title: In compressed lung tissue microscopic sections of adenocarcinoma in situ may mimic papillary adenocarcinoma.
abstract: BACKGROUND
  Surgical removal and pathologic handling of lung tissue has a compressive effect upon its architecture. The effect of surgical atelectasis on morphology has not been examined in depth, especially with respect to lung adenocarcinomas.
  
  
  OBJECTIVE
  To examine the influence of surgical atelectasis on morphologic lepidic growth pattern, mimicking papillary adenocarcinoma pattern.
  
  
  METHODS
  In 2 cases serial sections of resected pulmonary adenocarcinoma were used, as was a 3-dimensional reconstruction. Elastin stains were performed on primary and metastatic adenocarcinomas.
  
  
  RESULTS
  Perfusion fixation of another case showed marked morphologic differences of less compressed peripheral lung tissue, emphasizing the preexisting alveolar structure. An elastic stain may help identify true lesional architecture.
  
  
  CONCLUSIONS
  We demonstrate that microscopic sections of adenocarcinoma in situ in compressed/collapsed tissue may give rise to a pseudopapillary pattern mimicking invasive adenocarcinoma. Accurate appreciation of different tumor architecture in lung adenocarcinoma has important biologic and clinical implications. Pathologists should be aware of the possibility of misclassification of adenocarcinoma pattern due to tissue artifacts caused by lung tissue handling.
authors.affiliation: From the Departments of Pathology (Drs Thunnissen and Beliën), Radiology (Dr Lely), and Surgery (Dr Hartemink), VU University Medical Center, Amsterdam, the Netherlands; the Department of Pathology, Aberdeen Royal Infirmary, Aberdeen University Medical School, Aberdeen, Scotland (Dr Kerr); the Department of Pathology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea (Dr Chung); the Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (Dr Flieder); the Department of Pathology, Institute of Basic Medical Sciences, University of Tsukuba, Tsukuba, Japan (Dr Noguchi); the Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan (Dr Yatabe); the Department of Pathology, University Health Network-Princess Margaret Hospital and University of Toronto, Toronto, Ontario, Canada (Drs Hwang and Tsao); and the Department of Pathology, Symbiant/Medical Center Alkmaar, Alkmaar, the Netherlands (Dr Meijer-Jorna).
authors.forename: Erik
authors.initials: E
authors.lastname: Thunnissen
authors.forename: Jeroen A M
authors.initials: JA
authors.lastname: Beliën
authors.forename: Keith M
authors.initials: KM
authors.lastname: Kerr
authors.forename: Jin-Haeng
authors.initials: JH
authors.lastname: Chung
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Flieder
authors.forename: Masayuki
authors.initials: M
authors.lastname: Noguchi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yatabe
authors.forename: David M
authors.initials: DM
authors.lastname: Hwang
authors.forename: Rutger J
authors.initials: RJ
authors.lastname: Lely
authors.forename: Koen J
authors.initials: KJ
authors.lastname: Hartemink
authors.forename: Lorine B
authors.initials: LB
authors.lastname: Meijer-Jorna
authors.forename: Ming-Sound
authors.initials: MS
authors.lastname: Tsao
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology*; D000231:Adenocarcinoma, Papillary / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology*; D000369:Aged, 80 and over; D016477:Artifacts; D014408:Biomarkers, Tumor / Q000378:metabolism; D003937:Diagnosis, Differential; D004549:Elastin / Q000378:metabolism; D005260:Female; D006651:Histocytochemistry / Q000379:methods*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000378:metabolism; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D013048:Specimen Handling / Q000009:adverse effects; D014057:Tomography, X-Ray Computed
chemical_list: D014408:Biomarkers, Tumor; D004549:Elastin