Thoracic pathology includes a variety of specimen types ranging from small biopsies to large resections. These biopsies may be from the lung, the mediastinum, or the pleura. The approach to each of these specimen types and sites is somewhat unique; knowledge of these subtleties is part of the “secret sauce” that enables an accurate diagnosis in thoracic pathology. Each site and specimen type is associated with important principles, terminologies, and teaching points that may be relevant to the diagnosis depending on the scenario. For example, the work-up for lung cancer in a small biopsy should focus on preserving tissue to ensure that there is adequate material for molecular testing, whereas tissue preservation is not typically a concern in a larger resection specimen. Another example is frozen section specimens. In these samples, the diagnostic question is often quite different from those that must be addressed on permanent sections. In this book, we have approached the diagnosis from the point of view of the pathologist looking at a specific specimen type. In keeping with this principle, the chapters are organized by specimen type rather than by disease entity. This approach allows us to provide the reader with practical insights and advice for the work-up and diagnosis of various specimen types. As a consequence, some diagnostic entities appear more than once in the book. We minimize overlap and focus on relevant details that pertain to making and reporting specific diagnoses in the context of a specimen type.
This book is divided into 6 chapters that cover the field of thoracic pathology. In Chapter 1, we discuss small biopsy specimens, focusing on how to diagnose and report cases in which lesional tissue may be minimal, and tissue preservation is an important consideration. In Chapter 2, we provide an approach to reporting thoracic frozen sections. In Chapter 3, we focus on resection specimens and discuss important considerations when reporting lung cancer and other mass-forming lesions. In Chapter 4, we provide a practical approach to non-neoplastic lung diseases that are typically diagnosed in transbronchial or surgical lung biopsies or are seen in the background of resection specimens. In Chapter 5, we discuss the approach to pleural specimens, including mesothelioma and its mimics. Finally, in Chapter 6, we provide tips on how to tackle the immense variety of lesions that pathologists may encounter in mediastinal specimens.
We keep things simple, describe tips that we use in our own practices to diagnose cases in real life, explain terminology in simple language, and avoid an emphasis on esoteric “zebras.” In the few areas where our approach differs, we have attempted to state those differences. In keeping with the spirit of the “Survival Guide” series, the focus of this book is to help you survive!
We hope that you find this approach to thoracic pathology to be useful in your own practice and education.