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Histotechnology 1 > Specimen Entry and Grossing > Flashcards

Specimen Entry and Grossing Flashcards

1
Q

Why examine tissues?

A

Normal vs Abnormal
Benign vs Malignant
Unusual findings
Correlate with other lab findings – hematology, chemistry, microbiology

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2
Q

What tissues are removed from the body? (what not)

A

All tissue removed from the body except:

Exceptions: teeth, varicose veins, hernias, foreskin, tonsils from children, and normal placenta

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3
Q

Who decides what tissues are not removed from the body and examined?

A

Almost everything removed from the human body must be sent to the laboratory for description and microscopic examination. The College of Physicians and Surgeons have made an exception list.

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4
Q

What are reasons tissues are removed from the body during surgery?

A

Many different reasons:
SURGICAL – macro/microscopic examination, determine if pathology. Assist with treatment plan and prognosis of the patient.
MAJOR SURGICAL PROCEDURES
Whole Organ – such as uterus, lung, thyroid, etc
Partial Organ – such as lung, bowel, etc.
Excised Tumour – tumour w/ surrounding tissue and associated lymph nodes removed
Amputation - limb, appendage of the body
MINOR SURGICAL PROCEDURES
Cysts – entire cyst is removed
Biopsy – small piece of tissue from a larger source
Curettage – tissue growth or other material removed from a body cavity wall by a curette (a spoon shaped instrument)
Products of Conception (POC) – Tissue resulting from a miscarriage or an abortion
Exfoliated Cells – cells that have fallen off or been separated from the body during a normal or disease process

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5
Q

What is a biopsy specimen?

A

Biopsy Specimen – small piece of tissue taken from a living person for investigation of a disease process. Can be obtained in a variety of non-surgical methods.

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6
Q

What are the different type of biopsies (6)?

A
  1. Needle (aspiration) Biopsy
  2. Excision Biopsy
  3. Endoscopic Biopsy
  4. Wedge Biopsy
  5. Abrasion Biopsy
  6. Cone Biopsy
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7
Q

What is a needle (aspiration) biopsy?

A

Needle (aspiration) Biopsy – hollow needle inserted through the skin into an internal organ. Part of the internal organ passes into the needle and is removed on extraction of the needle. This technique is used for liver and kidney biopsies.

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8
Q

What is an excision biopsy?

A

Excision Biopsy – removal of a small lesion. Removal of a skin tag or lesion is an example of this.

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9
Q

What is endoscopic biopsy?

A

Endoscopic Biopsy - a small specimen of the digestive or respiratory tract can be obtained by inserting an endoscope

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10
Q

What is wedge biopsy?

A

Wedge Biopsy – small specimen obtained during exploratory surgery. Surgeon takes a small pie-shaped piece of a particular organ. This may be from the liver, kidney, breast, etc.

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11
Q

What is abrasion biopsy?

A

Abrasion Biopsy - abraded or scraped from the surface of a lesion by a sponge or brush. This could be from a skin or mouth lesion.

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12
Q

What is a cone biopsy?

A

Cone Biopsy – special procedure in which a cone-shaped portion of the cervix is removed

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13
Q

What is an autopsy?

A

AUTOPSY - tissue removed during the post mortem examination to determine the actual cause of death

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14
Q

What are the various classes of autopsies?

A

Classification of Autopsies
Sudden or unexpected death
request of family when death occurs at home
patient dies in hospital – family permission
Medico-legal – permission is not required from family
Referred from another institute

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15
Q

What is the pathway of a specimen in histopathology?

A

Arrival of specimen at laboratory - identification, accessioning
Technical preparatory steps - gross examination, dissection, chemical treatment, processing, embedding, microtomy, staining
Pathologist viewing – microscopic evaluation of H&E slides Additional requirements - recuts, special demonstration techniques
Reporting steps - verbal, word processing
Storage - filing - blocks, slides, requisitions

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16
Q

How does a specimen typically arrive to a histopathology lab?

A

The specimen arrives at the laboratory in fixative, or fresh, according to protocol for that specimen.

A fixative stops any decomposition of the specimen.

If the specimen is very small it is usually placed into a fixative immediately.

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17
Q

Diagram the histology workflow?

A

See slide 10 from Specimen Entry and Grossing lecture.

  1. Specimen comes to lab - gets accessioned
  2. Grossing
  3. Fixation, may require decalcification
  4. Processing
  5. Embedding
  6. Microtomy
  7. Staining
  8. Coverslipping
  9. Evaluation
  10. Pathologist examination
  11. Recut or special stain requests
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18
Q

Where is labelling done?

A

Labelling - done at the site of specimen procurement

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19
Q

What label information is put on the specimen?

A

SPECIMEN: Patient name, MHSC #, Dr.

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20
Q

What information is on the requisition?

A

REQUISITION: Patient name, ID #, PHIN#, Dr., number of specimen submitted, Type and exact location of specimen, past history, and clinical diagnosis (specimen should be rejected if not all information is there)
Match specimen and requisition

21
Q

What is the hospital information system typically called?

A

LABORATORY INFORMATION SYSTEM (LIS)

22
Q

What is important to verify between the requisition and the sample label?

A

A requisition is the paper that accompanies the specimen. The information on it must match the information on the sample exactly!

23
Q

How are lab numbering typically done?

A

LAB Number:
JAN 1ST: STARTS AT #1;
Includes the last two digits of the year (20)
Letter to indicate what hospital specimen accessioned at
Bar code acc. number put on req., sample, cassettes, slides
Most hospitals use the “S” designation for surgical specimens and “A” for autopsy

24
Q

Manitoba Hospitals uses an ___________ cassette labelling machine.

A

automatic

25
Q

What are the provincial colour of cassettes?

A 
Provincial Colour of cassettes:
White – routine
Green – urgent (prelim results out by 1100 am the next day)
Pink – pediatric specimen
Peach – biopsy &/or special techniques
Lilac – resident specimens
Orange – decalcification specimen
Beige – neural specimen
Red – immuno specimen
Blue and Yellow– autopsy
26
Q

If you handwrite the cassette label in pencil, what kind of pencil is used and why?

A

Handwrite label cassettes in the lab with special “histo” pencils whose markings won’t come off in processor or embedding station.

27
Q

What is a gross description?

A

Gross Description: Precise and thorough rendition of what was received and in what condition. Done by pathologist assistant.

It includes the size, colour, consistency, texture, shape, weight and any other helpful information. It must be accurate, and factual. It must state whether some or all of the tissue was submitted. This will help the pathologist in their diagnosis.

28
Q

In the gross description process, describe what specimens are submitted for processing?

A

Small representative samples are retrieved and submitted for processing (“blocking”)
3 x 2 x 0.3 cm (size slightly smaller than tissue cassette)
Established protocols
Small specimen = everything in one cassette
Large specimen or organ = 1 – 70 cassettes

29
Q

How are mix-ups between specimens avoided during grossing?

A

SIMILAR SPECIMENS ARE ALWAYS SEPARATED BY OTHER TYPES OF TISSUE

30
Q

Describe the bench area typically used for grossing.

A

Bench area:

  1. Must be well ventilated with a fume hood
  2. Must have good lighting
  3. Appropriate location of recording device (should not have to touch with hand to activate)
  4. Plexiglass screen to prevent splashing
31
Q

Describe the gross dissection board typically used for grossing.

A

Gross Dissection Board:
1. Must be impervious and readily cleaned
2. High density polyethylene commonly used, usually sits in a stainless steel tray which drains to a sink
3. Paper towel used on board
- Changed between specimens
- Helps absorb liquid
- Helps prevent carryover between cases
- Disposed into biological waste bag – tiny
fragments of tissue
4. Specimens are drained through a sieve into a sink.

32
Q

Describe the various types of cutting tools used for grossing.

A

Cutting Tools:
1. Stainless steel scalpel handle and disposable blades
2. Blade size 22 is common
3. Dissecting scissors may be used
4. Dissecting knives - Large specimens are sliced, similar in size to kitchen carving knife
5. Saw - Bone specimens
Note: Amputated specimens are often dissected in the autopsy suite where there is appropriate equipment

33
Q

Describe other misc. equipment used for grossing.

A

Forceps - Variety used for different purposed
Ruler – for measurement of specimen
Scale – to weigh specimen
Marking reagents
Ink - indicates resection margins or guide to embedding
Wax trays
Pins
Fixative - 10% neutral buffered formalin most common – usually on tap
Cassettes
Computer Terminal

34
Q

What info is entered in the computer and what special precautions are taken with its use?

A

Computer Terminal
Used to update information on the LIS system, number of cassettes per specimen, special instructions for embedding, cutting, or staining
Keyboard protected by a cover, must be able to clean

35
Q

Describe a typical routine cassette.

A

ROUTINE – perforated plastic container 4 x 3 x 0.5 cm with a snap lid.

36
Q

How is loss of biopsy tissue prevented?

A

Prevention of loss of Tissue

  1. Biopsy Cassette – smaller perforations
  2. Sponges – keep tissue in place
  3. Fine mesh bags or paper wraps – allows fixative to enter and fix specimen but avoids loss of tissue.
  4. Must be careful when unwrapping!
37
Q

Where do you label cassettes?

A

LABELLING

Label on beveled edge - have to be able to read label after it is filed in a box.

38
Q

How do you properly fix lung?

A

Lungs are fixed inside and out. First fixative is pumped inside the lung.

39
Q

Why is a specimen marked with resection lines?

A

There are two different reasons why a specimen may be marked:

  1. Identify the resection margins / cut edges of the specimen - aids Pathologist in visualizing whole organ from the blocks which were selected. When blocks are selected they are taken from the excision margins as well as the tumour area of the specimen.
  2. Guide to embedding - Sometimes it is extremely important to embed tissue so that a particular plane is sectioned.
40
Q

How are marked resection lines performed?

A

Marking is achieved by dipping a swab into a coloured reagent and touching the tissue on certain locations.

41
Q

What are some common marking reagents/methods used?

A

Common marking reagents and/or methods:

  1. Mrs. Stewart’s blueing,
  2. Mercurochrome (temporary),
  3. Tattoo or India ink or
  4. Swabs impregnated with silver chloride (permanent). 5. Small “v” shaped groove as an alternative to marking.
42
Q

How are autopsy specimens grossed?

A

Autopsy specimens don’t go through the normal grossing and dissection area. The organs/tissues are described and recorded in the autopsy suite.
1. Small pieces of most organs removed (each
pathologist will have their own routine requests) –
fixed in 10% NBF
2. Smaller pieces put into labelled cassettes
3. Whole brain is removed and fixed 10-14 days
4. Fluids may be taken for toxicology screens,
chemistry results
Small pieces are put into cassettes in the morgue and put in a fixative. They will have the year and then “A” on the cassette.

43
Q

What safety practices are taken in the grossing and dissection area?

A

ROUTINE PRACTICES: Fresh tissue is potentially infectious
VENTILATION – chemicals are quite dangerous to breathe in (formalin is considered a carcinogen)
AEROSOLS & SPLASHING – proper PPE must be worn
SHARPS CONTAINMENT
Known Diagnosis – may be put on the requisition to protect the technologist (still have to keep confidential – PHIA)

44
Q

Give some examples of known diagnosis that are made known so that special precautions can be taken. Describe those special precautions.

A

HEPATITIS, TB – EXTEND FIXATION (At times liver biopsy containing hepatitis is fixed for 24 hours instead of 4 hours)
AIDS – ROUTINE FIXATION (24-48 hours)
CJD – EXTENDED SPECIAL FIXATION (the tissue should be fixed for a minimum of one week in phenolized formalin before tissue processing)

45
Q

How are instruments cleaned in the grossing and dissection area?

A

INSTRUMENTS

  1. Disposable blades – biohazard sharps containers, incinerated
  2. Non-disposable small equipment –
    a) Soak in commercial laboratory detergent containing a phenolic disinfectant. Some facilities autoclave afterwards while others wash in hot soapy water.
    b) Soak in glutaraldehyde disinfectant for the recommended time followed by hot soapy water.
46
Q

How is the bench cleaned in the grossing and dissection area?

A

BENCH

  1. CLEAN PAPER TOWELS BETWEEN CASES – prevent carry-over
  2. Sodium Hypochlorite – made fresh daily.(hypochlorite should not be used on the metal drain tray as it corrodes metal. An alternative for hypochlorite is glutaraldehyde as it does not corrode).
47
Q

What is done with general waste material (not sharps) in the grossing and dissection area?

A

WASTE MATERIAL – Paper towels, tissue fragments, gloves, disposable aprons, etc.
Biohazard bag, incinerated

48
Q

How are specimens stored and for how long?

A

Completed specimens are checked to see that they are covered with fixative and are then filed numerically on shelves in tightly sealed containers.
The length of time that a specimen is kept varies which each institution - 1 to 3 months is the norm in a routine hospital laboratory
Some legal cases are identified and kept indefinitely

Histotechnology 1 (10 decks)

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