In Compressed Lung Tissue Microscopic Sections of Adenocarcinoma In Situ May Mimic Papillary Adenocarcinoma

Thunnissen, Erik; Beliën, Jeroen A.M.; Kerr, Keith M.; Chung, Jin-Haeng; Flieder, Douglas B.; Noguchi, Masayuki; Yatabe, Yasushi; Hwang, David; Lely, Rutger J.; Hartemink, Koen J.; Meijer-Jorna, Lorine B.; Tsao, Ming‐Sound

doi:10.5858/arpa.2012-0613-sa

Cited by 18 publications

(21 citation statements)

References 17 publications

(14 reference statements)

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“…First, depending on the amount of diminished air, the collapsed alveoli may show a pseudopapillary pattern (Figure 1, B). If the alveolar walls are covered with tumor cells (ie, lepidic pattern), this may be mistaken for a papillary carcinoma 2,6 ( Figure 1, C and D). However, in 3 dimensions, these ''papillae'' are connected with other fragments above or beneath the plane of section, indicating that the stromal components of these ''pseudopapillae'' are actually the stromal components of preexisting alveolar walls.…”

Section: Mechanisms Of Ex Vivo Artifacts Surgical Collapsementioning

confidence: 99%

“…In our opinion in case of thin ''papillae'' the presence of (frequently discontinuous) elastin fibers is diagnostic of lepidic pattern and supports in the distinction of a papillary carcinoma. 2,7 A second pitfall may occur if preexisting fibrosis is present adjacent to lepidic patterns of adenocarcinoma. This fibrosis may be collagenous or of the infarction type with abundant fibroelastosis.…”

Section: Mechanisms Of Ex Vivo Artifacts Surgical Collapsementioning

confidence: 99%

“…The elastin stain is helpful in this instance, since the identification of elastin in these thin alveolar walls points to the underlying architecture of peripheral lung tissue. 2 Conceptually, in statistical terms the probability of finding a straight papilla in a section of peripheral lung is low, probably as close as the probability of finding a completely straight hair in a histologic section of the skin. The probability of finding 15 papillae in 1 microscopic field of view is much smaller, providing an additional argument that the proliferation represents cross-sections of lepidic pattern as opposed to true papillae.…”

Section: Mechanisms Of Ex Vivo Artifacts Surgical Collapsementioning

confidence: 99%

“…Recently, attention has been focused on dynamic changes in the lung that cause a pitfall in the diagnosis of pulmonary papillary adenocarcinoma. 2 It is certain that when one concentrates on a specific problem, one may not notice other, perhaps peripheral, issues. This ''inattentional blindness'' can occur in the interpretation of lung biopsies, especially when the pathologist focuses only on a particular aspect of a tissue sample and in doing so neglects other findings or even the possibility that the morphology has been altered by artifact(s).…”

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confidence: 99%

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Ex Vivo Artifacts and Histopathologic Pitfalls in the Lung

Thunnissen

Blaauwgeers²,

Cuba³

et al. 2016

Archives of Pathology &Amp; Laboratory Medicine

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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.

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Section: Mechanisms Of Ex Vivo Artifacts Surgical Collapsementioning

confidence: 99%

Section: Mechanisms Of Ex Vivo Artifacts Surgical Collapsementioning

confidence: 99%

Section: Mechanisms Of Ex Vivo Artifacts Surgical Collapsementioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Ex Vivo Artifacts and Histopathologic Pitfalls in the Lung

Thunnissen

Blaauwgeers²,

Cuba³

et al. 2016

Archives of Pathology &Amp; Laboratory Medicine

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“…A large recent study, however, showed papillary predominant cases to behave as badly as solid or micropapillary predominant cases 32. The basis of this difference may be through differences in interpretation between lepidic and papillary disease 35. Studies have shown that inter-observer agreement varies according to the patterns in question but that education can improve outcomes 26 36…”

Section: Surgically Resected Invasive Adenocarcinomamentioning

confidence: 99%

Clinical relevance of the new IASLC/ERS/ATS adenocarcinoma classification

Kerr

2013

J Clin Pathol

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In 2011, recommendations for a multidisciplinary classification of lung adenocarcinoma were published under the auspices of the International Association for the Study of Lung Cancer, the American Thoracic Society and the European Respiratory Society. The review was considered necessary due to emerging data on the radiological features, genetics and therapeutic approaches to lung adenocarcinoma, all underpinned by expanding the knowledge of the pathology of this common tumour. The existing WHO classification of 2004 was not really fit for this multidisciplinary focus on the disease. This review describes the recommendations made on the reporting of surgically resected lung cancers according to their predominant pattern, and argues the case for replacing the term bronchioloalveolar carcinoma (WHO 1999 and 2004 definition) with adenocarcinoma in situ and for the introduction of minimally invasive adenocarcinoma. There is also a discussion of diagnosis of non-small-cell lung carcinomas in the small biopsy or cytology setting, a practice that was inadequately addressed in WHO 2004, yet this is much more relevant to most pathologists' daily practice because 85% or so of adenocarcinomas are never resected. Predictive immunohistochemistry, used correctly, can reduce non-specific diagnosis to less than 10% of the cases. Finally, there is an overview of the emerging data on therapeutically relevant lung adenocarcinoma genetics, considering targetable mutations that are now the focus of much activity. The clinical relevance of these changes is discussed.

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Compact portable multiphoton microscopy reveals histopathological hallmarks of unprocessed lung tumor tissue in real time

Huizen

Radonic²,

Mourik

et al. 2020

Transl Biophotonics

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During lung cancer operations a rapid and reliable assessment of tumor tissue can reduce operation time and potentially improve patient outcomes. We show that third harmonic generation (THG), second harmonic generation (SHG) and two-photon excited autofluorescence (2PEF) microscopy reveals relevant, histopathological information within seconds in fresh unprocessed human lung samples. We used a compact, portable microscope and recorded images within 1 to 3 seconds using a power of 5 mW. The generated THG/SHG/2PEF images of tumorous and nontumorous tissues are compared with the corresponding standard histology images, to identify alveolar structures and histopathological hallmarks. Cellular structures (tumor cells, macrophages and lymphocytes) (THG), collagen (SHG) and elastin (2PEF) are differentiated and allowed for rapid identification of carcinoid with solid growth pattern, minimally enlarged monomorphic cell nuclei with salt-and-pepper chromatin pattern, and adenocarcinoma with lipidic

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In Compressed Lung Tissue Microscopic Sections of Adenocarcinoma In Situ May Mimic Papillary Adenocarcinoma

Cited by 18 publications

References 17 publications

Ex Vivo Artifacts and Histopathologic Pitfalls in the Lung

Ex Vivo Artifacts and Histopathologic Pitfalls in the Lung

Clinical relevance of the new IASLC/ERS/ATS adenocarcinoma classification

Compact portable multiphoton microscopy reveals histopathological hallmarks of unprocessed lung tumor tissue in real time

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