The correct procedures for handling resected tissue and preparing gross specimens for histologic evaluation of thoracic tumors are of great importance not only for diagnostic purposes but also for staging of the various neoplasms occurring in the lung and pleura. In every case, therefore, resected specimens must be handled with the utmost care, and the sections submitted for histologic evaluation must be representative of the different areas involved in disease.
The nature of the clinical case often necessitates special considerations in obtaining and preparing surgical specimens. Although the entire gamut of different forms and shapes that may appear in tumors of the lung and pleura is beyond the scope of this discussion, a selected group of cases that may pose problems in macroscopic evaluation are presented in this chapter, to provide some guidance for proper sectioning. The following cases are considered:
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Extrapleural pneumonectomy
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Resections with staple line
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Neoplasms obstructing the airway
EXTRAPLEURAL PNEUMONECTOMY
Extrapleural pneumonectomy has become a commonly used procedure for the surgical treatment of malignant mesothelioma. Resected specimens usually comprise the following anatomic structures: (1) lung, (2) visceral pleura, (3) parietal pleura, (4) diaphragm, and (5) pericardium. Each of these structures must be properly identified and sampled, and it also is imperative to obtain appropriate lymph nodes to complete the required staging of these tumors. Figures 15-1 to 15-8 illustrate many of the considerations and techniques involved.
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