Special Instructions for Anatomical Pathology Specimens Histopathology Cytopathology Post Mortem
Specimen Collection for HistopathologyRoutine Surgical Biopsies
Depending on specimen size and fixation, sections are usually available for the pathologist to report on the day following receipt of the specimen. It should be noted that some tissue diagnoses may require elaborate special staining or further sectioning of the tissue, which may delay the report. For urgent histopathology reports, doctors are requested to indicate this or to discuss the case with the pathologist at the time the specimen is submitted. All surgically removed tissue from patients should be sent to histopathology for examination and report. A request form must accompany all specimens detailing any clinical diagnosis, relevant history and operative findings. All biopsies and tissues except for the specimens requiring special procedures (see below) should be put into containers, which are available from the laboratory and covered with 10% formalin as soon as possible. Where culture is required, fresh tissue without formalin is required and should be immediately sent with the request slip to Central Specimen Reception. The container must be appropriately labelled and in addition include surgeon’s name and type of tissue.
Lymph Nodes should be forwarded immediately to Anatomical Pathology in a sterile container where they will be imprinted, cultured and fixed for section.
Gastrectomy, enterocolectomy, lobectomy, pneumonectomy and cystectomy specimens should be sent to Anatomical Pathology without fixative, so that appropriate examination and arrangement of any special investigations can be made before distortion of the specimens by fixation has taken place
Specimens requiring special procedures Frozen Section Diagnosis should be booked 24 hours in advance to avoid delay. When an operation is delayed or cancelled or a frozen section not required, please inform Anatomical Pathology as soon as possible. The following information should be given when booking, ph 9496 5425:
* Patient Name
* Nature of operation and specimen * Date and approx time of operation * Name of surgeon and number of Theatre
Muscle Biopsies and Nerve Biopsies. Please contact Anatomical Pathology at least 24 hrs in advance to arrange for proper fixatives and equipment, Ph: 03 9496 5467. These biopsies must be scheduled on the morning Theatre Lists. Renal Biopsies are collected into saline moist gauze and brought directly to Anatomical Pathology by the clinician for consultation with a Pathologist. Tissues for Immunofluorescent studies should be submitted in a container with saline moist gauze. Electron Microscopy (EM). The necessity for EM is normally decided by the Pathologists. However clinicians who require EM examinations are asked to discuss the case with the Pathologists. Only fresh tissues with appropriate fixation and treatment will yield optimal results. Lymph Nodes. Similar conditions apply as for Frozen sections. Bookings should be made at least 24 hrs in advance to avoid delay. When an operation is delayed, not required or cancelled please inform Anatomical Pathology as soon as possible. The following infomation should be given when booking: Name of patient Nature of the operation and specimen Date and approx time of operation Name of surgeon and number of the Theatre
Specimen Collection for CytopathologyGeneral Information Specimens cannot be accepted unless they are adequately labelled Glass slides should be marked with patient's name and UR/Reference Number (or date-of-birth) written in pencil on the frosted end of the slide Specimens arriving in a hazardous condition (ie unsealed caps or obvious signs of leakage) cannot be accepted Specimens should be transported in plastic specimen bags Any cytology specimens collected (or received by Central Specimen Reception) out of hours should be refrigerated until delivered to the laboratory during business hours
Collection of Cytology Specimens Bronchoscopy Specimens from the endoscopy theatre - washings, brushings, lavages - should arrive at the laboratory with a form for each specimen, requesting any specicial investigations required, eg pneumocystis, viral changes, fungi, etc The specimens for each patient should be placed in separate bags Each specimen should be clearly labelled and includ the specimen collection site
Sputum Malignant cells are shed from a cancer growing in or communicating with a bronchus and may be coughed up in sputum (not in saliva). As malignant cells may be shed intermittently, a series of sputum specimens increases the chance of detection Where there is difficulty in obtaining sputum, assistance from a Physiotherapist should be sought Three good early morning deep cough specimens are required on consecutive days Post bronchoscopy specimens should always be sent for cytological examination Investigation for asbestos bodies, viral changes, fungi and eosinophils can also be performed in the Cytopathology Department
Urine The entire second morning sample should be collected and sent immediately to the laboratory for examination Three separate specimens are desirable If the urine sample delivery is to be delayed, please refrigerate at 4 deg C If the urine is to be collected as an outpatient collection, an equal volume of 50% ethanol is added to the urine sample. Containers are available form the Pathology Collection staff
Ascitic, Peritoneal, Pericardial and Pleural Fluids Deliver all serous fluids immediately to the laboratory either in a specimen container or the collection bag Heparin must be added to the specimens immediately upon collection (5 units/mL of specimen) to prevent clotting A large volume is best, preferably the entire fluid remaining after allocation for other tests, such as Microbiology and Chemistry
Cerebrospinal fluid (CSF) At least 3 mL fluid (preferably 5 mL) is required for the detection of mestastases or CNS lymphoma Do not add preservative Prompt delivery to the laboratory is required Specimens should be processed within 1 hr
Direct smears, scrapings, brushings from other sites Specimens must be sprayed immediately with 'Cytospray', available from the laboratory. Failure to fix the specimen may render the material unsuitable for diagnosis All glass slides should be clearly labelled in lead pencil with the patient's Name and UR/Reference Number (or date-of-birth if no UR Number) Enquiries to Ms Gerardine Mitchell, Senior Scientist Cytopathology, Ph: 03 9496 5480
Fine Needle Aspirates (FNA) FNA can be used to biopsy both superficial and deep mass lesions, the latter usually under CT or ultrasound guidance Cytology staff are available to attend the aspirate and prepare smears and collect samples for other ancillary techniques if required, eg immunocytochemistry or flow cytometry All FNA's must be booked with the laboratory, Ph: 03 9496 5590 Radiological aspirates should be booked preferabley 4 hrs in advance
Cervical and Vault smears Gynaecological smears should be labelled in lead pencil with the patient's Surname and UR/Reference Number (or date-of-birth) Prepared smears should be fixed immediately, either in 95% ethanol or spray-fixed with 'Cytospray' Please provide all relevant gynaecological and other clinical details on the Request Form and send the sample and form to Pathology Specimen Reception
Other Specimens The following specimens should be fresh and sent to the laboratory immediately Hydrocoele fluid Bile for crystals Cyst fluid Endometrial washings
Post Mortem ExaminationsPermission for every Post Mortem must be obtained form the next-of-kin by the RMO. In general an Autopsy should be requested on every deceased patient (except coroner's cases), as frequently unsuspected findings will throw light on puzzling or obscure clinical findings. A high Post Mortem index is a yardstick of good quality medical care.
|
