PRELIM LEC: PRE-ANALYTICAL FACTORS, GROSS EXAMINATION Flashcards by Chin Lys

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

Ischemia Time

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Ischemia Time DIVIDED INTO:

Warm Ischemia Time
Cold ischemia time

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Occurs during operation when blood supply of tissue is cut
off

Warm Ischemia Time

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

Ischemia Time

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

Warm Ischemia Time

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Beyond the control of the histopathology lab

Warm Ischemia Time

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

Cold Ischemia Time

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

Warm Ischemia Time

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Extensions may contribute to poor fixation

Cold Ischemia Time

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If prolonged, temperature of specimen will gradually reach the external temperature, and autolysis and drying of the surface may occur

Cold Ischemia Time

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All parts to be examined must be initially fixed

Pre-Analytic Fixation

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Earlier fixation  better preservation of tissue morphology

Pre-Analytic Fixation

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Proper ratio with tissue must be observed

Pre-Analytic Fixation

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

Pre-Analytic Fixation

6-48hrs

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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

sectioned prior to fixation

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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.

Specimen Reception

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Criteria for Rejection of Specimens:

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

Specimen Accessioning

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

Specimen Accessioning

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Also useful for ease of retrieval of specimens, slides, and blocks

Specimen Accessioning

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Indicating codes may be used for the following

Specimen Accessioning

o Surgical
o Autopsy
o Cytology

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

Specimen Accessioning

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

GROSS EXAMINATION

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One of the basis of pathologists’ diagnosis

GROSS EXAMINATION

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

GROSS EXAMINATION

cleaned before and after use (to avoid carryover)

Cutting Tools

Cutting Tools:

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

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

CATEGORY A

Gross Table or Gross Workstations:

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

Specimen Categories:

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

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

CATEGORY A

CATEGORY A SPECIMEN EXAMPLE

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

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

CATEGORY B

CATEGORY B SPECIMENS EXAMPLE

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

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

CATEGORY C

CATEGORY C SPECIMENS EXAMPLE

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

Dissection and sampling required needing a moderate level of assessment

CATEGORY D

CATEGORY D SPECIMENS EXAMPLE

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

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

Specimens requiring complex dissection and sampling methods

CATEGORY E

CATEGORY E SPECIMENS EXAMPLE

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

Identify orientation markers used by surgeons, if available

Describing Specimens and Gross Description

Identify the specimen. Note and verify all anatomical structures.

Describing Specimens and Gross Description

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

Inks

– indicates laterality

Nicks

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

Sutures

Describe all notable characteristics:

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

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

Weight

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

Dimensions

Taking a representative sample of the tissue.

Sectioning

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

Small specimens

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

Large specimens

Specimen must fit easily into the standard cassette, which measures

3 x 2.5 x 0.4 cm

Indicate number of sections and blocks on the gross description

sectioning

When possible, edges of tissue should be

squared

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

Paper tags

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

Thickness

if printed, ___ must be used.

dot matrix

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

yasss

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

Brain

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

Colon Cancers Polyps

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

Large polyps

Bisected and placed in one cassette

Small polyps

- 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

Dermatologic SPX

Inject fixative first then gross.

Eyes

Wash in running water then immerse in tissue softeners

Hard Tissues

Must be cut open longitudinally and fixed with cottons inside

Hollow Structures

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

Lymph Nodes

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

Sentinel lymph nodes

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

Mastectomy

Additional processes such as IHC, flow cytometry, cytogenetics and molecular genetics is often done. These may require fresh, frozen, or specially processed tissues

Pediatric SPX

Specimen with Tumor - Identify:

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

- 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

Specimen Worksheet