Specimen Handling (Ch. 2)

Question 1

What information should be included on a specimen label?

Answer 1

Patient’s first and last name
Medical record number
Date specimen was obtained
Site of specimen
Initials of person labeling the container
Time the specimen was placed in the container
Fixative, if any

Question 2

What information must be included on the requisition form?

Answer 2

Patient identifiers
Clinical diagnosis or differential
Pertinent clinical history
Procedure performed, including date and time
Site of each container
Requesting physician’s name, signature, and contact information
Any special instructions regarding specimen handling

Question 3

What sort of information should you expect to find in the clinical history?

Answer 3

Purpose of removal of the specimen
Type of specimen
Locations and types of any lesions
Prior diagnoses
Prior/current treatment
Specific purpose of the consultation
If the specimen requires expedited diagnosis or any special processing
Special instructions for disposition

Question 4

What are some common special instructions regarding specimen handling?

Answer 4

Special stains (e.g. lymphoma workup)
Whether a specimen should be processed as STAT
Requests for a specific attending pathologist or service to be assigned

Question 5

What is the minimum amount of time a specimen must be retained in storage following completion of a case?

Answer 5

2 weeks

Question 6

What are some common methods surgeons use for indicating specimen orientation?

Answer 6

Sutures of varying lengths (short = superior, long = lateral) or colors
Metal clips
Pinning or suturing the specimen to cardboard, surgical drape, or needle grid

Question 7

What is the definition of a ‘margin?’

Answer 7

Surfaces of a specimen that abut the tissue left behind in the patient (i.e., anywhere that a cut was made)

Question 8

What are the two ways that surgical margin sections may be taken? In what circumstances might each be used?

Answer 8

Tangential (shave, parallel, en face) - useful in large resection specimens where the disease process is well free of the margin
Perpendicular - useful when the lesion is close to the margin or for certain tumors with poorly defined borders

Question 9

For what applications is photographing a specimen especially useful?

Answer 9

Documentation
Teaching
Conferences
Publications

Question 10

What specimens are photographed at Duke?

Answer 10

Any large, complicated, or unusual specimen
Many large oriented skins
All oriented breast specimens
Large bone tumor resections
Traumatic amputations
"Cool" things

Question 11

How should you prepare to take a specimen photo?

Answer 11

Use a solid background, such as a clean cutting board with attached ruler
Blot blood and gore to prevent it from leaking
Include a label with patient’s name, MRN, date, specimen site, and accession number
Position the label so it can be cropped

Question 12

How else could you document a specimen, should the camera not be working?

Answer 12

Photocopy
Scanner
Hand-drawing

Question 13

What are some special studies that might be performed on a specimen?

Answer 13

Histochemistry
Immunoperoxidase/immunohistochemical stains
Electron microscopy
Snap freezing
Immunofluorescence
Molecular diagnostics
Cytogenetics
Flow cytometry
Radiography
Microbiologic cultures

Question 14

On what type of tissue are most histochemical stains performed?

Answer 14

Formalin-fixed, paraffin-embedded tissue

Question 15

What are the indications for immunoperoxidase staining?

Answer 15

Tumor classifications
Determining in situ vs. invasion
Prognosis
To guide therapeutic decisions
To identify extracellular material
To identify infectious agents

Question 16

What are some commonly requested immunoperoxidase stains at Duke?

Answer 16

CMV - cytomegalovirus in immunosuppressed patients
ADV - adenovirus in small/large bowel in immunosuppressed pediatric patients
HP - H. pylori in all gastric antral biopsies
Cytokeratin - sentinel lymph nodes in breast cancer
EBNA 2 & LMP-1 - Ebstein-Barr virus
Calretinin - Hirschsprung’s disease

Question 17

When are electron microscopy studies commonly requested at Duke?

Answer 17

Muscle and nerve biopsies
Sarcoma workup
Pediatric tumor workup
Other difficult-to-classify tumors
Medical heart biopsies
Renal biopsies
Nasal cilia biopsies

Question 18

What fixative is used to prepare electron microscopy specimens?

Answer 18

4% buffered glutaraldehyde

Question 19

When might you want to snap freeze a specimen?

Answer 19

For some immunoperoxidase stains, enzyme studies, and DNA/RNA studies
Most often used diagnostically at Duke for lymphoproliferative disorders

Question 20

For what disorders is immunofluorescence detection useful?

Answer 20

Immune complex deposition diseases, such as glomerular diseases and bullous skin disorders
Also explanted donor kidneys

Question 21

What specimens are typically submitted for cytogenetic studies?

Answer 21

All pediatric tumors, including lymphomas
Some sarcomas
Tubes and ovaries in patients who have had a BSO and have a history of BRCA 1 and 2 mutations

Question 22

What techniques are often used for molecular diagnostics? What specimens are typically submitted for MD?

Answer 22

Southern blots, PCR, and FISH

Lymphoproliferative disorders and pediatric tumors

Question 23

What characteristics of cell populations are analyzed during flow cytometry?

Answer 23

Cell size
Cytoplasmic granularity
DNA content
Presence or absence of immunohistochemical markers

Question 24

For what specimens might radiography be necessary?

Answer 24

Breast biopsies with localizing microclips

Lumpectomy specimens with microcalcifications

Question 25

What is used to snap freeze specimens?

Answer 25

Liquid nitrogen