154 Chapter 12 mention the routine handling procedure for pulmonary resection specimens (including wedge resections). Overall, in contrast to biological collapse involving a central area of the tumour, the structural change of iatrogenic collapse is most prominent in lightmicroscopic evaluation at the level of the alveolar walls. Figure 2. Example of tumor atelectasis*) In A and B sequential slices of a lobectomy specimen after 24+ hours buffered formaldehyde fixation. The orientation of 16 slices was as described before [33]. The fibrous adhesion on the left(upper) side was during gross examination colored with red ink. The slices were numbered from crania(a)l (1) to cauda(a)l (16) direction. The slice orientation is shown in the right upper corner (Media(a)l = m; Ventra(a)l = v; Dorsa(a)l = D; Latera(a) l = L). The letters D-G adjacent to the slices denote location of sample taken for initial microscopic analysis. Note i) that peripheral areas were fixed (grey) and some central areas are unfixed (red). In addition, ii) the slices do not show a solid lesion (which is associated with a firm consistency). iii) The bronchial and vascular resection margins as wells as lymph nodes were sampled before cutting the 16 slices. In C and D microscopic images of haematoxylin-eosin stained section (sampled from slice 12, location N) showing overview (C) and detail (D) with monolayer of tumor cells on the alveolar wall (compatible with AIS). Note i) the variability in the amount of ‘air’ space: more collapse is less ‘air’; and ii) in these images there are no signs of invasion. *) Shown upon request of a few reviewers279. In some cases of AIS and LPA, the elastic fibers are increased in number and lie in sheets261, which, light-microscopically, are characterised by continuous elastic fibers. Noguchi type B is a clear example10. This increase in the number of elastic fibers emphasises the pre-existing lepidic (alveolar) structure (Figure 1D). Eto et al.273
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