title: Pathological findings in spontaneous pneumothorax specimens: does the incidence of unexpected clinically significant findings justify routine histological examination?
abstract: OBJECTIVE
  The utility of routine histological examination of clinically primary spontaneous pneumothorax (SPTX) specimens has been questioned. In this retrospective study, we aimed to assess the clinical significance of unexpected SPTX histopathological findings, to determine whether such findings justify routine histological examination of SPTX specimens.
  
  
  RESULTS
  Records and slides from all SPTX resections at our institution from 2002-2012 were reviewed. Clinically significant unexpected histological findings were identified in 8.3% of 72 patients, including: one patient with lung cancer, one with endometriosis, one with Birt-Hogg-Dubé (BHD) syndrome, and three with 'bong lung'. Detection of BHD syndrome has the potential to avert advanced renal carcinoma by identifying individuals who should undergo periodic abdominal CT screening. The cost of treating a case of advanced renal carcinoma far exceeds that of histologically examining all SPTX specimens received in a 10-year period at our institution.
  
  
  CONCLUSIONS
  Gross examination alone is an inadequate evaluation of SPTX specimens. This is the first study to demonstrate that routine histological examination of SPTX specimens is justified, in that it discloses unexpected findings that are clinically significant and impact on patient management.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Vermont/Fletcher Allen Health Care, Burlington, VT, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Sauter
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Butnor
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008168:Lung / Q000473:pathology*; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010994:Pleura / Q000473:pathology*; D011030:Pneumothorax / Q000473:pathology*; D012189:Retrospective Studies; D055815:Young Adult
keywords: lung; pleura; primary spontaneous pneumothorax; unexpected pathological findings