PRE-ANALYTICAL FACTORS Flashcards
PRE-ANALYTICAL FACTORS
_______
• Time interval between surgical intervention and proper fixation of the removed specimen
Ischemia Time
Ischemia time
Surgical theatre
Pathological anatomy
Grossing
> Starts a series of biochemical changes that leads to tissue poor quality
Affected by the whole surgical procedure
Warm Ischemia Time
> Occurs during operation when blood supply of tissue is cut off
Warm Ischemia Time
• Prolonged > temperature of specimen will gradually reach the external temperature, and autolysis and drying of the surface may occur
Cold Ischemia Time
• Interval between tissue removal from the patient and arrival in the pathology laboratory for grossing
Cold Ischemia Time
Pre-Analytic Fixation
• All parts to be examined must be initially____
•_______-> better tissue preservation
• _______-> impede tissue processing
fixed
Earlier fixation
Improper fixation
Pre analytic factors
• Observe proper tissue-to-fixative ratio
• 3-5mm thick tissues: fixed for…
•______ thick tissues and_____(such as limbs): sectioned prior to fixation, or else, fixation will not be complete and may occur only at the periphery of the tissue
6-48hrs
5mm; large tissues
Specimen Reception
• Specimens must be put in a container labeled with
patient’s name
specimen source/site
pathology requisition form
Criteria for Rejection of Specimens:
• Discrepancies between requisition form and specimen labels
• Unlabeled, mislabeled, and inappropriately identified specimens (last resort: DNA identification)
• Leaking specimen containers
• Absent clinical data or history, and other necessary info
• Specimens are given a unique identification number that will identify each specimen for each patient
Specimen Accessioning
• 1st and most important step in HP outside the tissue processing procedures
Specimen Accessioning
Specimen Accessioning
• Indicating codes may be used for the following: (3)
• Sample Format of Accession Number:
Indicating Code - Year - ID Number of Specimen
• E.g. #594-12345
Surgical, Autopsy, Cytology
T or F
Avoid serial accessioning of similar specimen types to reduce mix-up of specimens, and cross-contamination
True
GROSS EXAMINATION
• Consists of describing the specimen and placing all or parts of it into a____, in preparation for tissue processing
• One of the basis of_____’ diagnosis
• Where the pathologist will choose a representation of the tissues, most especially if the tissue is large in size
• Involves selection of elements that appear to be of clinical significance for histologic examination
plastic cassette
pathologists
MATERIALS FOR GROSS EXAMINATION
Cutting tools
Gross Table or Gross Workstations
Cutting Tools
Scissors
Forceps
Blade Holders
Blade
Gross Table or Gross Workstations
Sink
Tabletop
Water supply
Irrigation system
Fume extraction/ventilation system
Water disposal unit
Specimens only requiring transfer from container to tissue cassette
A
Specimens requiring transfer but with standard sampling, counting, weighing or slicing
B
Simple dissection required with sampling needing a low level of diagnostic assessment and/or preparation
C
Dissection and sampling required needing a moderate level of assessment
D
Specimens requiring complex dissection and sampling methods
E
Examples
Endometrium
Breast core biopsies
Colonic series
A
Examples
Small lipoma made of fatty tissues)
Small skin biopsy
Cervical LLETZ
B
Example
Prepuce
Gallbladder
Haemorrhoids
Appendix
C
Example
Pigmented skin lesions
Large intestine (Crobin’s)
Skin with markers
Salivary gland tumour
D
Example
Thyroid (medullary Ca)
Breast cancer
Testis (seminoma)
Uterus (endomet. Ca)
E
• Are removed in the body not because of an abnormality, but because of some instances where the tissue/part must be removed in the body
• Sent in the lab for disposal
• Disease is not histologic level
SPECIMENS FOR GROSS DESCRIPTION ONLY
Exempted for routine microscopic review: ABEIN PPUTV
Accessory digits
Bunions (aka hallux valgus) & hammer toes
Extraocular muscle from corrective surgery
Inquinal hernia sacs in adult
Nasal bone & cartilage from rhinoplasty
Prosthetic breast implant
Prosthetic heart valves without
attached tissue
Tonsils and adenoids from children
Umbilical hernia sacs in children
Varicose veins
SPECIMENS EXCLUDED FROM
MANDATORY SUBMISSION
BBCD FFFIMM OPRSSTN
Bone donated
Bone segments
Cataracts
Dental appliances and teeth
Fat
Foreign bodies
Foreskin
IUDS
Medical devices
Middle ear ossicles
Orthopedic hardware and other radiopaque
Placentas
Rib segments
Saphenous veins
Skin or other normal tissue removed
Therapeutic radioactive sources
Normal toenails and fingernails
GROSS DESCRIPTION
- Identify the specimen. Note and verify all anatomical structures.
- Identify orientation markers used by surgeons, if available
- Describe all notable characteristics
Identify the specimen. Note and verify all anatomical structures.
• Type of organ/ tissue
• Left or right
Identify orientation markers used by surgeons, if available
•_____ - used to identify and orient the specimen’s components, distinguish samples, for embedding instructions
•_____ - indicates laterality
•_____ - represented by LL: long lateral; or SS - short superior
Inks
Nicks
Sutures
• Purpose: to accurately and faithfully transmit information to allow accurate and reliable microscopic assessment of this margin
INKING
Resection margins
Embedding instructions
Orientation
Distinguish between samples
Identify the cut surface
Inking
instruct the embedder to embed the tissues a certain way
Ink dots
Different color scheme used to identify its orientation:
(Superior)
(Inferior)
(Posterior or Deep)
(Medial)
(Anterior)
(Lateral)
Blue
Green
Black
Red
Yellow
Orange
If 2 or 3 colors are needed, the preferred color to be used are
black, blue, and orange
is used to remove the ink
Acetic Acid
Gross examination
Describe all notable characteristics:
• Type of specimen
• Shape
• Color
• Texture/Consistency
• Odor
• Dimensions
• Weight
Weight - of intact organs are rounded to the nearest
0.1g
Dimensions - (length, width, depth) are rounded to nearest_____.
For multiple pieces, indicate size of the_____
1.0cm
largest piece
Gross examination
• Taking a representative sample of the tissue
SECTIONING
Gross examination
Cross sectioning
• Indicate number of________ on the gross description
• Indicate also the number of______ used
sections and blocks
cassettes
• Specimen must fit easily into the standard cassette, which measures
3 x 2.5 x 0.4cm
Sectioning
Thickness: not more than____ to allow for closing of cassette and fixative penetration
0.3cm
A. SECTIONING
SMALL SPECIMENS
Cut serially about_____ thick to look for small lesions.
Lesions are then sampled for histologic exam.
______ may be used in wrapping small sample
2mm
Filter paper
SECTIONING
LARGE SPECIMEN
• Cut an interval of______ thickness (termed as breadloafing) to ensure that pathologic areas or tumoral areas are identified
1cm
- an en bloc excision of all cancer bearing tissues in the pelvis including the bladder, the prostate
Cystoprostatectomy
LABELING
•______are embedded in the cassette
• Labeled with accession number using_____. Markers and pens will dissolve upon processing
• If printed, _____must be used
• Original containers with specimen are saved until case is signed out (backup evidence in cases of discrepancies)
Paper tags
(lead) pencil
dot matrix
OTHER SPECIMEN CONSIDERATIONS
BRAIN
Brain is_____ first before grossed
Tied at the______ and suspended
Must___________ to avoid deformity
fixed
Circle of Willis
not touch side of container
Fixation of BRAIN
Recommended: In________ for_______
10% NBF (Neutral Buffered Formalin)
2-3 weeks
SPECIMEN CONSIDERATIONS
Colon Cancers
Polyps: base (the area where cautery arteries are located) is always______
•_______: bisected and places in one cassette
•_______: sides are trimmed away from the stalk, and stalk is placed in a separate cassette
inked
Small polyps
Large polyps
SPECIMEN CONSIDERATIONS
Dermatologic Specimen
•_______ orientation is always maintained (using markers)
•_______ are submitted whole
• Tissues greater than_____ are dissected
Vertical
Punch biopsies
4mm
SPECIMEN CONSIDERATIONS
• Skin ellipses: serially cut along the short axis at______ interval.
The two most distal sections or tips are submitted in two separate cassettes.
Remainder is submitted in one or more cassettes
2 to 3 mm
SPECIMEN CONSIDERATIONS
Eyes
Inject fixative first then gross
SPECIMEN CONSIDERATIONS
Hard Tissues
Wash in running water then immerse in TSE softeners
Must undergo the process of decalcification
SPECIMEN CONSIDERATIONS
Hollow Structures
o Must be cut open______ and_____
longitudinally
fixed with cottons inside (cottons soaked in fixative)
SPECIMEN CONSIDERATIONS
Most important component of tumor resections because they are essential for prognosis and planning therapeutic options
Lymph Nodes
SPECIMEN CONSIDERATIONS
LYMPH NODES
Should be received_______
Node is_____, and entirely submitted
___________: usually the first lymph node to be involved during metastasis. Entirely submitted. However, large specimens may be bisected, and submitted in one or two cassettes
fresh and not immersed in formalin
bivalved
Sentinel lymph nodes
SPECIMEN CONSIDERATIONS
Mastectomy
Note for
weight
size of breast and axillary dissection
skin ellipse
nipple scar
basal margins
SPECIMEN CONSIDERATIONS
Additional processes such as IHC, flow cytometry, cytogenetics and molecular genetics is often done.
These may require fresh, frozen, or specially processed tissues
Pediatric Specimen
SPECIMEN CONSIDERATIONS
Specimen with Tumor
Identify:
• Site & size of tumor
• Location & structure invaded by tumor
• Vascular invasion
• Presence of lvmph node
• Distance from resection margin
