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Histopath LEC > PRE-ANALYTICAL FACTORS > Flashcards

PRE-ANALYTICAL FACTORS Flashcards

1
Q

PRE-ANALYTICAL FACTORS
_______
• Time interval between surgical intervention and proper fixation of the removed specimen

A

Ischemia Time

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2
Q

Ischemia time

A

Surgical theatre

Pathological anatomy

Grossing

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3
Q

> Starts a series of biochemical changes that leads to tissue poor quality
Affected by the whole surgical procedure

A

Warm Ischemia Time

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4
Q

> Occurs during operation when blood supply of tissue is cut off

A

Warm Ischemia Time

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5
Q

• Prolonged > temperature of specimen will gradually reach the external temperature, and autolysis and drying of the surface may occur

A

Cold Ischemia Time

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6
Q

• Interval between tissue removal from the patient and arrival in the pathology laboratory for grossing

A

Cold Ischemia Time

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7
Q

Pre-Analytic Fixation

• All parts to be examined must be initially____
•_______-> better tissue preservation
• _______-> impede tissue processing

A

fixed

Earlier fixation

Improper fixation

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8
Q

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

A

6-48hrs

5mm; large tissues

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9
Q

Specimen Reception
• Specimens must be put in a container labeled with

A

patient’s name
specimen source/site
pathology requisition form

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10
Q

Criteria for Rejection of Specimens:

A

• 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

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11
Q

• Specimens are given a unique identification number that will identify each specimen for each patient

A

Specimen Accessioning

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12
Q

• 1st and most important step in HP outside the tissue processing procedures

A

Specimen Accessioning

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13
Q

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

A

Surgical, Autopsy, Cytology

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14
Q

T or F

Avoid serial accessioning of similar specimen types to reduce mix-up of specimens, and cross-contamination

A

True

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15
Q

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

A

plastic cassette

pathologists

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16
Q

MATERIALS FOR GROSS EXAMINATION

A

Cutting tools

Gross Table or Gross Workstations

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17
Q

Cutting Tools

A

Scissors
Forceps
Blade Holders
Blade

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18
Q

Gross Table or Gross Workstations

A

Sink
Tabletop
Water supply
Irrigation system
Fume extraction/ventilation system
Water disposal unit

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19
Q

Specimens only requiring transfer from container to tissue cassette

A

A

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20
Q

Specimens requiring transfer but with standard sampling, counting, weighing or slicing

A

B

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21
Q

Simple dissection required with sampling needing a low level of diagnostic assessment and/or preparation

A

C

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22
Q

Dissection and sampling required needing a moderate level of assessment

A

D

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23
Q

Specimens requiring complex dissection and sampling methods

A

E

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24
Q

Examples
Endometrium
Breast core biopsies
Colonic series

A

A

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25
Q

Examples
Small lipoma made of fatty tissues)
Small skin biopsy
Cervical LLETZ

A

B

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26
Q

Example
Prepuce
Gallbladder
Haemorrhoids
Appendix

A

C

27
Q

Example

Pigmented skin lesions
Large intestine (Crobin’s)
Skin with markers
Salivary gland tumour

A

D

28
Q

Example

Thyroid (medullary Ca)
Breast cancer
Testis (seminoma)
Uterus (endomet. Ca)

A

E

29
Q

• 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

A

SPECIMENS FOR GROSS DESCRIPTION ONLY

30
Q

Exempted for routine microscopic review: ABEIN PPUTV

A

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

31
Q

SPECIMENS EXCLUDED FROM
MANDATORY SUBMISSION

BBCD FFFIMM OPRSSTN

A

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

32
Q

GROSS DESCRIPTION

A
  1. Identify the specimen. Note and verify all anatomical structures.
  2. Identify orientation markers used by surgeons, if available
  3. Describe all notable characteristics
33
Q

Identify the specimen. Note and verify all anatomical structures.

A

• Type of organ/ tissue
• Left or right

34
Q

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

A

Inks

Nicks

Sutures

35
Q

• Purpose: to accurately and faithfully transmit information to allow accurate and reliable microscopic assessment of this margin

A

INKING

36
Q

Resection margins
Embedding instructions
Orientation
Distinguish between samples
Identify the cut surface

A

Inking

37
Q

instruct the embedder to embed the tissues a certain way

A

Ink dots

38
Q

Different color scheme used to identify its orientation:

(Superior)
(Inferior)
(Posterior or Deep)
(Medial)
(Anterior)
(Lateral)

A

Blue

Green

Black

Red

Yellow

Orange

39
Q

If 2 or 3 colors are needed, the preferred color to be used are

A

black, blue, and orange

40
Q

is used to remove the ink

A

Acetic Acid

41
Q

Gross examination

Describe all notable characteristics:

A

• Type of specimen
• Shape
• Color
• Texture/Consistency
• Odor
• Dimensions
• Weight

42
Q

Weight - of intact organs are rounded to the nearest

A

0.1g

43
Q

Dimensions - (length, width, depth) are rounded to nearest_____.

For multiple pieces, indicate size of the_____

A

1.0cm

largest piece

44
Q

Gross examination

• Taking a representative sample of the tissue

A

SECTIONING

45
Q

Gross examination
Cross sectioning

• Indicate number of________ on the gross description

• Indicate also the number of______ used

A

sections and blocks

cassettes

46
Q

• Specimen must fit easily into the standard cassette, which measures

A

3 x 2.5 x 0.4cm

47
Q

Sectioning

Thickness: not more than____ to allow for closing of cassette and fixative penetration

A

0.3cm

48
Q

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

A

2mm

Filter paper

49
Q

SECTIONING

LARGE SPECIMEN

• Cut an interval of______ thickness (termed as breadloafing) to ensure that pathologic areas or tumoral areas are identified

A

1cm

50
Q
  • an en bloc excision of all cancer bearing tissues in the pelvis including the bladder, the prostate
A

Cystoprostatectomy

51
Q

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)

A

Paper tags

(lead) pencil

dot matrix

52
Q

OTHER SPECIMEN CONSIDERATIONS

BRAIN

Brain is_____ first before grossed

Tied at the______ and suspended

Must___________ to avoid deformity

A

fixed

Circle of Willis

not touch side of container

53
Q

Fixation of BRAIN

Recommended: In________ for_______

A

10% NBF (Neutral Buffered Formalin)

2-3 weeks

54
Q

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

A

inked

Small polyps

Large polyps

55
Q

SPECIMEN CONSIDERATIONS

Dermatologic Specimen
•_______ orientation is always maintained (using markers)

•_______ are submitted whole

• Tissues greater than_____ are dissected

A

Vertical

Punch biopsies

4mm

56
Q

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

A

2 to 3 mm

57
Q

SPECIMEN CONSIDERATIONS

Eyes

A

Inject fixative first then gross

58
Q

SPECIMEN CONSIDERATIONS

Hard Tissues

A

Wash in running water then immerse in TSE softeners

Must undergo the process of decalcification

59
Q

SPECIMEN CONSIDERATIONS

Hollow Structures
o Must be cut open______ and_____

A

longitudinally

fixed with cottons inside (cottons soaked in fixative)

60
Q

SPECIMEN CONSIDERATIONS

Most important component of tumor resections because they are essential for prognosis and planning therapeutic options

A

Lymph Nodes

61
Q

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

A

fresh and not immersed in formalin

bivalved

Sentinel lymph nodes

62
Q

SPECIMEN CONSIDERATIONS

Mastectomy
Note for

A

weight
size of breast and axillary dissection
skin ellipse
nipple scar
basal margins

63
Q

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

A

Pediatric Specimen

64
Q

SPECIMEN CONSIDERATIONS

Specimen with Tumor

Identify:

A

• Site & size of tumor
• Location & structure invaded by tumor
• Vascular invasion
• Presence of lvmph node
• Distance from resection margin

Histopath LEC (37 decks)

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