Erdinç AYDIN, Suat AVCI, Hampar AKKAYA, Nalan AKALIN, Leyla KANSU

Shrinkage of Nasal Mucosa and Cartilage During Formalin Fixation

Background: After resection, specimens are subjected to formalin fixation during histological processing. This procedure can result in tissue shrinkage, with the amount of shrinkage related to tissue composition and tissue type. Aims: To evaluate the shrinkage of nasal mucosa and cartilage tissue and compare differences in shrinkage after resection, after formalin fixation, and during microscopic examination to understand differences in the rate of shrinkage of different tissue types. Study Design: Animal experimentation. Methods: Fresh nasal septa were excised from sheep (10 mm diameter in 40 sheep and 20 mm diameter in 40 sheep). The mucosa was separated from one side of the cartilage, with the contralateral mucosa remaining attached to the cartilage. Specimen diameters were measured in situ, after resection, after fixation for 6 or 24 hours (10% formalin), and during microscopic examination. Results: There were no differences between the in situ and after resection diameters of any tissue components (free mucosa, mucosa attached to cartilage, and cartilage) of all nasal specimens (10- or 20-mm diameter and 6- or 24-hour fixation). However, significant shrinkage occurred between resection and after-fixation. Regarding tissue specimens that were fixed for different durations (6 or 24 hours), we observed a significantly smaller mean tissue diameter in specimens fixed for 24 hours versus those fixed for 6 hours for mucosa attached to cartilage (in the 10-mm diameter after-fixation samples), free mucosa (in the 20-mm diameter after-fixation samples), mucosa attached to cartilage (in the 20-mm diameter after-fixation and microscopic measurement samples), and cartilage (in the 20-mm diameter afterfixation samples). Tissue shrinkage was greatest in free mucosal tissue and least in cartilage. Conclusion: These results should be considered when evaluating patients undergoing surgical procedures for nasal cavity and paranasal sinus malignancies. Surgical margins should be measured before fixation or evaluated if possible before fixation and shrinkage.

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1. Slootweg PJ, Ferlito A, Cardesa A, Thompson LD, Hunt JL, Strojan P, et al. Sinonasal tumors: a clinicopathologic update of selected tumors. Eur Arch Otorhinolaryngol 2013;270:5-20.
2. Stern SJ, Hanna E. Cancer of the nasal cavity and paranasal sinuses. In: Myers EN, Suen JY, eds. Cancer of the Head and Neck. 3rd ed. Philadelphia: WB Saunders; 1996;205-33.
3. Brennan JA, Mao L, Hruban RH, Boyle JO, Eby YJ, Koch WM, et al. Molecular assessment of histopathological staging in squamous-cell carcinoma of the head and neck. N Engl J Med 1995;332:429-35.
4. Kurita H, Nakanishi Y, Nishizawa R, Xiao T, Kamata T, Koike T, et al. Impact of different surgical margin conditions on local recurrence of oral squamous cell carcinoma. Oral Oncol 2010;46:814-7.
5. Johnson RE, Sigman JD, Funk GF, Robinson RA, Hoffman HT. Quantification of surgical margin shrinkage in the oral cavity. Head Neck 1997;19:281-6.
6. Rutherford EE, Karanjia ND. The measurement of liver resection margins. HPB (Oxford) 2004;6:18-20.
7. Siu KF, Cheung HC, Wong J. Shrinkage of the esophagus after resection for carcinoma. Ann Surg 1986;203:173-6.
8. Jonmarker S, Valdman A, Lindberg A, Hellström M, Egevad L. Tissue shrinkage after fixation with formalin injection of prostatectomy specimens. Virchows Arch 2006;449:297-301.
9. Hsu PK, Huang HC, Hsieh CC, Hsu HS, Wu YC, Huang MH, et al. Effect of formalin fixation on tumor size determination in stage I non-small cell lung cancer. Ann Thorac Surg 2007;84:1825-9.
10. Quester R, Schröder R. The shrinkage of the human brain stem during formalin fixation and embedding in paraffin. J Neurosci Methods 1997;75:81-9.
11. Small CS, Peterson DI. The reliability of dimensions of formalin-fixed brains. Neurology 1982;32:413-5.
12. Kimura M, Tayama N, Chan RW. Geometrical deformation of vocal fold tissues induced by formalin fixation. Laryngoscope 2003;113:607-13.
13. Kerns MJ, Darst MA, Olsen TG, Fenster M, Hall P, Grevey S. Shrinkage of cutaneous specimens: formalin or other factors involved? J Cutan Pathol 2008;35:1093-6.
14. Dauendorffer JN, Bastuji-Garin S, Guéro S, Brousse N, Fraitag S. Shrinkage of skin excision specimens: formalin fixation is not the culprit. Br J Dermatol 2009;160:810-4.
15. Mistry RC, Qureshi SS, Kumaran C. Post-resection mucosal margin shrinkage in oral cancer: quantification and significance. J Surg Oncol 2005;91:131-3.
16. Yeap BH, Muniandy S, Lee SK, Sabaratnam S, Singh M. Specimen shrinkage and its influence on margin assessment in breast cancer. Asian J Surg 2007;30:183-7.
17. Loree TR, Strong EW. Significance of positive margins in oral cavity squamous carcinoma. Am J Surg 1990;160:410-4.
18. Bradley PJ, MacLennan K, Brakenhoff RH, Leemans CR. Status of primary tumour surgical margins in squamous head and neck cancer: prognostic implications. Curr Opin Otolaryngol Head Neck Surg 2007;15:74-81.
19. Ravasz LA, Slootweg PJ, Hordijk GJ, Smit F, van der Tweel I. The status of the resection margin as a prognostic factor in the treatment of head and neck carcinoma. J Craniomaxillofac Surg 1991;19:314-8.
20. Slootweg PJ, Hordijk GJ, Schade Y, van Es RJ, Koole R. Treatment failure and margin status in head and neck cancer. A critical view on the potential value of molecular pathology. Oral Oncol 2002;38:500-3.
21. Lum H, Mitzner W. Effects of 10% formalin fixation on fixed lung volume and lung tissue shrinkage. A comparison of eleven laboratory species. Am Rev Respir Dis 1985;132:1078-83.
22. Pritt B, Tessitore JJ, Weaver DL, Blaszyk H. The effect of tissue fixation and processing on breast cancer size. Hum Pathol 2005;36:756-60.
23. Werner M, Chott A, Fabiano A, Battifora H. Effect of formalin tissue fixation and processing on immunohistochemistry. Am J Surg Pathol 2000;24:1016-9.
24. Prentø P, Lyon H. Commercial formalin substitutes for histopathology. Biotech Histochem 1997;72:273-82.
25. Altunkaynak BZ, Altunkaynak ME. Farklı Fiksasyon İşlemlerinin Karaciğer Boyutu Üzerine Etkisi: Stereolojik Bir Çalışma. İnönü Üniversitesi Tıp Fakültesi Dergisi 2006;13:151-6.
26. Mouritzen Dam A. Shrinkage of the brain during histological procedures with fixation in formaldehyde solutions of different concentrations. J Hirnforsch 1979;20:115-9.
27. Boonstra H, Oosterhuis JW, Oosterhuis AM, Fleuren GJ. Cervical tissue shrinkage by formaldehyde fixation, paraffin wax embedding, section cutting and mounting. Virchows Arch A Pathol Anat Histopathol 1983;402:195-201.
28. Iwadare T, Mori H, Ishiguro K, Takeishi M. Dimensional changes of tissues in the course of processing. J Microsc 1984;136:323-7.
29. Dobrin PB. Effect of histologic preparation on the cross-sectional area of arterial rings. J Surg Res 1996;61:413-5.
30. Schned AR, Wheeler KJ, Hodorowski CA, Heaney JA, Ernstoff MS, Amdur RJ, et al. Tissue-shrinkage correction factor in the calculation of prostate cancer volume. Am J Surg Pathol 1996;20:1501-6.