Introduction. Diffuse alveolar damage (DAD) is a morphological prototype of acute interstitial pneumonia. Hospital autopsies or open-lung biopsies are used to monitor common alveolar damage and hyaline membrane (HM) development histopathologically. The aim of this study was to detect histopathological profiles and frequency of DAD and HM in adult forensic autopsies. Materials and Methods. In total, 6813 reports with histopathological samples in 12,504 cases on which an autopsy was performed between 2006 and 2008 were investigated. Sixty-six individuals >18 years of age who were diagnosed with DAD were included. Hematoxylin- and eosin-stained lung preparations were reexamined in line with the 2002 American Thoracic Society/European Respiratory Society idiopathic interstitial pneumonia consensus criteria. Results. Histopathological examination revealed that 50 cases (75.7%) were in the exudative phase and 16 (24.2%) were in the proliferative phase. Only the rate of alveolar exudate/oedema in exudative phase cases (P = 0.003); those of alveolar histiocytic desquamation (P = 0.037), alveolar fibrosis (P = 0.017), chronic inflammation (P = 0.02), and alveolar fibrin (P = 0.001) in proliferative cases were significantly higher. The presence of alveolar fibrin was the only independent variable in favour of proliferative cases (P = 0.016). Conclusion. The detection of all DAD morphological criteria with the same intensity is not always possible in each case. Forensic autopsies may provide a favourable means for expanding our knowledge about acute lung damage, DAD, and interstitial lung disease.

Objective:The aim of this study was to investigate the interobserver agreement in determination of the dominant histological pattern and the final diagnosis in lung adenocarcinomas. Material and Method:A total of 12 patients with a diagnosis of primary lung adenocarcinoma were included in the study. twelve pathologists from eight study centers were asked first to determine the dominant histological pattern in these cases and then to decide whether the final diagnosis was in situ, minimally invasive or invasive adenocarcinoma. Results:The kappa value for the agreement in determining the dominant pattern among the pathologists was 0.36 (p<0.001), with the values for the lepidic, acinar, papillary, solid, micropapillary patterns and mucinous character of adenocarcinoma being 0.34, 0.28, 0.30, 0.80, 0.16 and 0.38 respectively (p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001). none of the cases was diagnosed as in situ adenocarcinoma. On the other hand, the kappa value for the agreement in differentiating minimally invasive from invasive adenocarcinoma among reviewers was 0.17 (p<0.001). Conclusion:The agreement among pathologists in determining the subtype of lung adenocarcinomas that depends on the identification of the dominant pattern was at intermediate level. In addition, the agreement in deciding whether the case is minimally invasive or invasive, was at low level. The criteria defining the histological patterns should be clarified and described in more detail. Educational activities and larger multicenter studies might be helpful in improving the agreement and standardization. ÖZAmaç: bu çalışmanın amacı, akciğer adenokarsinomunda baskın histolojik patern belirlemede ve nihai tanı konusunda değerlendiriciler arası uyumun araştırılmasıdır. Gereç ve Yöntem:Komplet cerrahi rezeksiyon uygulanan ve mikst tipte primer akciğer adenokarsinom tanılı 12 olgu çalışmaya alındı. Çalışma sekiz merkezden 12 patologun katılımı ile yapıldı. Değerlendiricilerden baskın patern tayini ile son tanı olarak invaziv adenokarsinom, minimal invaziv adenokarsinom arasında seçim yapmaları istendi. Bulgular: Patologlar arasında baskın patern uyumunda kappa değeri 0.36 idi. lepidik, asiner, papiller, solid, mikropapiller ve musinöz paternde uyum sırasıyla 0,34, 0,28, 0,30, 0,80, 0,16, 0,38 (p<0,001, p<0,001, p<0,001, p<0,001, p<0,001, p<0,001) idi. Hiçbir olgu in situ adenokarsinom tanısı almadı. Minimal invaziv adenokarsinom ve invaziv adenokarsinom tanısı için değerlendiriciler arasındaki uyum düşüktü (kappa değeri 0,17 (p<0,001)).Sonuç: Patologlar arası akciğer adenokarsinomunu baskın patern saptamasında uyum orta düzeyde bulundu. Minimal invaziv adenokarsinom ile İAK arası uyum ise düşük düzeyde idi. Histolojik patern kriterleri daha açık ve daha detaylı olarak tanımlanmalıdır. Eğitim programları ve çok merkezli çalışmalar tanıların standardizasyon ve uyumunu geliştirilebilir.

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