Pre-Analytical Stage (Part 2) | F Flashcards
What are the components (/ flow) in the surgical pathology?
1) Pt
2) Surgeon
3) Sx
4) Receiving
5) Accessioning
6) Grossing
7) Sx storage
8) Processing
a. Embedding
b. Cutting
c. Deparaffinization
d. Staining
e. Clearing
f. Mounting
g. Labeling
9) Analysis / Evaluation
10) Report generation
What are the purpose of histopathology / cytology studies?
1) To diagnose
2) To confirm dx
3) To treat
4) To assess px
5) To assess treatment
6) To screen for disease
What are the morphologic methods for lab dx of CA?
1) Cytology
a. Exfoliative cytology
i. Cervical Pap’s Smear
ii. Washings / Brushings
b. Fine needle aspiration biopsy (FNAB)
c. Fluids
i. Pleural
ii. Peritoneal
iii. CSF
iv. Urine
2) Tissue / Tissue biopsies
a. Incision biopsy
b. Punch biopsy
c. Core biopsy
d. Cone biopsy
e. Excision biopsy
f. Tissue resection
g. Frozen section dx
3) Immunohistochemistry
a. Basic battery to differentiate tumors
i. Cytokeratin
ii. Vimentin
iii. LCA
iv. S-100 / NSE
What is a biopsy?
It is a medical / surgical procedure considered by most as the gold std for definitive dx for malignancy / CA
What is done in a biopsy?
It entails sampling of a tissue / tumor mass for examination under the microscope by a patho
What are the characteristics of biopsy?
It can be:
1) Out-pt procedure
2) Invasive surgical procedure
The biopsy w/c is an invasive surgical procedure necessitates what?
Admission
What are the types of tissue biopsy?
1) FNAB
2) Core needle biopsy
3) Vacuum-assisted biopsy
4) Endoscopic biopsy
5) Bone marrow biopsy
6) Surgical biopsy
7) Curettings / Scrappings
What are the types of tissue biopsy w/c are image-guided biopsy?
1) FNAB
2) Core needle biopsy
3) Vacuum-assisted biopsy
Curettings / scrappings are for what type of sxs?
Gynecologic sxs
What are the characteristics of endoscopes?
1) Thin
2) Lighted
3) Flexible
4) W/ cameras
What are endoscopes?
These are thin, lighted, flexible tubes w/ cameras
Who uses endoscopes?
Doctors
What is the fxn of endoscopes?
To view inside of the body, including the:
1) Bladder
2) Abdomen
3) Joints
4) GIT
What are the 2 types / ways of surgical biopsy?
1) Incisional biopsy
2) Excisional biopsy
What is the meaning of the suffix “ectomy”?
To cut / remove an organ
Provide an ex of using the suffix “ectomy”
Hysterectomy
What is hysterectomy?
It is the removal of the uterus
What is the meaning of the suffix “ostomy”?
To make a hole / small incision
Provide an ex of using the suffix “ostomy”
Thoracostomy
What is thoracostomy?
Making a hole going to the thoracic cavity
What is the meaning of the suffix “otomy”?
It means to open a cavity / organ
Provide an ex using the suffix “otomy”
Exploratory laparotomy
What is exploratory laparotomy?
Opening of the abdominal cavity
What are the different types of colon resection?
1) Left colectomy (/ left hemicolectomy)
2) Right colectomy (/ right hemicolectomy)
3) Sigmoid colectomy (/ sigmoidectomy)
4) Low anterior resection
5) Abdominal perineal resection (/ mile’s resection)
6) Segmental resection
What is the meaning of TAH?
Total Abdominal Hysterectomy
What is TAH?
It is the removal of uterus w/ cervix
What is oophorectomy?
It is the removal of ovaries
What is salpingectomy?
It is the removal of fallopian tubes
What is salpingo-oophorectomy?
It is the removal of both ovaries and fallopian tubes
What is it called if removal of uterus w/ cervix + removal of ovaries / fallopian tubes is present?
Total Abdominal Hysterectomy Bilateral Salphingo-Oophorectomy
What is prostatectomy?
It is the removal of the whole prostate
What is the meaning of cysto-TURP?
Cystoscopic Transurethral Resection of Prostate
What is colectomy?
It is the removal of portions of the colon
What is right hemicolectomy?
It is the removal of the portions of the colon in the right side
What is left hemicolectomy?
It is the removal of the portions of the colon in the left side
What is sigmoidectomy?
It is the removal of portions of the colon in the sigmoid
What is mile’s resection?
It is a special case whereas it is done if the CA is very near the anus (whereas there are no margins), hence, the only margin is the outside / exterior w/c is the anus itself, as a result, the anus itself should be removed producing a problem for the pt in terms of defecation
What is gastrectomy?
It is the removal of stomach
What are the 2 ways / types of gastrectomy?
1) Partial
2) Complete
What are the 3 types / ways of removal of small intestines (depending on the sp. part that will be removed)?
1) Duodenectomy
2) Jejunectomy
3) Iliectomy
What is duodenectomy?
It is the removal of duodenum
What is jejunectomy?
It is the removal of jejunum
What is iliectomy?
It is the removal of ileum
What is appendectomy?
It is the removal of appendix
What is cholecystectomy?
It is the removal of gallbladder
What are the materials needed for grossing histopathologic sxs?
1) Counter (should be near a H2O source [sink] and vent)
2) Cutting board
3) Scalpel and corresponding blade
4) Forceps
a. Toothed
b. Not toothed
5) Surgical scissors
6) Ruler
7) Tape measure
8) Strainer
9) Bone cutter
10) Weighing scale
a. For big sxs
b. For small sxs
11) Pencil
12) Filter paper
13) Light source
14) Container of cassettes
What is mastectomy?
It is the removal of breast
What is radical mastectomy?
It is the removal of breast w/ skeletal muscle
What is the modified radical mastectomy (MRM)?
It is the removal of breast w/ fascia (no muscle)
What are the things that should be considered when grossing of histopathologic sxs in surgical path?
1) Proper grossing attire
2) Labels, cassettes / gauze, and requests
3) Materials for grossing
4) Grossing proper
a. Excision biopsy sxs (small masses)
b. Appendix / gallbladder
c. Prostate chips / placental tissues
d. Hollow organs
i. GIT
ii. TAHBSO
5) Solid organs
a. Breast
b. Liver / Spleen / Kidney
What are the requirements for the counter used for grossing histopathologic sxs?
1) Near a H2O source (sink)
2) Has a vent
What are the sxs that are considered as small biopsy sxs?
1) Incision biopsy sx
2) Core needle biopsy sxs
3) Bone marrow biopsy sxs
4) Endoscopic biopsy sxs
5) Excision biopsy sx
6) Skin biopsy
What should be the measurement for a clinically benign lesion (for excision biopsy sx)?
Not 3 cm >
If malignancy is highly suspected clinically, excision biopsy sxs in general and sxs w/c are < 3 cm are considered in what size?
Medium
What should be done to small biopsy sxs (multiple tissue fragments)?
1) Gross description should be provided
a. Shape
b. Color
c. Consistency
d. Aggregate measurement (metric system)
2) Note if the sx has mucus or blood
3) For sxs w/ an aggregate measurement of < 0.5 cm and for bone marrow biopsies
a. Wrap these sxs in a filter paper
b. Place the filter paper w/ sx into the cassette (to avoid loss of sxs) together w/ the proper label
What should be done to small biopsy sxs (mass / single mass)?
1) Gross description should be noted
a. Shape
b. Color
c. Consistency
d. Measurement (metric system)
e. Is it lobulated?
f. Is it encapsulated?
2) Is it w/ skin ellipse?
a. What is the measurement of the skin ellipse?
b. What is the appearance of the ellipse?
c. Is the mass extending to the skin?
3) Note the appearance of the cut section
a. Is it cystic?
b. Is it solid?
c. Is it partly cystic-solid?
4) For excision w/ margins, note the ff
a. How far from the superior, inferior, medial, lateral, and basal margins?
What should be done to excision small biopsy sxs (mass) w/ margins?
The margins should be inked (especially if malignancy is considered)
What is considered a necessity to be done in the histopath lab?
Sx disposition and disposal
Why is sx disposition and disposal considered as a necessity in the histopath lab?
Because the stored sxs poses health hazards
The stored sxs (in the lab) are considered to pose health hazards according to what law?
PD 856 : Sanitation Code of Philippines
Is there a legality in terms of disposing sxs?
Yes
Sx disposition and disposal is based on what?
Practicality
Why should be practicality observed in terms of sx disposition and disposal?
Due to lack of:
1) Space
2) Manpower
3) Resources (in terms of maintaining the sxs stored)
Prior to sx disposition and disposal, what should be done?
Classifying the sx
The sxs (prior to sx disposition and disposal) should be classified into what?
1) Certainly innocent sx
2) Sx w/c could be under possible litigation
3) Sx under ongoing litigation
4) Sx in a concluded litigation
In certainly innocent sxs, lab dx is what?
Certain
Lab dx can be in what?
1) Histopath
2) PAPS (/ Pap smear)
3) Other lab examinations
a. Blood
b. Urine
True or False
For certainly innocent sxs, the pt is discharged w/out complaint (meaning, the treatment was successful)
True
What are prescription of actions?
It is the period within w/c a person can exercise his/her right of action against one who caused his suffering
What are the 3 types of liabilities that the pt can do (in relationship w/ sx disposition and disposal)?
1) Administrative
2) Civil (contracts)
3) Criminal
What is the prescriptive period for administrative liability?
Generally none unless the administrative law so provides
What are the 2 types of civil (contracts) liability?
1) Oral / verbal
2) Written
What is the prescriptive period for oral / verbal liability (under civil liability)?
6 yrs
What is the prescriptive period for written liability (under civil liability)?
10 yrs
What is the prescriptive period for criminal liability?
Generally 25 yrs unless the criminal law so provides
What is the duration of the keeping of medical records (legally speaking) by the hospital?
25 yrs
As per DOH Circular (administratively speaking), the hospital can dispose the medical records after how many yrs (for in-patients)?
After 15 yrs from the time of last confinement
As per DOH Circular (administratively speaking), the hospital can dispose the medical records after how many yrs (for OPD pts)?
After 10 years
What are the concepts associated w/ certainly innocent sx?
1) Histopath results
2) Other lab results
3) Request forms
How do you proceed if you want to dispose innocent sx before 25 yrs?
Have the pt sign the consent for sx disposal
What are the ways to document the state of the sx for sx w/c could be under possible litigation?
1) By description in words narrating the last state of condition before disposal
2) Print photography
3) Disc documentation (still photography)
4) Video-audio documentation
Is there a legality in terms of disposing sxs?
Yes
True or False
Litigations in the Philippines take placed from 10 - 15 yrs
False, because litigations in the Philippines take placed from 5 - 20 yrs
What are the things that cannot be denied (/ are inevitable) for sx w/c could be under possible litigation?
1) Unavoidable deterioration of the sx and the slides
2) Unavoidable turnover of pathology staff in the lab
For sx w/c could be under possible litigation, what must be made known to the pt?
If the sx will be transferred / disposed and if any deterioration or other things are done to the sx
For sx w/c could be under possible litigation, the documentation of the state of sx should be done in the presence of whom?
1) Pt
2) Pt’s representative (if the pt is not available)
For sx under ongoing litigation, the documentation of the state of sx should be done in the presence of whom?
1) Pt
2) Pt’s representative (if pt is not available)
3) Court representative
What should be done to sx under concluded litigation?
Proceed in the manner as if in the innocent sx (because the litigation is already done), but in the consent for disposal, it should be noted that even if the pt has / takes an appeal, the sx can’t be used anymore
