constrictive bronchiolitis, and lymphedema. CONCLUSION: Four patterns of pulmonary ex vivo artifacts are important to recognize in order to avoid morphologic misinterpretations.
Authors: Julian A Villalba; Angela R Shih; Treah May S Sayo; Keiko Kunitoki; Yin P Hung; Amy Ly; Marina Kem; Lida P Hariri; Ashok Muniappan; Henning A Gaissert; Yolonda L Colson; Michael D Lanuti; Mari Mino-Kenudson Journal: J Thorac Oncol Date: 2020-12-24 Impact factor: 15.609