Specimen Handling (Ch. 2) Flashcards
What information should be included on a specimen label?
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
What information must be included on the requisition form?
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
What sort of information should you expect to find in the clinical history?
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
What are some common special instructions regarding specimen handling?
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
What is the minimum amount of time a specimen must be retained in storage following completion of a case?
2 weeks
What are some common methods surgeons use for indicating specimen orientation?
Sutures of varying lengths (short = superior, long = lateral) or colors
Metal clips
Pinning or suturing the specimen to cardboard, surgical drape, or needle grid
What is the definition of a ‘margin?’
Surfaces of a specimen that abut the tissue left behind in the patient (i.e., anywhere that a cut was made)
What are the two ways that surgical margin sections may be taken? In what circumstances might each be used?
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
For what applications is photographing a specimen especially useful?
Documentation
Teaching
Conferences
Publications
What specimens are photographed at Duke?
Any large, complicated, or unusual specimen Many large oriented skins All oriented breast specimens Large bone tumor resections Traumatic amputations "Cool" things
How should you prepare to take a specimen photo?
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
How else could you document a specimen, should the camera not be working?
Photocopy
Scanner
Hand-drawing
What are some special studies that might be performed on a specimen?
Histochemistry Immunoperoxidase/immunohistochemical stains Electron microscopy Snap freezing Immunofluorescence Molecular diagnostics Cytogenetics Flow cytometry Radiography Microbiologic cultures
On what type of tissue are most histochemical stains performed?
Formalin-fixed, paraffin-embedded tissue
What are the indications for immunoperoxidase staining?
Tumor classifications Determining in situ vs. invasion Prognosis To guide therapeutic decisions To identify extracellular material To identify infectious agents
What are some commonly requested immunoperoxidase stains at Duke?
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
When are electron microscopy studies commonly requested at Duke?
Muscle and nerve biopsies Sarcoma workup Pediatric tumor workup Other difficult-to-classify tumors Medical heart biopsies Renal biopsies Nasal cilia biopsies
What fixative is used to prepare electron microscopy specimens?
4% buffered glutaraldehyde
When might you want to snap freeze a specimen?
For some immunoperoxidase stains, enzyme studies, and DNA/RNA studies
Most often used diagnostically at Duke for lymphoproliferative disorders
For what disorders is immunofluorescence detection useful?
Immune complex deposition diseases, such as glomerular diseases and bullous skin disorders
Also explanted donor kidneys
What specimens are typically submitted for cytogenetic studies?
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
What techniques are often used for molecular diagnostics? What specimens are typically submitted for MD?
Southern blots, PCR, and FISH
Lymphoproliferative disorders and pediatric tumors
What characteristics of cell populations are analyzed during flow cytometry?
Cell size
Cytoplasmic granularity
DNA content
Presence or absence of immunohistochemical markers
For what specimens might radiography be necessary?
Breast biopsies with localizing microclips
Lumpectomy specimens with microcalcifications
What is used to snap freeze specimens?
Liquid nitrogen
