136 Chapter 11 surgery (see below, ‘displacement during surgery handling’), v) iatrogenic collapse206 , the pathologist’s vi) hand and vii) knife120 (see below ‘pathology aspects’). Figure 3. A: Cartoon with cross section of the right lung. Note that under the pleural surface is a network of lymph vessels (green) present. Lymph vessel also accompany the pulmonary artery towards the centre of the lobe. B: Cartoon of clamp compressing during the clamping. The lymph in between the clamps will be pressed to both sides, causing dilatation and extravasation of lymph in surrounding tissue (interstitium and alveoli). C: Histological example of clamping artifact in an open lung biopsy. The blue oval denotes the septal area with the stretched lymph vessels and interstitial lymph. On the upper left side iatrogenic collapsed alveoli and interstitial inflammatory cells are visible. The asterisks denote the dilated alveolar spaces, probably due to the clamping. Note that a difference between empty space filled with lymph or air cannot be made in histological slides. The similarity in overdistension between the alveoli and adjacent septum strongly supports the interpretation of intra-alveolar lymph. The yellow circle denotes the normal size of the lymph vessels. Of note, the area covered by the yellow circle approximates the size of a cluster of around 50-100 tumour cells.
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