Histopath Lec (Quality)n [Midterm]
Block or tissue slides can be stored in the lab at least ____ years
10
cold ischemia time of pancrease
12-24
cold ischemia time of kidney (cs)
24-36
cold ischemia time of Heart
3-4
cold ischemia time of lungs
3-5
Standard Csssette sizes *Specimen should not be more than 0.3 in thickness *Tissue cassettes should not buldge when closed
3.0x2.5x0.4 cm
cold ischemia time of intestine
6
cold ischemia time of kidney (mp)
72
cold ischemia time of liver
<21
Factors: (QMS) >Skilled histotechnologist/histotechnician >Proper _______ collection and _______ >________ processing of result and __________ >High quality of reagent and equipment >Preventive maintenance of equipment-regularly _________ >Continious professional education of staff
>Skilled histotechnologist/histotechnician >Proper specimen collection and processing >Efficient processing of result and documentation >High quality of reagent and equipment >Preventive maintenance of equipment-regularly calibrated >Continious professional education of staff
Services in Histopath Lab
>Tissue processing >Cytology >Frozen biopsied sections-specimens needed to examined immediately >Special staining (freeze drying) >Immunostaining
Histotechnologist/Histotechnician -Ensure ______ and other are fresh in good working quality -Regularly filters ________ and other reagents -Maintains equipment in high quality condition (preventive maintenance no overloading) -Works systematically to __________ errors -Analyzes problems and corrects them -Provides slides and properly labaled, processed stained, mounted and sequenced
Histotechnologist/Histotechnician -Ensure formalin and other are fresh in good working quality -Regularly filters HEMATOXYLIN and other reagents -Maintains equipment in high quality condition (preventive maintenance no overloading) -Works systematically to minimized errors -Analyzes problems and corrects them -Provides slides and properly labaled, processed stained, mounted and sequenced
cold ischemia is preserved in flush ______ ________ until transplant
Hyperthermic solution
Important usage of fresh specimen >Allows p_________ activity to be insert
Important usage of fresh specimen >Allows protoplastic activity to be insert
Document problems related to personnel performance or other complaints -Involve are the staff of the hospital
Incident reports
Done before bread loafing
Ingking
Instruct the embder to embed the tissue a certain way
Ink dots
Three markers
Inking Nicking Saturing
[Autopsy Disection Techniques] This technique remove all mass and subsequent remobe of blocks
Le Tulle
Indicates laterality
Nicking
ACCESSIONING -Same sample types from different patients must be________ with_______ -Question of ID similar sample, the lab may have to resort to ___ ID -Differentiate each specimen from different patient -Give extra differentiation
ACCESSIONING -Same sample types from different patients must be accessioned with interval -Question of ID similar sample, the lab may have to resort to DNA ID - -Differentiate each specimen from different patient -Give extra differentiation
Aids in the identification and correct orientation of the tissue during embedding
Orientation markers (denoting margins)
Assists in the correct placement of the intended surface of the tissue block towards the microtome balded during sectioning
Orientation markers (denoting margins)
Distinguishes surgical margins (surgery) from trimming margins
Orientation markers (denoting margins)
suggest or recommend the code schemic time for breast cancer sample should less than 1 hr and up to 3 hrs for other test, transplant (20 mins only)
American Society in Encology athology (ASCP)
PROPERLY FILLED-UP SURGICAL PATHOLOGY REQUEST: >Must accompany the patient to the ___ lab >Never receive a sample without ______ form >Accomplished by ______ >Includes the ff dtata: a. Patient's history b. Description of the ____ of origin C. Physical findings d. Lab findings e. Imaging finding f. Pre-operative and ______-operative diagnosis (if different) >After encoding the patients date, the specimen are given a number that will identify each specimen for each patients ADDITIONAL DATA: Middle or maiden name → Birthdate → Hospital number (different si hospital number from laboratory number)
PROPERLY FILLED-UP SURGICAL PATHOLOGY REQUEST: >Must accompany the patient to the HP lab >Never receive a sample without request form >Accomplished by clinician >Includes the ff dtata: a. Patient's history b. Description of the site of origin C. Physical findings d. Lab findings e. Imaging finding f. Pre-operative and post-operative diagnosis (if different) >After encoding the patients date, the specimen are given a number that will identify each specimen for each patients ADDITIONAL DATA: Middle or maiden name → Birthdate → Hospital number (different si hospital number from laboratory number)
Human Resource Managemnt (2)
Pathologist and Associate Pathologist
[SPECIMEN CATEGORIES] Specimens are requiring transfer but with standard sampling, counting, weighing or slicing -moderare assessment
B
What specimen category is cervical LLETZ large loop excision of transformation zone)
B or 2
What specimen category is small lipoma
B or 2
What specimen category is small skin biopsy
B or 2
use for specific specimen form particular patients
Barcoding
Common method for surgical examinations in histopath
Breadloafing technique
Incomplete parallel cuts minimum of 2 cm apart perform on large specimens to ensure that pathologic areas or tumural areas are identified
Breadloafing technique
[SPECIMEN CATEGORIES] Simple dissection required with sampling needing dissection required with sampling needng a low level of diagnostic assessment and'or preparation -Simple assessment
C
What specimen category is appendix
C or 3
What specimen category is gallbladder
C or 3
What specimen category is haemorrhoids
C or 3
What specimen category is prepuce
C or 3
CRITERIA FOR THE REJECTION OF THE GROSS SPECIMENS 1. _________ in the requisition and labels 2. Specimens with no labels, mislabeled or inappropriately identified 3. Leaking specimen containers-specific fixative placed or depende of the size of the specimen 4. ________ clinical data or history 5. Specimen ____ in formalin or any preservative
CRITERIA FOR THE REJECTION OF THE GROSS SPECIMENS 1. Discrepancies in the requisition and labels 2. Specimens with no labels, mislabeled or inappropriately identified 3. Leaking specimen containers-specific fixative placed or depende of the size of the specimen 4. Absent clinical data or history 5. Specimen not in formalin or any preservative
-Done in gross examination -Put the specimen
Cassetting
What ischemia is an hypoxic event seen in tissues preserved in hypothermic state until it is processed
Cold ischemia
Type of document inconsistent report from needed to be clarify
Corrected reports
[SPECIMEN CATEGORIES] Dissection and sampling required needing a moderate level and assessment
D
What specimen category is large intestine (Crohn's)
D or 4
What specimen category is pigmented skin lessions
D or 4
What specimen category is salivary glan tumour
D or 4
What specimen category is skin with markers
D or 4
may be stored numerically, alphabetically or chronologically
Documents
[SPECIMEN CATEGORIES] Specimens requiring complex dissection and sampling methods -Complicated assessment -Cancerous dissection
E
What specimen category is breast cancer
E or 5
What specimen category is is thyroid (medulkary Ca)
E or 5
What specimen category is testis (seminoma)
E or 5
What specimen category is uterus (endometrial Ca)
E or 5
[Autopsy Disection Techniques] REmoval of thoracic and abdominal organ blocks prior to gross examination
Evisceration
[Autopsy Disection Techniques] Removing organ in sequence the orhans are weigh and describe
Evisceration
[Autopsy Disection Techniques] Weigh after and describe
Evisceration
[BIOPSY SPECIMEN] B. Fixed Remove the tissue sample an organ through biopsy procedure
FFPE (formalin fixed paraffin embedded tissues0
[BIOPSY SPECIMEN] B. Fixed Used preservative to preserve tissue sample
FFPE (formalin fixed paraffin embedded tissues0
Type of document Conveys result after test is completed
Final Reports
rapid diagnosis of the sample
Frozen section
Quality Assurance it means: G A O F W A
Getting the right test At the right time On the right specimen From the right patient With the right diagnosis At the right price
[Autopsy Disection Techniques] Organs are being divided and remove an end block
Ghon
Consist of describing the specimen and placing all parts of it into a plastic cassette as it is being processed to a paraffin block
Gross Examination
Pre-Analytical Factors: >Events resulting in _________ changes that lead to ______ tissue quality >_______ delivering/ arriving the specimen in the laboratory
Pre-Analytical Factors: >Events resulting in biochemical changes that lead to poor tissue quality >Before delivering/ arriving the specimen in the laboratory
Type of document Status of results 48-72 hours from receipt of specimen
Preliminary Reports
[BIOPSY SPECIMEN] A. Fresh/Unfixed drop secretion in 1 slide facing from other slides and disperesed the material-drop indirect motion
Pull apart
-indicates anatomical orientation -used to indicate margins or for orientation -used variable numbers and/ or colors of suture - there must be clear description of what the sutures indicate in the submission/ request form
Saturing
[Saturing] Lateral margins
Single Suture
[BIOPSY SPECIMEN] A. Fresh/Unfixed Microscopic tissue preparation use in cytologic examination
Smearing
Tissue sample come in container in a box
Specimen Reception
A.k.a gross worksheet
Specimen worksheet
guides histotechnician in assuring that all block are processed
Specimen worksheet/gross worksheet
[BIOPSY SPECIMEN] A. Fresh/Unfixed distributed in the slide evenly
Spreading
[BIOPSY SPECIMEN] A. Fresh/Unfixed Also known as crushing
Squashing
[BIOPSY SPECIMEN] A. Fresh/Unfixed Small pieces of tissues than 1mm placed in the slide and compressed another slide added with other vital stain and examined cells microscopically
Squashing
[BIOPSY SPECIMEN] A. Fresh/Unfixed using zigzag line through of the slide
Striking
[BIOPSY SPECIMEN] A. Fresh/Unfixed Being dissected or separated and examined under microscope
Teasing
[BIOPSY SPECIMEN] A. Fresh/Unfixed Known as dissociation, specimen imeresed when normal saline solution
Teasing
[BIOPSY SPECIMEN] A. Fresh/Unfixed Stain or unstained
Teasing
Type of document Final diagnosis will be sent out in your report form
Telepjpne reports
[BIOPSY SPECIMEN] A. Fresh/Unfixed or inclusion smear that transfer cells; slightly/touch preparation press the sample in the microscope
Touch prick
[Saturing] caudal margins
Two suture
Unacceptable Accessioning 1. Unlabeled specimen 2. Improper (mismatched data)-data are ________ or information of the patients or request form ____________ 3. Listed number of samples do _______ correspond to the number submitted
Unacceptable Accessioning 1. Unlabeled specimen 2. Improper (mismatched data)-data are inconsistent or information of the patients or request form mismatch 3. Listed number of samples do not correspond to the number submitted
[Autopsy Disection Techniques] Common used method in autopsy
Virchow
[Autopsy Disection Techniques] Father of moder pathology
Virchow
[Autopsy Disection Techniques] Name after Rudolf Virchow
Virchow
[Autopsy Disection Techniques] Organs remove one by one of a deceased body
Virchow
^^WHAT DOES THE PATHOLOGIST NEED TO KNOW? Provide good descriptions - Say what you see! >Shape >Color >Weight-runded to the nearesr 0.1 gram > Dimensions-rounded to the nearest 1.0 cm >Consistency >Distances from margin (s) >Orientation markers >Cut surface appearance
WHAT DOES THE PATHOLOGIST NEED TO KNOW? Provide good descriptions - Say what you see! >Shape >Color >Weight-runded to the nearesr 0.1 gram > Dimensions-rounded to the nearest 1.0 cm >Consistency >Distances from margin (s) >Orientation markers >Cut surface appearance
What ischemia is initial anoxic insult in tissues when blood supply is cut off
Warm Ischemia
medical technologist: -Identify and match specimen with _______ -describe specimen in detail (drawing/photo) -Take __mm sections and label properly -Ensure sections are fully _________ and adequately fixed (__ hours) before processing
medical technologist: -Identify and match specimen with request -describe specimen in detail (drawin/photo) -Take 3mm sections and label properly -Ensure sections are fully immersed and adequately fized (6 hours) before processing
conveys the diagnosis
patient's report
Grossing table consist of scissor, scalpel, ruler, pencil
scissor, scalpel, ruler, pencil
preliminary diagnosis
telephone reports
Beyong the control of the histopath lab
warm ischemia
Interruption of blood supply in the organ-remove from the body
warm ischemia
duration of warm ischemia
depends on circumstances of surgery
>Transplantation the generative reactions slow down by ______ easily decompose the body if it is_______ temperature of the sourrounding * >H______thermic environment of the body, organs, and tissue samples it ___ down the d_________ or d_______ of the body >Preserving the body at __°C slows down the metabolism of the factor of __-12 >During procurement or getting the organs it should flush with ______ preservative solution so it will ___ easily decompose >Rapid cooling __°C remain the main strategies to m________ schemic injury and ________ the volubility of the tissue samples -need cold ischemic phase of our tissues that remove from the body after warm ischemic phase - so that it will not easily decompose >Hence, we use _________ preservative solution with ____ temperature
>Transplantation the generative reactions slow down by hyperthermia- easily decompose the body if it is higher temperature of the sourrounding * >Hyperthermic environment of the body, organs, and tissue samples it slow down the degradation or decomposition of the body >Preserving the body at 4°C slows down the metabolism of the factor of 11-12 >During procurement or getting the organs it should flush with cold preservative solution so it will not easily decompose >Rapid cooling 4°C remain the main strategies to minimizes schemic injury and increase the volubility of the tissue samples -need cold ischemic phase of our tissues that remove from the body after warm ischemic phase - so that it will not easily decompose >Hence, we use hyperthermic preservative solution with low temperature
specimen worksheet contains the following
>accession number >number of sections and blocks >'comments' column
[SPECIMEN CATEGORIES] Specimen only requiring transfer from container to tissue cassette
A
What specimen category is breast core biopsies
A or 1
What specimen category is colonic series
A or 1
What specimen category is endometrium
A or 1
>Pinpoint __________ situations and find _________or preventive measures >Only _______ sections that are properly processed, stained, labeled, and sequenced -Monitor staff performance >Inspect patients for frozen sections, _____, aliquot tissue for flow _____ or fixation in glutaraldehyde for ___ >Open or section ______ to allow fixation of fixative and forestall autolysis.
QMS functions: >Pinpoint problematic situations and find solutions or preventive measures >Only accept sections that are properly processed, stained, labeled and sequence -Monitor staff performance >Inspect patients for frozen sections, formalin fixation, aliquot tissue for flow cytometry or fixation in glutaraldehyde for EM >Open or section hollow tissues to allow fixation of fixative and forestall autolysis.
A set of coordinated activities to regulate a laboratory in order to continually imrpove its performance
Quality Manage System
Request Form -Patients name, age, sex, dob, ____/___/____ -Hospital/lab ______ numberr -Specimen type/source; _____ impression -Pertinent history; _____ findings -Test requested; _______ performed -Date and time of request, collection and transportation -Requesting physician
Request Form -Patients name, age, sex, dob, room/bed/OPD -Hospital/lab accession number -Specimen type/source; clinical impression -Pertinent history; operative findings -Test requested; procedure performed -Date and time of request, collection and transportation -Requesting physician
[Autopsy Disection Techniques] If organ are infected the notable organ are the only one removed not all
Rotintsky
[Autopsy Disection Techniques] Inside examination of visera and removal or portable organ
Rotitnsky
[Autopsy Disection Techniques] On the spot pag tanggal
Rotitnsky
SAMPLE DOCUMENTING >When your laboratory using LIS _________ all information of the patient >What we input in LIS should match from the _________ form >Every laboratory software assigned in a particular pathologist
SAMPLE DOCUMENTING >When your laboratory using LIS input all information of the patient >What we input in LIS should match from the request form >Every laboratory software assigned in a particular pathologist
SPECIMEN LABELLING >Critical steps in histiopath laboratory ___________________-mortal sin in the lab > Label can attached in the cap but for the _________ it should be placed in the body of the container >In the requisition form the unique number of barcode should be place in patients _________ number
SPECIMEN LABELLING >Critical steps in histiopath laboratory >MISLABELLING SAMPLE-mortal sin in the lab >Label can attached in the cap but for the standard it should be placed in the body of the container >In the requisition form the unique number of barcode should be place in patients barcode number
SPECIMEN QUALITY CONTROL - specimen identification must be placed in the ______of the container not in the ___ - if it placed in the _______ it has _________ risk to interchange the caps from other samples -has initial diagnosis on the patients case - CO-__________ of, OE-_________/__________
SPECIMEN QUALITY CONTROL - specimen identification must be placed in the body of the container not in the cap - if it placed in the cap it has higher risk to interchange the caps from other samples -has initial diagnosis on the patients case - CO-complains of, OE-objectives/examination
[Important things to note in breadloafing technique] a. All hollow structures must be ____ b. Specimen edges should be ________ c. Specimens must be ___ easily into the cassette-tissue size not be more than __ cm in thickness in order for the fixative penetrate in the tissue d. e___ p_______ t_____ inside the cassette-graphite of the _____ cannot be erase when staining e. Wrap minute and multiple tissue fragments-wrap in _____ paper f. Indicate the number of s______ of blocks in the specimen g. If the specimen is entirely submitted for processing, the specimen containers are saved until the case is signed
[Important things to note in breadloafing technique] a. All hollow structures must be opned b. Specimen edges should be squared c. Specimens must be fit easily into the cassette-tissue size not be more than 3 cm in thickness in order for the fixative penetrate in the tissue d. embed paper tags inside the cassette-graphite of the pencil cannot be erase when staining e. Wrap minute and multiple tissue fragments-wrap in toter paper f. Indicate the number of sections of blocks in the specimen g. If the specimen is entirely submitted for processing, the specimen containers are saved until the case is signed
[SPECIMENS THAT MAY BE EXCLUDED FROM MANDATORY SUBMISSION TO HISTOPATH LAB] -Bone donated to the _____ -Bone seg_____ removed as part of reconstructive or_____ procedures -F____ removed by liposuction -F_______ from circumcision -B_____ or other medico-legal evidence given directly to law enforcement personnel -I_____ without attached soft tissue -Middle____ ossicles -Sa_____ vein segments harvested from coronary artery bypass -S_______ or other normal tissue removed during cosmetic or reconstructive procedure (not lesion or the patients does not have a history of malignancy) --Normal t____ and f______ that are incidentally removed
[SPECIMENS THAT MAY BE EXCLUDED FROM MANDATORY SUBMISSION TO HISTOPATH LAB] -Bone donated to the bank -Bone segments removed as part of reconstructive or orthopedic procedures -Fat removed by liposuction -Foreskin from circumcision -Bullets or other medico-legal evidence given directly to law enforcement personnel -IUDs without attached soft tissue -Middle ear ossicles -Saphenous vein segments harvested from coronary artery bypass -Skin or other normal tissue removed during cosmetic or reconstructive procedure (not lesion or the patients does not have a history of malignancy) --Normal toenails and fingernails that are incidentally removed
[Specimen for gross description only] >A__________ digits > B_______ and h________ toesn-common deformity > Extra________ muscle from corrective ________-eyes > In_____ hernia sac in adults > Nasal bone and cartilage from rhinoplasty- ilong > Prosthetic breast implants > Prosthetic ____ ________- without attached tissue >T_______ from children >U_________ hernia sacs in children >Varicose veins
[Specimen for gross description only] >Accessory digits > Bunions and hammer toes-common deformity > Extraocular muscle from corrective surgery-eyes > Inguinal hernia scas in adults > Nasal bone and cartilage from rhinoplasty-ilong > Prosthetic breast implants > Prosthetic heart valves without attached tissue >Tonsils from children >Umbilical hernia sacs in children >Varicose veins
^^Inking >orients specimen component >resection margins >embedding instructions orientation >distinguish between samples i >dentify the cut surface >DONE BEFORE BREAD LOAFING >Dry first before applying formalin >India Ink, Silver Nitrate, Various artists pigments >If the specimen is suspected the ink will covered the margin of the specimen >Different color inks are used depends on the dye and different areas >The ink will mark on the actual margin of the slide
^^Inking >orients specimen component >resection margins >embedding instructions orientation >distinguish between samples i >dentify the cut surface >DONE BEFORE BREAD LOAFING >Dry first before applying formalin >India Ink, Silver Nitrate, Various artists pigments >If the specimen is suspected the ink will covered the margin of the specimen >Different color inks are used depends on the dye and different areas >The ink will mark on the actual margin of the slide
