Introduction (Ch. 1)

Question 1

What is the purpose of surgical pathology?

Answer 1

“To examine all tissues and foreign objects removed from patients to identify disease processes, document surgical procedures and release tissue for research”

Question 2

What are three indications for frozen sections?

Answer 2

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

Question 3

What are four limitations of frozen sections?

Answer 3

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

Question 4

Inappropriate frozen sections may be:

Answer 4

Unnecessary, but not harmful (“curiosity” frozen)
Unnecessary and potentially harmful
Not very sensitive, but potentially (rarely) helpful

Question 5

What are the steps to performing a frozen section, after the tissue has been obtained from the OR?

Answer 5

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

Question 6

What are the stains that are performed on frozen sections?

Answer 6

Polychrome stain - rapid, nonpermanent

Hematoxylin and eosin (H & E) - permanent record of the FS

Question 7

What are the advantages to performing introperative cytologic preparations on specimens?

Answer 7

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

Question 8

What is a touch prep, and for what specimens is it useful?

Answer 8

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

Question 9

What is a scrape prep?

Answer 9

A freshly cut tissue surface is scraped with a scalpel, which is then smeared on a glass slide

Question 10

What stains might be used on cytologic preps?

Answer 10

Diff Quick - includes dips in methanol, xanthene (red), and thiazine (blue); often used for fine needle aspirates
Polychrome stain
H & E

Question 11

What are the steps to triaging a tubular organ such as the GI tract?

Answer 11

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

Question 12

What are the steps to triaging a solid organ?

Answer 12

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

Question 13

What are the steps to triaging a breast biopsy/lumpectomy?

Answer 13

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

Question 14

What are the steps to triaging a lung specimen?

Answer 14

1) Weigh it!

2) Inflate with formalin by injecting parenchyma with a 60cc syringe fitted with a 16.5 gauge needle

Question 15

A single patient has two separate surgical procedures on the same day - do the resulting specimens receive the same accession number?

Answer 15

NO - a different accession number is assigned for each procedure

Question 16

When would specimens obtained from a single procedure receive different accession numbers?

Answer 16

When the specimens are assigned to different services (e.g., muscle and nerve biopsies)

Question 17

What is the first step in accurate gross analysis?

Answer 17

Making sure the patient’s identity is scrupulously maintained, by matching patient name and accession number on the requisition form, specimen containers, and cassettes.

Question 18

What are the six parts of a gross analysis?

Answer 18

Patient identity
Clinical history
Gross description
Block identification and submission
CPT code
HSE sheet

Question 19

What is the most common cause of a mislabeled cassette reaching the histology lab? How can you prevent it?

Answer 19

Mislabeling when making additional blocks

Double check to make sure all blocks are correctly labeled!

Question 20

What does HSE stand for? What information about the specimen should it include?

Answer 20

Histology specimen entry

It should include how many blocks per container and any special instructions

Question 21

What is a CPT code?

Answer 21

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)