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HISTOPATHOLOGY > PRELIM LEC: PRE-ANALYTICAL FACTORS, GROSS EXAMINATION > Flashcards

PRELIM LEC: PRE-ANALYTICAL FACTORS, GROSS EXAMINATION Flashcards

1
Q

Time interval between surgical intervention and proper fixation of the removed specimen

A

Ischemia Time

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2
Q

Ischemia Time DIVIDED INTO:

A

Warm Ischemia Time
Cold ischemia time

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2
Q

Occurs during operation when blood supply of tissue is cut
off

A

Warm Ischemia Time

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2
Q

If prolonged, ischemia will allow activation of tissue enzymes, autolysis, and degradation of proteins and nucleic acids, which affects visualization of tissues

A

Ischemia Time

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3
Q

During this period, the tissue is alive and active, but will undergo progressive metabolic stress due to hypoxia

A

Warm Ischemia Time

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3
Q

Beyond the control of the histopathology lab

A

Warm Ischemia Time

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4
Q

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

A

Cold Ischemia Time

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4
Q

Affected by the whole surgical procedure (complexity of procedure, ability of surgeon, modality of intervention)

A

Warm Ischemia Time

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5
Q

Extensions may contribute to poor fixation

A

Cold Ischemia Time

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5
Q

If 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

All parts to be examined must be initially fixed

A

Pre-Analytic Fixation

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6
Q

Earlier fixation  better preservation of tissue morphology

A

Pre-Analytic Fixation

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7
Q

Proper ratio with tissue must be observed

A

Pre-Analytic Fixation

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8
Q

** 3-5mm thick tissues** may be fixed for

Pre-Analytic Fixation

A

6-48hrs

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9
Q

5mm thick tissues and large tissues (such as limbs) must be ________, or else, fixation will not be complete and may occur only at the periphery of the tissue

Pre-Analytic Fixation

A

sectioned prior to fixation

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10
Q

Submitted specimens must be put in a container** labeled with patient’s name and specimen source/site,** and must be accompanied with a duly accomplished pathology requisition form.

A

Specimen Reception

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11
Q

Criteria for Rejection of Specimens:

A

a) Discrepancies between requisition form and specimen labels
b) Unlabeled, mislabeled, and inappropriately identified specimens (last resort: DNA identification)
c)** Leaking specimen containers**
d) Absent clinical data or history, and other necessary info

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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

Specimens are given a unique identification number (may be a barcode, for some laboratories) that will identify each specimen for each patient

A

Specimen Accessioning

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14
Q
  • Also useful for ease of retrieval of specimens, slides, and blocks
A

Specimen Accessioning

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15
Q
  • Indicating codes may be used for the following

Specimen Accessioning

A

o Surgical
o Autopsy
o Cytology

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16
Q

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

A

Specimen Accessioning

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17
Q

Consists of describing the specimen and placing all or parts of it into a plastic cassette, in preparation for tissue processing

A

GROSS EXAMINATION

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18
Q

One of the basis of pathologists’ diagnosis

A

GROSS EXAMINATION

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19
Q

Involves selection of elements that appear to be of clinical significance for histologic examination

A

GROSS EXAMINATION

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20
Q

cleaned before and after use (to avoid carryover)

A

Cutting Tools

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21
Q

Cutting Tools:

A

o Scissors
o Forceps
o Blade holders
o Blades - disposed in sharps container

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21
Q

Specimens only requiring transfer from container to tissue cassette. No dissection required

A

CATEGORY A

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22
Q

Gross Table or Gross Workstations:

A

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

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23
Q

Specimen Categories:

A
  1. A
  2. B
  3. C
  4. D
  5. E
24
Q

May need to be placed in filter paper first before placing in cassette because of their small size

A

CATEGORY A

25
Q

CATEGORY A SPECIMEN EXAMPLE

A

e.g. endometrium, colonic series, breast core biopsies

26
Q

Specimens requiring transfer and routine sample dissection: sampling, counting, weighing, or slicing

A

CATEGORY B

27
Q

CATEGORY B SPECIMENS EXAMPLE

A

e.g. small lipoma, small skin biopsy, cervical LLETZ (Large Loop Excision or Transformation Zone)

28
Q

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

A

CATEGORY C

29
Q

CATEGORY C SPECIMENS EXAMPLE

A

e.g. Prepuce (fore skin in male) / Folds in clitoris (female) Gall bladder, hemorrhoids, appendix

30
Q

Dissection and sampling required needing a moderate level of assessment

A

CATEGORY D

31
Q

CATEGORY D SPECIMENS EXAMPLE

A

e.g. Pigmented skin lesions, skin w/ markers, large intestine (Crohn’s), large glands tumors

32
Q

Specimens for Gross Description Only
(because disease is not histologic level):

A
33
Q

Specimens requiring complex dissection and sampling methods

A

CATEGORY E

34
Q

CATEGORY E SPECIMENS EXAMPLE

A

e.g. thyroid, breast cancer, testis (seminoma), uteri

35
Q

Identify orientation markers used by surgeons, if available

A

Describing Specimens and Gross Description

36
Q

Identify the specimen. Note and verify all anatomical structures.

A

Describing Specimens and Gross Description

37
Q

used to identify and orient the specimen’s
components, distinguish samples, for embedding instructions

A

Inks

38
Q

– indicates laterality

A

Nicks

39
Q

represented by LL: long lateral; or SS – short superior

A

Sutures

40
Q

Describe all notable characteristics:

A

type of specimen, shape,
color, texture, consistency, dimensions, weigh

41
Q

of intact organs are rounded to the nearest 0.1g. (In some cases, weight is more important than histopathologic characteristics. Examples are hyperplastic tissues.)

A

Weight

42
Q

(length, width, depth) are rounded to nearest 1.0 cm. For multiple pieces, indicate size of the largest piece.

A

Dimensions

43
Q

Taking a representative sample of the tissue.

A

Sectioning

44
Q

Cut serially about 2 mm thick to look for small
lesions. Lesions are then sampled for
histologic exam. Filter paper may be used in
wrapping small samples

A

Small specimens

45
Q

Cut at an interval of 1 cm thickness (termed
as breadloafing) to ensure that pathologic
areas or tumoral areas are identified

A

Large specimens

46
Q

Specimen must fit easily into the standard cassette, which
measures

A

3 x 2.5 x 0.4 cm

46
Q

Indicate number of sections and blocks on the gross description

A

sectioning

47
Q

When possible, edges of tissue should be

A

squared

47
Q

are embedded in the cassette. They should labelled with accession number using pencil. Markers and pens will dissolve upon processing.

A

Paper tags

47
Q

not more than 0.3 cm to allow for closing of cassette and fixative penetration

A

Thickness

48
Q

if printed, ___ must be used.

A

dot matrix

49
Q

Original containers with specimen are saved until case is signed out (backup evidence in cases of discrepancies)

A

yasss

50
Q

is fixed first before grossed
 Tied at the Circle of Willis and suspended
 Must not touch side of container to avoid deformity
 In 10% NBF for 2-3 weeks

A

Brain

51
Q

Base (the area where cautery arteries are located) is
always inked.

A

Colon Cancers Polyps

52
Q

sides are trimmed away from the stalk,
and stalk is placed in a separate cassette

A

Large polyps

52
Q

Bisected and placed in one cassette

A

Small polyps

52
Q
  • Vertical orientation is always maintained (using markers)
  • Punch biopsies are submitted whole
  • Tissues greater than 4mm are dissected
  • Skin ellipses: serially cut along the short axis at 2 to 3 mm interval.
    The two most distal sections or tips are submitted in two separate cassettes. Remainder is submitted in one or more cassettes
A

Dermatologic SPX

53
Q

Inject fixative first then gross.

A

Eyes

54
Q

Wash in running water then immerse in tissue softeners

A

Hard Tissues

55
Q

Must be cut open longitudinally and fixed with cottons inside

A

Hollow Structures

56
Q

most important component of tumor resections because they are essential for prognosis and planning therapeutic options
- Should be received fresh and not immersed in formalin
- Node is bivalved, and entirely submitted

A

Lymph Nodes

57
Q

usually first lymph node to be involved
during metastasis. Entirely submitted. However, large specimens may be bisected, and submitted in one or two cassettes

A

Sentinel lymph nodes

58
Q

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

A

Mastectomy

59
Q

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 SPX

60
Q

Specimen with Tumor
- Identify:

A

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

61
Q
  • Aka “gross worksheet”
  • Guides histotechnician in assuring that all blocks are processed
  • Must be properly filled up; filled for future reference
  • Contains the following:
  • Accession number
  • Number of sections and blocks
  • “Comments” column (for special requests & etc.)
  • Gross description
A

Specimen Worksheet

HISTOPATHOLOGY (13 decks)

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