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Histopathology in Practice Sample Reception, Dissection, Processing, Embedding
1. Histopathology in Practice
Sample Reception, Dissection,
Processing, Embedding.
Della Thomas
Senior Biomedical Scientist
Independent Histopathology Services
della.thomas@unilabs.com
2. Histology
The science concerned with the microscopic
structure of tissues and organs in relation to
their function.
Also called microanatomy.
5. Specimen QC
Mickey Mouse
Rt nasal polyp
DOB:
MOUSE
Mr. MICKEY
18/11/28
26/11/13
Dr. Makewell
Rt nasal polyp
C/O loss of
function - ↓
ability to sniff
out cheese
O/E: nasal polyp
? nature.
18/11/28
123456
Dr. Makewell
26/11/13 8am
M
7. Sample documenting
Assign the
specimen to a
pathologist
MOUSE
Mr. MICKEY
Rt nasal polyp
C/O loss of
function - ↓
ability to sniff
out cheese
O/E: nasal polyp
? nature.
18/11/28
123456
Dr. Makewell
26/11/13 8am
M
11. Cut-up dictation
• “Morphology” computer
system
• “Dragon” dictation system
• Hands-free
• Just scan the barcode and
away we go!!
12. Specimen Categories
A
B
C
Specimens only requiring transfer from container
to tissue cassette.
D
E
Dissection and sampling required needing a
moderate level of assessment.
Specimens requiring transfer but with standard
sampling, counting, weighing or slicing.
Simple dissection required with sampling
needing a low level of diagnostic assessment
and/or preparation.
Specimens requiring complex dissection and
sampling methods
19. What does the pathologist
need to know?
Provide good descriptions - say what you see!!
• Shape
• Colour
• Texture
• Dimensions
• Weight
• Distances from margin(s)
• Orientation markers
• Cut surface appearance
etc....
• Keep your fingers crossed for good clinical history
22. Specimen Sampling
• Literally, taking a sample of the tissue
• Representative
• Generally, fewer blocks required if the tissue
looks uniform throughout (for benign cases)
• Sampling “rules”
23. Sampling rules: prostate chips
• If the chippings weigh 12g
or less, the entire
specimen must be
processed
• If the chippings weigh
more than 12g, a minimum
of 6 cassettes must be
processed
Prostate chips (19g)
Sampled in 8 cassettes:
First 12g = 6 cassettes
• For every 5g over 12g, one
more cassette must be
processed
19g = 7g over 12g
1 cassette per 5g over = 2
more cassettes.
39. Calcified / firm tissue
Most common:
• Femoral head
• Bone Marrow Trephine
• Ethmoid mucosa / nasal polyps (cartilage)
• Nail
• Hardened cysts
40. Softening
• For bony / hard tissue:
10% Formic Acid
• For nail:
Phenol or hair removal
cream.
41. Firm tissue testing methods
• X-ray - Expensive / ? bench space, but
very accurate
• Chemical end-point test (Ammonium
Hydroxide/Ammonium Oxalate) - very
time consuming, but accurate
• Physical manipulation - not very
accurate, may damage the specimen,
but simple and inexpensive
43. Specimen Storage
• Ventilated storage units
• Largest buckets lower shelves
• Units are in date (week) order
• 5-weeks’ worth of storage
• Only authorised specimens
are discarded after 5 weeks
• Any outstanding cases are
stored separately until further
notice
51. Embedding tips
• Always keep your eye on the tissue:
even for the most careful embedders,
tissue can ping like tiddlywinks. Make
sure you see where it lands!!
• Ink dots: usually used to instruct the
embedder to embed the tissue a specific
way. Make sure you know your own
lab’s protocol.
• Hide-and-seek: open lids / sponges
carefully - tissue often sticks to them.
~ why it’s important for the embedder to
know number of bits in the cassette
• Cleanliness: always watch out for potential carry-over!!