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AAD - Boards Fodder > Biopsy Techniques > Flashcards

Biopsy Techniques Flashcards

1
Q

Hemotoxalin & Eosin (H&E) Transport Medium

A

Formalin

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2
Q

Direct Immuno Fluorescence (DIF) Transport Media [4]

A
  1. Normal saline
  2. Michel
  3. Zeus
  4. LN2
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3
Q

Culture transport medium

A

Non-bacteriostatic saline

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4
Q

Electron microscopy transport medium

A

2.5% glutaraldehyde solution

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5
Q

Flow cytometry transport media [2]

A
  1. Fresh specimen on saline soaked gauze

2. RPMI medium

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6
Q

Autoimmune Bullous disease biopsy technique

  1. H&E
  2. DIF
  3. Comments
A
  1. H&E - Saucerized intact bulla, OR broad saucerization of peripheral bulla
  2. DIF - Perilesional skin <1cm from bulla
  3. Comments - Avoid lower extremities. Trunk skin is preferred. Saline is superior to other DIF transport media if delivered to the lab within 48 hours.
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7
Q

Epidermolysis bullosa biopsy technique

  1. H&E
  2. DIF
  3. Comments
A
  1. H&E - Saucerized intact bulla, OR broad saucerization of peripheral bulla
  2. DIF - NONE
  3. Comments - Avoid blisters >12 hours old. Can induce fresh blister on nearby clinically uninvolved skin.
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8
Q

Vasculitis biopsy technique

  1. H&E
  2. DIF
  3. Comments
A
  1. H&E - Punch or deep shave of lesion >72hrs old
  2. DIF - Punch or deep shave of lesion <24 hrs old
  3. Comments - Specimens should show both post capillary venule and deep plexus
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9
Q

Panniculitis biopsy technique

  1. H&E
  2. DIF
  3. Comments
A
  1. H&E - Deep incisional biopsy at the edge of necrotic focus
  2. DIF - NONE
  3. Comments - 6mm punch is the smallest size that can be divided for culture and H&E
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10
Q

Lupus biopsy technique

  1. H&E
  2. DIF
  3. Comments
A
  1. H&E - >4mm punch biopsy of lesion >6 months old that is still active
  2. DIF - Punch biopsy of lesion >6 months old that is still active
  3. Comments - NONE
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11
Q

Dermatomyositis biopsy technique

  1. H&E
  2. DIF
  3. Comments
A
  1. H&E - >4mm punch biopsy of lesion >6 months old that is still active
  2. DIF - Punch biopsy of lesion >6 months old that is still active
  3. Comments - NONE
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12
Q

SJS/TEN/SSSS biopsy technique

  1. H&E
  2. DIF
  3. Comments
A
  1. H&E - Shave or punch biopsy of acute lesion including full thickness of epidermis
  2. DIF - NONE
  3. Comments - Can submit desquamating sheets
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13
Q

Scarring alopecia biopsy technique

  1. H&E
  2. DIF
  3. Comments
A
  1. H&E - Two >4mm punch biopsies of lesions >6 months old that are still active
  2. DIF - >4mm punch biopsy of a lesions >6 months old that is still active
  3. Comments - Two biopsies: 1 for vertical and one for horizontal sectioning. Avoid active advancing border. Place punch at same angle as emerging hairs.
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14
Q

Pattern alopecia or Telogen effluvium biopsy technique

  1. H&E
  2. DIF
  3. Comments
A
  1. H&E - Two >4mm punch biopsies from an established area of alopecia
  2. DIF - NONE
  3. Comments - Two biopsies: 1 for vertical and one for horizontal sectioning. Submit transverse section or intact specimen for lab to section with HoVert or Tyler techniques
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15
Q

Alopecia areata or Syphilis biopsy technique

  1. H&E
  2. DIF
  3. Comments
A
  1. H&E - Two >4mm punch biopsies of active lesions with recent onset
  2. DIF - NONE
  3. Comments - Two biopsies: 1 for vertical and one for horizontal sectioning. Submit intact.
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16
Q

Non-melanoma skin cancer biopsy technique

  1. H&E
  2. DIF
  3. Comments
A
  1. H&E - Shave or punch biopsy with enough depth to demonstrate invasive pattern and detect perineural invasion
  2. DIF - NONE
  3. Comments - Use more superficial shave techniques on convex sites or thin facial skin
17
Q

Suspected melanoma skin cancer biopsy technique

  1. H&E
  2. DIF
  3. Comments
A
  1. H&E - Complete excisional removal
  2. DIF - NONE
  3. Comments - Saucerization is acceptable. Consider scoring or tagging at 12 o’clock for orientation
18
Q

Dermatofibroma sarco protuberans biopsy technique

  1. H&E
  2. DIF
  3. Comments
A
  1. H&E - Deep incisional biopsy
  2. DIF - NONE
  3. Comments - NONE
19
Q

Cutaneous T-cell lymphoma biopsy technique

  1. H&E
  2. DIF
  3. Comments
A
  1. H&E - Broad shave biopsy below the depth of DEJ
  2. DIF - NONE
  3. Comments - Broad shaves are superior to punch biopsies. Consider sending specimens from multiple anatomic sites
20
Q

Primary cutaneous B-cell lymphoma biopsy technique

  1. H&E
  2. DIF
  3. Comments
A
  1. H&E - Deep incisional biopsy
  2. DIF - NONE
  3. Comments - Punch biopsy or saucerization are superior to shave biopsies
21
Q

Nail matrix biopsy technique

  1. H&E
  2. DIF
  3. Comments
A
  1. H&E - Punch biopsy or horizontal distal matrix elliptical excision with Vicryl closure
  2. DIF - NONE
  3. Comments - Total or partial nail plate avulsion is usually done prior to nail matrix biopsy. Punch biopsy <3mm does not need sutured closure
22
Q

Nail bed biopsy technique

  1. H&E
  2. DIF
  3. Comments
A
  1. H&E - Punch biopsy or longitudinal elliptical excision with Vicryl closure
  2. DIF - NONE
  3. Comments - Nail plate avulsion is usually done prior to nail bed biopsy, but is not necessary

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