surgical pathology

1. DEPARTMENT OF PATHOLOGY F.M.C ASABA A SEMINAR PRESENTED BY: NWACHUKWU CHIGOZIE J TOPIC: SAMPLE HANDLING IN SURGICAL PATHOLOGY DATE: 4 TH JULY, 2013

2. OUTLINE INTRODUCTION DEFINITION OF TERMS SOURCES OF SAMPLE FOR SURGICAL PATHOLOGY TRANSPORTATION OF SURGICAL PATHOLOGY SPECIMEN RECEPTION AND SAMPLE IDENTIFICATION CRITERIA FOR ACCEPTING SAMPLE IN SURGICAL PATHOLOGY CRITERIA FOR REJECTING SURGICAL PATHOLOGY SAMPLE HANDLING OF SPECIMEN FOR FROZEN SECTION CYTOPATHOLOGY SAMPLE CONCLUSION

3. INTRODUCTION Surgical pathology is the aspect of Anatomical Pathology that deals with the gross and microscopic examination of surgical specimens, as well as biopsies submitted by surgeons and other medical practicioners . Surgical pathology specimens are obtained through invasive procedures, and in many instances no remaining diagnostic tissue of that type is available. Proper specimen handling requires that specimen integrity be maintained by proper preservative when indicated.

4. DEFINITION OF TERMS SPECIMEN : any product of a medical procedure. Also “sample ”, “specimen”, and “tissue”. FIXATIVE : a solution used to stabilize cellular components in preparation for histological examination. FRESH : no fixative has been used. Fresh tissue samples must be frozen, placed in a transport media to keep the cells alive, or stabilized in some other way as soon as possible to prevent autolysis . PERMANENTS : specimen that have been treated with fixative and processed to a paraffin matrix that permanently preserves them at ambient temperature. GROSS ONLY EXAMINATION : a descriptive exam of the macroscopic features of the specimen that does not include a microscopic exam. Specimens for “gross only” are usually foreign bodies or otherwise not practical to be made into permanents.

5. SOURCES OF SAMPLE FOR SURGICAL PATHOLOGY Three main sources: BIOPSY Core Incisional Excisional SURGICAL RESECTION AUTOPSY Others.

6. TRANSPORTATION OF SURGICAL PATHOLOGY SPECIMEN All samples for paraffin embedding should be transported to the laboratory, preferably, in a general purpose fixative e.g. formalin and its derivatives. Leak-proof container, larger than the specimen and properly labeled with patient data should be used. Sample for frozen section to be delivered to the lab unfixed in an appropriately clean container. Peripheral nerve biopsy  3-4cm should be placed directly on a cardboard or notecard, allowed to dry, then transported to lab immediately. Paraffin block could be received in envelope pack, with accompanying report of initial diagnosis.

7. RECEPTION AND SAMPLE IDENTIFICATION In the lab: Adequacy of fixative Check sample for proper labeling Cross-check label on container with requisition form Check other details in requisition form, viz 1. Patient name. 2 . Medical record (M) number. 3 . Patient location. 4 . Patient age. 5 . A concise and complete summary of relevant patient clinical history. 6 . Pre-op and post-op diagnosis. 7 . Specimen source. 8 . Date specimen was obtained . Register sample in the laboratory register and assign lab number with which the sample will be identified in the remaining lab procedures.

8. CRITERIA FOR ACCEPTING SAMPLE IN SURGICAL PATHOLOGY Adequately fixed; Properly labeled; Accompanied with requisition form.

9. CRITERIA FOR REJECTING SURGICAL PATHOLOGY SAMPLE Unlabeled or unidentified specimen will NOT be accessioned until properly labeled by physician or their designee. Lack of request form. Sample placed in an inappropriate fluid ( savlon etc ) for more than 24hrs. Unusual specimen e.g. blood, urine, stool, csf , etc. CAVEAT: except sample is meant for cytology.

10. HANDLING OF SPECIMEN FOR FROZEN SECTION Frozen section of tissue is typically performed for intra-operative diagnosis , therefore timely results are important . The specimen should be brought to the Laboratory in a fresh, moist state with no fixative added . Received sample should be transferred to the refrigerator without delay.

11. CYTOPATHOLOGY SAMPLE Samples for both Gynaecological and non- gynaecological cytology. Slides fixed in appropriate cytological fixative. Fluids from various body cavities e.g. pleural, peritoneal, synovial, sputum etc. Sample meeting aforementioned criteria is received, registered and sent into the lab for further processing.

12. CONCLUSION The accuracy of any laboratory result is hinged on analyzing the right sample on the right patient at the right time. In order to achieve this objective, samples for surgical pathology should be handled in such a manner that will ensure the tissue retains its in vivo characteristics as it is often difficult to get a new sample if the initial one is lost or distorted.

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