Surgical Pathology

Question 1

what is considered the routine and is the most widely used procedure to examine specimens?

Answer 1

paraffin embedding method

*this is most accurate and conclusive

Question 2

which method is used intra-operatively to examine specimens?

Answer 2

frozen section

Question 3

which method is exfoliative and uses fine needle aspiration to examine specimens?

Answer 3

cytological diagnosis

Question 4

what are the general rules for biopsy?

Answer 4

• avoid necrosis and hemorrhage areas
• the larger the lesion, the more numerous biopsies you need
• for ulcerated tumor, peripheral biopsy is suggested
• all fragments should be collected
• do not squeeze, crush, or do cautery
• fix in fixatives ASAP if it is for paraffin sectioning
• orienting specimen (e.g. deep/ superior/inferior margins)

Question 5

what kind of container should you get for your specimen?

Answer 5

• size should be corresponding to specimen volume
• lid for leak-proof
• wide mouth, flat bottom

Question 6

how much fixative: specimen volume ratio should you use?

Answer 6

10x volume of fixative over the specimen volume

Question 7

what is the penetration rate of fixative solution?

Answer 7

1mm/ hr

Question 8

what is in the neutral buffered formalin solution?

Answer 8

100mL of formalin
900 mL of distilled water
(this makes a final volume of 1000mL) and is a 10x dilution

Question 9

what % of formalin is found in a 1000 mL volume of neutral buffered formalin?

Answer 9

10%formalin

Question 10

what is the best fixative solution?

Answer 10

10% formalin

Question 11

what are the advantages of formalin?

Answer 11

• satisfactory penetration into tissue
• little shrinkage
• very economic
• preserves color of tissue
• preserve fat & RBC well
• satisfactory hardening
• special stains can be used on tissues after fixation

Question 12

what are the disadvantages of formalin?

Answer 12

• needs to be changed every 3-6 months

- cannot preserve glycogen

Question 13

what are the procedures for paraffin sectioning?

Answer 13

1. fixation- w/ formalin
2. dehydration
3. clearing
4. paraffin impregnation
5. embedding
6. sectioning
7. attachment
8. dewax
9. staining
10. mounting

Question 14

in an H&E staining, what appears blue? what appears pink-red?

Answer 14

blue (basophilic)- nucleus

red (acidophilic)- cytoplasm

Question 15

what are the indications for frozen section?

Answer 15

• benign or malignant lesions
• metastatic lymph node
• adequacy of surgical margins
• presence/absence of ganglion cells in large intestinal wall of Hirschsprung disease

Question 16

what can you conclude in terms of a diagnosis from a frozen section?

Answer 16

NOT a specific diagnosis (cannot definitely say benign vs. malignant)

Question 17

what can you conclude in terms of a diagnosis from a frozen section?

Answer 17

NOT a specific diagnosis (cannot definitely say benign vs. malignant)

Question 18

what kinds of specimens should be collected for frozen section?

Answer 18

• must be fresh tissues

- small size of tissue (

Question 19

what are inappropriate specimens for frozen section?

Answer 19

• thyroid tissue
• large specimens
• highly infectious specimens: HIV, TB, hepatitis