73 Artifacts and histologic pitfalls in the lung Figure 3. Images supporting the hypothesis of the contraction artifact (continued) A, Uterus resection specimen before and after sagittal cut till cavum uteri. Note the difference in shape after 1 minute and 120 minutes at room temperature, owing to ex vivo smooth muscle contraction. B and C, Cross-section through bronchiole of collapsed lung resected for lung cancer, showing ex vivo smooth muscle contraction with folding of respiratory epithelium and underlying basement membrane and focal ex vivo aggregation of the elastin. Note that these histologic components are physiologic, except for occasional lymphocytes and surrounding edema. The pathologic diagnosis for this image may be mild chronic bronchiolitis. D and E, Images from 1 case with the same magnification of bronchioles with in vivo existing intraluminal mucus plug prohibiting the ex vivo smooth muscle contraction. Note in E also the contracted bronchiole (on the left side lumen without mucus). F, Image of another case where one part of the lobe is perfusion fixed; the nonperfused part had a similar appearance as the bronchiole left side in (E). Note that the smooth muscle contraction was reversible at the moment of perfusion fixation. G, Image from yet another case where artery and bronchiole were captured in 1 slide. Notice the difference in diameter. The intimal fibrosis prevents contraction of smooth muscle in the pulmonary artery, while the ex vivo contraction of the bronchiole remains unimpeded. Image courtesy of Anja C. Roden, MD, Mayo Clinic, Rochester, Minnesota (original magnification x0.5 [A, see ruler in picture]; hematoxylin-eosin, original magnifications x10 [B], x5 [D and E], x2.5 [F], and x10 [G]; Elastica van Gieson, original magnification x10 [C]). 5
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