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Histopath LEC > PRE-ANALYTICAL FACTORS > Flashcards

PRE-ANALYTICAL FACTORS Flashcards

(64 cards)

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1
Q

PRE-ANALYTICAL FACTORS
_______
• Time interval between surgical intervention and proper fixation of the removed specimen

A

Ischemia Time

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2
Q

Ischemia time

A

Surgical theatre

Pathological anatomy

Grossing

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3
Q

> Starts a series of biochemical changes that leads to tissue poor quality
Affected by the whole surgical procedure

A

Warm Ischemia Time

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4
Q

> Occurs during operation when blood supply of tissue is cut off

A

Warm Ischemia Time

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5
Q

• Prolonged > temperature of specimen will gradually reach the external temperature, and autolysis and drying of the surface may occur

A

Cold Ischemia Time

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6
Q

• Interval between tissue removal from the patient and arrival in the pathology laboratory for grossing

A

Cold Ischemia Time

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7
Q

Pre-Analytic Fixation

• All parts to be examined must be initially____
•_______-> better tissue preservation
• _______-> impede tissue processing

A

fixed

Earlier fixation

Improper fixation

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8
Q

Pre analytic factors

• Observe proper tissue-to-fixative ratio

• 3-5mm thick tissues: fixed for…

•______ thick tissues and_____(such as limbs): sectioned prior to fixation, or else, fixation will not be complete and may occur only at the periphery of the tissue

A

6-48hrs

5mm; large tissues

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9
Q

Specimen Reception
• Specimens must be put in a container labeled with

A

patient’s name
specimen source/site
pathology requisition form

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10
Q

Criteria for Rejection of Specimens:

A

• Discrepancies between requisition form and specimen labels
• Unlabeled, mislabeled, and inappropriately identified specimens (last resort: DNA identification)
• Leaking specimen containers
• Absent clinical data or history, and other necessary info

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11
Q

• Specimens are given a unique identification number that will identify each specimen for each patient

A

Specimen Accessioning

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12
Q

• 1st and most important step in HP outside the tissue processing procedures

A

Specimen Accessioning

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13
Q

Specimen Accessioning
• Indicating codes may be used for the following: (3)

• Sample Format of Accession Number:
Indicating Code - Year - ID Number of Specimen
• E.g. #594-12345

A

Surgical, Autopsy, Cytology

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14
Q

T or F

Avoid serial accessioning of similar specimen types to reduce mix-up of specimens, and cross-contamination

A

True

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15
Q

GROSS EXAMINATION
• Consists of describing the specimen and placing all or parts of it into a____, in preparation for tissue processing

• One of the basis of_____’ diagnosis

• Where the pathologist will choose a representation of the tissues, most especially if the tissue is large in size

• Involves selection of elements that appear to be of clinical significance for histologic examination

A

plastic cassette

pathologists

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16
Q

MATERIALS FOR GROSS EXAMINATION

A

Cutting tools

Gross Table or Gross Workstations

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17
Q

Cutting Tools

A

Scissors
Forceps
Blade Holders
Blade

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18
Q

Gross Table or Gross Workstations

A

Sink
Tabletop
Water supply
Irrigation system
Fume extraction/ventilation system
Water disposal unit

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19
Q

Specimens only requiring transfer from container to tissue cassette

A

A

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20
Q

Specimens requiring transfer but with standard sampling, counting, weighing or slicing

A

B

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21
Q

Simple dissection required with sampling needing a low level of diagnostic assessment and/or preparation

A

C

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22
Q

Dissection and sampling required needing a moderate level of assessment

A

D

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23
Q

Specimens requiring complex dissection and sampling methods

A

E

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24
Q

Examples
Endometrium
Breast core biopsies
Colonic series

A

A

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25
Examples Small lipoma made of fatty tissues) Small skin biopsy Cervical LLETZ
B
26
Example Prepuce Gallbladder Haemorrhoids Appendix
C
27
Example Pigmented skin lesions Large intestine (Crobin's) Skin with markers Salivary gland tumour
D
28
Example Thyroid (medullary Ca) Breast cancer Testis (seminoma) Uterus (endomet. Ca)
E
29
• Are removed in the body not because of an abnormality, but because of some instances where the tissue/part must be removed in the body • Sent in the lab for disposal • Disease is not histologic level
SPECIMENS FOR GROSS DESCRIPTION ONLY
30
Exempted for routine microscopic review: ABEIN PPUTV
Accessory digits Bunions (aka hallux valgus) & hammer toes Extraocular muscle from corrective surgery Inquinal hernia sacs in adult Nasal bone & cartilage from rhinoplasty Prosthetic breast implant Prosthetic heart valves without attached tissue Tonsils and adenoids from children Umbilical hernia sacs in children Varicose veins
31
SPECIMENS EXCLUDED FROM MANDATORY SUBMISSION BBCD FFFIMM OPRSSTN
Bone donated Bone segments Cataracts Dental appliances and teeth Fat Foreign bodies Foreskin IUDS Medical devices Middle ear ossicles Orthopedic hardware and other radiopaque Placentas Rib segments Saphenous veins Skin or other normal tissue removed Therapeutic radioactive sources Normal toenails and fingernails
32
GROSS DESCRIPTION
1. Identify the specimen. Note and verify all anatomical structures. 2. Identify orientation markers used by surgeons, if available 3. Describe all notable characteristics
33
Identify the specimen. Note and verify all anatomical structures.
• Type of organ/ tissue • Left or right
34
Identify orientation markers used by surgeons, if available •_____ - used to identify and orient the specimen's components, distinguish samples, for embedding instructions •_____ - indicates laterality •_____ - represented by LL: long lateral; or SS - short superior
Inks Nicks Sutures
35
• Purpose: to accurately and faithfully transmit information to allow accurate and reliable microscopic assessment of this margin
INKING
36
Resection margins Embedding instructions Orientation Distinguish between samples Identify the cut surface
Inking
37
instruct the embedder to embed the tissues a certain way
Ink dots
38
Different color scheme used to identify its orientation: (Superior) (Inferior) (Posterior or Deep) (Medial) (Anterior) (Lateral)
Blue Green Black Red Yellow Orange
39
If 2 or 3 colors are needed, the preferred color to be used are
black, blue, and orange
40
is used to remove the ink
Acetic Acid
41
Gross examination Describe all notable characteristics:
• Type of specimen • Shape • Color • Texture/Consistency • Odor • Dimensions • Weight
42
Weight - of intact organs are rounded to the nearest
0.1g
43
Dimensions - (length, width, depth) are rounded to nearest_____. For multiple pieces, indicate size of the_____
1.0cm largest piece
44
Gross examination • Taking a representative sample of the tissue
SECTIONING
45
Gross examination Cross sectioning • Indicate number of________ on the gross description • Indicate also the number of______ used
sections and blocks cassettes
46
• Specimen must fit easily into the standard cassette, which measures
3 x 2.5 x 0.4cm
47
Sectioning Thickness: not more than____ to allow for closing of cassette and fixative penetration
0.3cm
48
A. SECTIONING SMALL SPECIMENS Cut serially about_____ thick to look for small lesions. Lesions are then sampled for histologic exam. ______ may be used in wrapping small sample
2mm Filter paper
49
SECTIONING LARGE SPECIMEN • Cut an interval of______ thickness (termed as breadloafing) to ensure that pathologic areas or tumoral areas are identified
1cm
50
- an en bloc excision of all cancer bearing tissues in the pelvis including the bladder, the prostate
Cystoprostatectomy
51
LABELING •______are embedded in the cassette • Labeled with accession number using_____. Markers and pens will dissolve upon processing • If printed, _____must be used • Original containers with specimen are saved until case is signed out (backup evidence in cases of discrepancies)
Paper tags (lead) pencil dot matrix
52
OTHER SPECIMEN CONSIDERATIONS BRAIN Brain is_____ first before grossed Tied at the______ and suspended Must___________ to avoid deformity
fixed Circle of Willis not touch side of container
53
Fixation of BRAIN Recommended: In________ for_______
10% NBF (Neutral Buffered Formalin) 2-3 weeks
54
SPECIMEN CONSIDERATIONS Colon Cancers Polyps: base (the area where cautery arteries are located) is always______ •_______: bisected and places in one cassette •_______: sides are trimmed away from the stalk, and stalk is placed in a separate cassette
inked Small polyps Large polyps
55
SPECIMEN CONSIDERATIONS Dermatologic Specimen •_______ orientation is always maintained (using markers) •_______ are submitted whole • Tissues greater than_____ are dissected
Vertical Punch biopsies 4mm
56
SPECIMEN CONSIDERATIONS • Skin ellipses: serially cut along the short axis at______ interval. The two most distal sections or tips are submitted in two separate cassettes. Remainder is submitted in one or more cassettes
2 to 3 mm
57
SPECIMEN CONSIDERATIONS Eyes
Inject fixative first then gross
58
SPECIMEN CONSIDERATIONS Hard Tissues
Wash in running water then immerse in TSE softeners Must undergo the process of decalcification
59
SPECIMEN CONSIDERATIONS Hollow Structures o Must be cut open______ and_____
longitudinally fixed with cottons inside (cottons soaked in fixative)
60
SPECIMEN CONSIDERATIONS Most important component of tumor resections because they are essential for prognosis and planning therapeutic options
Lymph Nodes
61
SPECIMEN CONSIDERATIONS LYMPH NODES Should be received_______ Node is_____, and entirely submitted ___________: usually the first lymph node to be involved during metastasis. Entirely submitted. However, large specimens may be bisected, and submitted in one or two cassettes
fresh and not immersed in formalin bivalved Sentinel lymph nodes
62
SPECIMEN CONSIDERATIONS Mastectomy Note for
weight size of breast and axillary dissection skin ellipse nipple scar basal margins
63
SPECIMEN CONSIDERATIONS Additional processes such as IHC, flow cytometry, cytogenetics and molecular genetics is often done. These may require fresh, frozen, or specially processed tissues
Pediatric Specimen
64
SPECIMEN CONSIDERATIONS Specimen with Tumor Identify:
• Site & size of tumor • Location & structure invaded by tumor • Vascular invasion • Presence of lvmph node • Distance from resection margin

Histopath LEC (37 decks)

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