Introduction (Ch. 1) Flashcards
What is the purpose of surgical pathology?
“To examine all tissues and foreign objects removed from patients to identify disease processes, document surgical procedures and release tissue for research”
What are three indications for frozen sections?
1) To provide rapid gross or microscopic diagnosis to guide intra- or perioperative patient management
2) To guide specimen triage to insure that appropriate studies are performed
3) To confirm that lesional/diagnostic tissue is present
What are four limitations of frozen sections?
1) Sampling error
2) Frozen section artifact (ice crystals, tissue folding and chatter, difficult-to-section tissue)
3) Necessary special studies cannot be performed in time
4) Difficult cases may require outside consultation
Inappropriate frozen sections may be:
Unnecessary, but not harmful (“curiosity” frozen)
Unnecessary and potentially harmful
Not very sensitive, but potentially (rarely) helpful
What are the steps to performing a frozen section, after the tissue has been obtained from the OR?
1) An FS form is filled out
2) Specimen is triaged and tissue to be submitted is determined
3) Specimen is placed on a pre-chilled chuck covered with OCT
4) Specimen is covered with more OCT and immersed in a Freon bath until frozen solid
5) Two slides and a cassette are prepared for the FS
6) The chuck is mounted in the cryostat, and 5 micron sections are placed on 2 slides
7) The slides are stained and submitted to sign-out
What are the stains that are performed on frozen sections?
Polychrome stain - rapid, nonpermanent
Hematoxylin and eosin (H & E) - permanent record of the FS
What are the advantages to performing introperative cytologic preparations on specimens?
Easy and rapid to perform
No ice crystal artifact
Tissue is preserved without being diminished
Large areas can be sampled
Cytologic information (cell-cell cohesiveness, nuclear morphology, etc.) is provided
What is a touch prep, and for what specimens is it useful?
A freshly-cut tissue surface is lightly touched to a glass slide, forming an imprint of the tissue
Useful for lymph nodes and other hematopoietic tissue, brain tumors, and some thyroid tumors
Also useful for tissue that is unsuitable for frozen section due to fat or bone content, or lack of adequate tissue
What is a scrape prep?
A freshly cut tissue surface is scraped with a scalpel, which is then smeared on a glass slide
What stains might be used on cytologic preps?
Diff Quick - includes dips in methanol, xanthene (red), and thiazine (blue); often used for fine needle aspirates
Polychrome stain
H & E
What are the steps to triaging a tubular organ such as the GI tract?
1) Open along the anti-mesenteric border, avoiding any lesions
2) Ink margins
3) Pin specimen, mucosa-side-up, to a gauze-covered corkboard
4) Place specimen in a large labeled container of formalin, making sure it isn’t touching the bottom, to fix
What are the steps to triaging a solid organ?
1) Weigh, measure, and record important parameters
2) Take mucosal and vascular margins and place in a blank cassette
3) Ink soft tissue margins
4) Bread-loaf or serially section the specimen
5) Weave gauze between slices to aid in proper fixation
What are the steps to triaging a breast biopsy/lumpectomy?
1) Determine orientation (via sutures and radiograph)
2) Ink specimen with four colors
3) Place in formalin and allow to fix overnight
4) Serially section the specimen
5) Re-radiograph, if indicated, and photograph slices
What are the steps to triaging a lung specimen?
1) Weigh it!
2) Inflate with formalin by injecting parenchyma with a 60cc syringe fitted with a 16.5 gauge needle
A single patient has two separate surgical procedures on the same day - do the resulting specimens receive the same accession number?
NO - a different accession number is assigned for each procedure
When would specimens obtained from a single procedure receive different accession numbers?
When the specimens are assigned to different services (e.g., muscle and nerve biopsies)
What is the first step in accurate gross analysis?
Making sure the patient’s identity is scrupulously maintained, by matching patient name and accession number on the requisition form, specimen containers, and cassettes.
What are the six parts of a gross analysis?
Patient identity Clinical history Gross description Block identification and submission CPT code HSE sheet
What is the most common cause of a mislabeled cassette reaching the histology lab? How can you prevent it?
Mislabeling when making additional blocks
Double check to make sure all blocks are correctly labeled!
What does HSE stand for? What information about the specimen should it include?
Histology specimen entry
It should include how many blocks per container and any special instructions
What is a CPT code?
Current Procedural Terminology code
Used by the billing office to generate charges for the specimen
Assigned at the time of grossing, to each container
Includes on the gross and microscopic analysis of routinely processed tissue (not special studies)
