Lungs: General Comments

Lungs

General Comments

Pathologists are routinely called on to process a diverse spectrum of lung specimens, ranging in size and complexity from minute biopsies to pneumonectomies. Despite this diversity, these specimens can be systematically approached by keeping in mind the five basic components of the lung specimen: the airways, the lung paren-chyma, the pleura, the vessels, and the lymph nodes.

Before beginning the dissection, be sure to ask yourself two questions: First, does the pathology need to be revealed immediately? For example, if an infection is suspected, cultures may have to be taken from fresh tissues in a sterile fashion. Likewise, in the case of a suspected neoplasm, frozen section evaluation may be required to es-tablish a diagnosis or to assess resection mar-gins, and sampling of fresh tissue may be needed for ancillary diagnostic studies, such as electron microscopy. Next, ask which method of dissec-tion will most effectively reveal the pathologic process and best demonstrate the relationship of the disease to the surrounding lung and pleura. There is more than one way to dissect a lung, and the method of sectioning is often dictated by the type of specimen, the suspected nature of the pathologic process, and the size and location of the pathologic process. Clearly, the more clinical information that is available, including radio-graphic findings, the more effectively these ques-tions can be answered. Finally, keep in mind that a wealth of information can be obtained simply by palpating the intact specimen. Even small focal lesions can be appreciated by palpation, and this fast and easy method of examination should become a routine part of the initial evaluation of any lung resection.