Anatomic Pathology

Question 1

What is diagnostic pathology?

Answer 1

Clinical pathology, histopathology, bacteriology, virology, serology, molecular diagnostics, electron microscopy, toxicology

Question 2

What are the two arms of diagnostic pathology?

Answer 2

Clinical and anatomic

Question 3

What is considered clinical pathology?

Answer 3

-Analysis of bodily fluids via biochemical analysis: blood, urine and effusion
-Cytology: FNA, Smears, Individual cells, quick and less intrusive, not always definitive and cant always grade

Question 4

What is considered anatomic pathology?

Answer 4

Morphologic evaluation - gross and microscopic
-Tissue, patterns, cell and adjacent tissue, longer turn around, more invasive, anesthesia, more definitive, grade, count, immunichem
-mass/tissue/architecture

Question 5

If you need your result back quickly which of the two types of pathology would be most ideal to use?

Answer 5

Clinical - blood and cells can be analyzed in 1-4 hours, less intrusive

Question 6

If you have time to wait what type of pathology could you use?

Answer 6

Anatomic - minimum of 2 days to fix and process it

Question 7

What are reasons you may take a tissue sample?

Answer 7

-Initial treatment was unsuccessful
-determine if it was cancer or not
-confirm a presumptive diagnosis
-differentiate amongst rule outs,
-cytology non-diagnostic or equivocal
-ultimate cause of death or disease
-Rule out disease

Question 8

What are some of the top considerations in sample collection?

Answer 8

Location, size and number

Question 9

Describe the optimal location to take a sample from a lesion:

Answer 9

Not directly in the issue (may just be necrosed cells), not in the fully normal (normal), need to be at the division and get some of each if possible (interface) - can see how cells are itneracting

Question 10

How big should your sample be?

Answer 10

Bigger is better!
-Punch, skin, incisional biopsy, mass
-Less susceptible to artifact

Question 11

How many samples should you take?

Answer 11

The more the merrier and get them from various areas
-Submit them call, never know which one will tell the story

Question 12

Why do we perform a necropsy?

Answer 12

-Sudden Death
-Clinical diagnosis
-Treatment failure
-extent of disease
-cataloging disease
-herd health implications
-teaching and research
-closure

Question 13

What are some keys to performing a quality necropsy?

Answer 13

-Consistent technique
-Completeness (more than interest area)
-Adequate and appropriate sampling
-Fresh/Formalin (Culture and serology)
-Clean tissue, then finish with GIT
-Dont handle mucosal side, handle serosal
-No clamp down hard with forceps
-submit placenta with fetal tissue
-Bread loaf large (get formalin all the way through)
-Report/describe well

Question 14

What organs should you sample?

Answer 14

Lungs, liver, kidney, spleen, small intestine, large intestine and heart

Question 15

What size should your samples be?

Answer 15

<1cm or starburst size

Question 16

What should the tissue to formalin ratio be?

Answer 16

1:10 Tissue to formalin

Question 17

What if your sample is larger?

Answer 17

Bread loaf it and place markers to differentiae which side

Question 18

What should you not do?

Answer 18

-Place a giant organ in a little formalin
-Place a giant organ not bread loafed
-put it in a container that is not approved by the lab
-Roll up skin…

Question 19

What should always accompany a sample?

Answer 19

A lab submission form
-Have your info on it, owners, good history helps, location of lesion very helpful

Question 20

How is tissue processed?

Answer 20

-Technician cuts it up and measures it into little cassettes (2 x 1 x 5)
-Placed in machine to be processed dehydrated and paraffin put on it to maintain stiffness, trim to put on slide (48hr)
-Use razor blade to put in fine section
-Give to pathologist to analyze

Question 21

What is provided in the pathology report?

Answer 21

Clinical history, specimen site, gross description, microscopic description, diagnosis, comments, pathologist signature
Diagnosis and comments critical

Question 22

Is there a standardized approach to getting complete margins of excision of tumors?

Answer 22

No - use paint or sutures
-Bread loaf every 2cm
-Cross section through mass
(assume symmetrical so margins may not be complete)

Question 23

What are the components of the morphologic diagnosis?

Answer 23

Process - inflammation, necrosis, hypertrophy
Chronicity or Timeframe - acute, chronic
Distribution - difuse, milliary, segmental, locally invasive or extensive
Organ - which
Severity - how bad