title: Ex Vivo Artifacts and Histopathologic Pitfalls in the Lung.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Four patterns of pulmonary ex vivo artifacts are important to recognize in order to avoid morphologic misinterpretations.
authors.forename: Erik
authors.initials: E
authors.lastname: Thunnissen
authors.forename: Hans J L G
authors.initials: HJ
authors.lastname: Blaauwgeers
authors.forename: Erienne M V
authors.initials: EM
authors.lastname: de Cuba
authors.forename: Ching Yong
authors.initials: CY
authors.lastname: Yick
authors.affiliation: From the Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands (Drs Thunnissen, de Cuba, and Yick);|the Department of Pathology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (Dr Blaauwgeers);|and the Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (Dr Flieder).
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Flieder
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D016477:Artifacts; D001249:Asthma / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy / Q000009:adverse effects; D055745:Bronchioles / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D001989:Bronchiolitis Obliterans / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000145:classification / Q000517:prevention & control*; D006801:Humans; D008168:Lung / Q000098:blood supply / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D008171:Lung Diseases / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D008175:Lung Neoplasms / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D008209:Lymphedema / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D009119:Muscle Contraction; D009130:Muscle, Smooth / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D009366:Neoplasm Seeding; D020545:Respiratory Mucosa / Q000098:blood supply / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D013048:Specimen Handling / Q000009:adverse effects
chemical_list: D015415:Biomarkers