examination of surgical specimens & biopsies ... Clean instruments thoroughly : Weekly. Check of mechanical parts : Every six months ... – PowerPoint PPT presentation
1 BASICS IN ANATOMICAL PATHOLOGY 2 Patient care is increasingly basedupon information provided by examination of surgical specimens biopsies 3 Patient report must contain all data necessary for appropriate patient care 4 The ultimate goal is to attain uniformity consistency ofincluded data found to be relevant to clinical management of patient 5 Quality assurance inanatomical pathology
Goals
Accuracy
Completeness
Timeliness of all the reports
6 Topics
Specimen collection
Specimen handling
Fixation
Processing
Tissue embedding
Staining
Cover slipping slide mounting
Reporting
7 What should be considered by the surgeon
Sample collection
Preoperative consultation with pathology staff about
Requirements for selection , handling , transporting and processing of tissues
Size of biopsy
Number of biopsies
Surgical margins
8 What should be considered by the surgeon
Sample handling
Not slicing the tumor specimen
Immediately placing the specimen into fixative
9 Containers
Types
Reusable or Disposable
Clean uncontaminated
Adequate size
Labeled after placing the specimen
10 Labeling
Two patient identifiers are required through the whole processing of the specimen
Patient , s name
Patient , s date of birth
Laboratory number
Hospital number
11 Fixation
Good preservation of tissue is the most important factor in the production of satisfactory histology slides
12 Aims of fixation
To prevent autolysis or decomposition ( due to bacterial or osmotic change )
To preserve tissue as near to its original form as possible
To protect tissue against subsequent changes during processing embedding
13 Aims of fixation
To give tissue a texture which permits easy sectioning
To render the various constituents of the tissue reactive to the proposed stains
14 Essentials to good fixation
Fresh tissue
Proper penetration of fixative
Right choice of a correctly formulated fixative
15 No fixative will penetrate a piece of tissue ticker than 10 mm 16
Solid organs cut slices not ticker than 5 mm
Hollow organs open out or fill with fixative
Large specimens inject fixative along vessels (or bronchi in case of lungs )
17
All fixative are used once only
Adequate volume (gt 2/3 of the container volume )
10 times volume of fixative to tissue
Fixation at room temperature ( not be heated )
18 Types of fixatives 19 Formalin
Commercially available solutions
37 - 40 formaldehyde in water
Conventional fixation is usually carried out in 10 neutral buffered formalin ( NBF )
20 Formalin
Suggested fixation time
gt8 hrs
24 - 48 hrs for complete fixation
(1/10 specimen to fixation ratio)
Formalin in containers should be replaced weekly and a standard PH should be adopted.( either neutral or slightly acidic )
21 Formalin benefits
Readily available
Penetrates tissue quickly
Long term storage in formalin is possible
22 Formalin disadvantages
penetrates quickly but fixation is slow
( may not be complete with shorter times )
May not be suited to long term storage of tissue for ICC
Hardens specimens
Antigen cross-linking
Partial Ag disappearance
Special handling disposal requirements
23 Notice
HCL and formalin should be avoided in combination
Formalin has respiratory and carcinogenic effects .
24 Zinc formalin
Mixture of zinc sulfate and formalin
Fixation time
4 48 hrs
( 4 - 6 hrs for complete fixation )
25 Zinc sulfate benefits
Shorter fixation time
Minimal need for Ag unmasking or retrieval
Preserve better tissue Ag morphology
26 Zinc formalin disadvantages
Possible quenching of primary fluorescence
Special handling and disposal requirements
27 Alcohol / Acetone
As 70 - 95 Et OH
90 Et OH / 10 acetone
For
Histopathology
Cryostat frozen section
Cytology smears
28 Fixation time
Variable
( often in tissue processing secondary
to formalin fixation )
10 - 15 minutes for
cryostat sections
cytology smears
29 Alcohol / Acetone benefits
Shorter fixation time ( 5 mm3 in 4 hrs )
Better cryostat sections
Good preservation of cytoplasmic intermediate filaments
30 Alcohol / Acetone disadvantages
quality and integrity of ICC staining
( especially after long term storage )
Ethanol has shrinking hardening effects
on tissues
31 Note
Tissue incompletely fixed by NBF or Zinc formalin will be subjected to alcohol fixation in the tissue processor
32 Bouin
Mixture of formalin and picric acid
Fixation time 1 -12 hrs
33 Bouin
Is used when enhanced staining for
connective tissue is required
34 Bouin benefits
Fixes tissues rapidly
An excellent premordant fixative for chromatin to be demonstrated ( if using iron haematoxylin methods )
Useful particularly for endocrine tissues and tumors
35 Bouin disadvantages
Preservation of many types of Ags
( particularly lipid containing Ags )
Poor penetration under fixation
Longer fixation brittle tissue
nuclear staining
36 B 5
Mixture of formalin mercuric chloride
sodium acetate
Fixation time 1 6 hrs
37 B 5 benefits
Primary use in lymph node tissue
Enhanced cytologic detail and immunoreactivity of cytolologic Igs
intracytoplasmic Ags
38 B 5 disadvantages
Tissue hardening
Surface Ags not well demonstrated
Special handling disposal requirements
39 Marker dye
For extremely small biopsies
6 drops of 4 aquaous eosin to 1 liter of 10 buffered formalin
40 Decalcification
Tissue disruption and removal of minerals ,
particularly hemosiderin
The procedure
- Adequately fixed tissue ( 48 hrs )
- Draining off fixative
- Replacing decalcifier ( 10 X to 20 X
specimen volume )
- Everyday checking for presence of Ca
( with dipstick or ammonium oxalate )
41 Macroscopic description cutting up the specimens 42 Rules
Qualified and trained staff
Established and documented macroscopic
description protocol
43 Processing
Dehydration clearing
Embedding
44 Dehydration clearing
Removing the water from within the tissue
cells removing the dehydration agent from the tissue prepared for paraffin embedding
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