Emergency pathology - Revision history

Mikael Häggström: Priority

2024-04-24T12:59:04Z

Priority

← Older revision		Revision as of 08:59, 24 April 2024
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	<noinclude>This article deals with the more time-sensitive matters encountered within pathology, and is written mainly for new pathology trainees.		<noinclude>This article deals with the more time-sensitive matters encountered within pathology, and is written mainly for new pathology trainees.

	</noinclude>{{Memorization-worthy}} Information relating to emergent pathology is often not conveniently and timely looked up when needed because of the ~~need for~~ a ~~fast~~ report.		</noinclude>{{Memorization-worthy}} Information relating to emergent pathology is often not conveniently and timely looked up when needed because of the urgency in reaching a report.

	{{Comprehensiveness}}		{{Comprehensiveness}}
	==Frozen sections==		==Frozen sections==
	Even new pathology trainees may end up being the first responders to frozen sections (as well as intraoperative consultations by gross inspection only).		Even new pathology trainees may end up being the first responders to frozen sections (as well as intraoperative consultations by gross inspection only).

	===Preparation===		===Preparation===
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	*For a [[donor kidney biopsy]], generally evaluate as per local protocol. {{further\|Donor kidney biopsy}}		*For a [[donor kidney biopsy]], generally evaluate as per local protocol. {{further\|Donor kidney biopsy}}
	However, for '''myocarditis''' requests (see the '''[[heart]]''' article), generally have the cardiac biopsy sent in formalin for regular H&E processing (even on weekends) rather than perform frozen sectioning, since good quality slides is the priority.		However, for '''myocarditis''' requests (see the '''[[heart]]''' article), generally have the cardiac biopsy sent in formalin for regular H&E processing (even on weekends) rather than perform frozen sectioning, since good quality slides is the priority.

			FOr further learning, focus on learning to triage, gross and sample specimens that may come for frozen sections. Microscopic evaluation is less of a priority as long as you can get assistance from seniors (including telepathology).
	<noinclude>		<noinclude>
	==See also==		==See also==

Mikael Häggström: /* Preparation */ Moderate

2024-01-10T20:15:10Z

Preparation: Moderate

← Older revision		Revision as of 16:15, 10 January 2024
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	*If possible, look up pertinent '''medical histories''' of potential cases that may appear as frozen sections or other forms of intraoperative consultations. For example, surgery departments may have schedules of patients for the day that you will cover frozen sections. On such lists, types of surgeries that often come as intraoperative consultations mainly include potentially malignant skin excisions, lung excisions (larger than biopsies), ovarian tumors, and samples from other common metastasis sites (lungs, liver, brain, bone). The most important details to find out are:		*If possible, look up pertinent '''medical histories''' of potential cases that may appear as frozen sections or other forms of intraoperative consultations. For example, surgery departments may have schedules of patients for the day that you will cover frozen sections. On such lists, types of surgeries that often come as intraoperative consultations mainly include potentially malignant skin excisions, lung excisions (larger than biopsies), ovarian tumors, and samples from other common metastasis sites (lungs, liver, brain, bone). The most important details to find out are:
	:*'''What you may do''' yourself if you will be alone when you get the specimen, or if you need to wait for particular seniors before doing potentially irreversible steps such as [[inking]] and sectioning.		:*'''What you may do''' yourself if you will be alone when you get the specimen, or if you need to wait for particular seniors before doing potentially irreversible steps such as [[inking]] and sectioning.
	:*'''Previous biopsies'''. For expected excisions from common metastasis sites, look thoroughly for any past cancer diagnoses. Note the pathologic diagnoses of the biopsies{{Comprehensive-begin}}, as well as the collection dates and accession numbers. Pull out previous slides of the malignancy so that you can compare its appearance with the current case.{{~~Comprehensive~~-end}}		:*'''Previous biopsies'''. For expected excisions from common metastasis sites, look thoroughly for any past cancer diagnoses. Note the pathologic diagnoses of the biopsies{{Comprehensive-begin}}, as well as the collection dates and accession numbers.{{Comprehensive-end}} {{Moderate-begin}}Pull out previous slides of the malignancy so that you can compare its appearance with the current case.{{Moderate-end}}
	:*'''Tumor sizes''' where applicable{{Moderate-begin}}, and whether the estimation was from imaging or microscopy{{Moderate-end}}.		:*'''Tumor sizes''' where applicable{{Moderate-begin}}, and whether the estimation was from imaging or microscopy{{Moderate-end}}.
	*Make sure you have a working '''microtome'''. Switch its blade if you are not certain it has had limited use.		*Make sure you have a working '''microtome'''. Switch its blade if you are not certain it has had limited use.

Mikael Häggström: +Myocarditis

2023-11-05T18:57:05Z

+Myocarditis

← Older revision		Revision as of 14:57, 5 November 2023
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	*In an [[intestine with tumor]], it is generally enough to open the intestine (avoiding cutting through a tumor unless it is corcumferantial, and grossly measuring the distances to the proximal and distal surgical margins, as well as the distances to the radial or mesenteric surgical margins. {{further\|Intestine with tumor}}		*In an [[intestine with tumor]], it is generally enough to open the intestine (avoiding cutting through a tumor unless it is corcumferantial, and grossly measuring the distances to the proximal and distal surgical margins, as well as the distances to the radial or mesenteric surgical margins. {{further\|Intestine with tumor}}
	*For a [[donor kidney biopsy]], generally evaluate as per local protocol. {{further\|Donor kidney biopsy}}		*For a [[donor kidney biopsy]], generally evaluate as per local protocol. {{further\|Donor kidney biopsy}}
			However, for '''myocarditis''' requests (see the '''[[heart]]''' article), generally have the cardiac biopsy sent in formalin for regular H&E processing (even on weekends) rather than perform frozen sectioning, since good quality slides is the priority.
	<noinclude>		<noinclude>
	==See also==		==See also==

Mikael Häggström: Intro

2023-11-05T18:40:53Z

Intro

← Older revision		Revision as of 14:40, 5 November 2023
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	\|author2=		\|author2=
	}}		}}
	<noinclude>This article is written ~~specifically~~ for new pathology trainees.		<noinclude>This article deals with the more time-sensitive matters encountered within pathology, and is written mainly for new pathology trainees.

	</noinclude>{{Memorization-worthy}} Information relating to emergent pathology is often not conveniently and timely looked up when needed because of the need for a fast report.		</noinclude>{{Memorization-worthy}} Information relating to emergent pathology is often not conveniently and timely looked up when needed because of the need for a fast report.

Mikael Häggström: /* Preparation */ Additional

2023-10-23T19:43:45Z

Preparation: Additional

← Older revision		Revision as of 15:43, 23 October 2023
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	===Preparation===		===Preparation===
	Prepare at least the following:		Prepare at least the following:
	*Finding out '''which senior to call for help''' if responding to a frozen section. A fairly new pathology trainee should generally not independently make a report to the referring physician without having at least consulted with a senior, and therefore the diagnostics of frozen section slides is not included in this section. In the meantime, ensure that you have the contact information to relevant seniors and/or attendings, and the means to perform '''[[micrography and telepathology]]''' if that person may not be able to be physically present within an acceptable time.		*Finding out '''which senior to call for help''' if responding to a frozen section. A fairly new pathology trainee should generally not independently make a report to the referring physician without having at least consulted with a senior, and therefore the diagnostics of frozen section slides is not included in this section. In the meantime, ensure that you have the contact information to relevant seniors and/or attendings, and the means to perform '''[[micrography and telepathology]]''' if that person may not be able to be physically present within an acceptable time. Also consider calling additional colleagues, even at your own level or below, if there are many specimens coming at once.
	[[File:Metastasis sites for common cancers.svg\|thumb\|270px\|Main sites of '''metastases''' for some common cancer types. Primary cancers are denoted by "''...cancer''" and their main metastasis sites are denoted by "''...metastases''".<ref>A list of included entries and references is found on main image page in Wikimedia Commons: [https://commons.wikimedia.org/wiki/File:Metastasis_sites_for_common_cancers.svg#Summary Commons:File:Metastasis sites for common cancers.svg#Summary]</ref>]]		[[File:Metastasis sites for common cancers.svg\|thumb\|270px\|Main sites of '''metastases''' for some common cancer types. Primary cancers are denoted by "''...cancer''" and their main metastasis sites are denoted by "''...metastases''".<ref>A list of included entries and references is found on main image page in Wikimedia Commons: [https://commons.wikimedia.org/wiki/File:Metastasis_sites_for_common_cancers.svg#Summary Commons:File:Metastasis sites for common cancers.svg#Summary]</ref>]]
	*If possible, look up pertinent '''medical histories''' of potential cases that may appear as frozen sections or other forms of intraoperative consultations. For example, surgery departments may have schedules of patients for the day that you will cover frozen sections. On such lists, types of surgeries that often come as intraoperative consultations mainly include potentially malignant skin excisions, lung excisions (larger than biopsies), ovarian tumors, and samples from other common metastasis sites (lungs, liver, brain, bone). The most important details to find out are:		*If possible, look up pertinent '''medical histories''' of potential cases that may appear as frozen sections or other forms of intraoperative consultations. For example, surgery departments may have schedules of patients for the day that you will cover frozen sections. On such lists, types of surgeries that often come as intraoperative consultations mainly include potentially malignant skin excisions, lung excisions (larger than biopsies), ovarian tumors, and samples from other common metastasis sites (lungs, liver, brain, bone). The most important details to find out are:

Mikael Häggström: /* Performing frozen sectioning */ v2

2023-10-13T23:57:10Z

Performing frozen sectioning: v2

← Older revision		Revision as of 19:57, 13 October 2023
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	File:Frozen sectioning 11 Setting the thickness to for example 5 micrometer and sectioning while holding the section down to prevent it from folding onto itself.jpg\|Generally set the thickness to 5μm, and advance the specimen over the blade while holding the section down to prevent it from folding onto itself		File:Frozen sectioning 11 Setting the thickness to for example 5 micrometer and sectioning while holding the section down to prevent it from folding onto itself.jpg\|Generally set the thickness to 5μm, and advance the specimen over the blade while holding the section down to prevent it from folding onto itself
	File:Frozen sectioning 12 Continuing until all the tissue of interest is in the section.jpg\|Continue until all the tissue of interest is in the section. Leave at least a small part connected to the chuck to avoid folding.		File:Frozen sectioning 12 Continuing until all the tissue of interest is in the section.jpg\|Continue until all the tissue of interest is in the section. Leave at least a small part connected to the chuck to avoid folding.
	File:Frozen sectioning 13 Putting a glass slide on the tissue.jpg\|Put a glass slide on the tissue (this case is actually borderline too spread out to fit on one slide). It is now ready to be put in staining solutions:		File:Frozen sectioning 13 Putting a glass slide on the tissue - version 2.jpg\|Put a glass slide on the tissue (this case is actually borderline too spread out to fit on one slide). It is now ready to be put in staining solutions:
	</gallery>		</gallery>
	[[File:Time in solutions for frozen sections.jpg\|thumb\|350px\|center\|Minimal time in solutions for frozen sections.]]		[[File:Time in solutions for frozen sections.jpg\|thumb\|350px\|center\|Minimal time in solutions for frozen sections.]]

Mikael Häggström: /* Reporting of intra-operative consults */ Expanded

2023-10-12T13:55:36Z

Reporting of intra-operative consults: Expanded

← Older revision		Revision as of 09:55, 12 October 2023
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	==Reporting of intra-operative consults==		==Reporting of intra-operative consults==
	*Call the requesting clinician		*'''Call''' the requesting clinician
	*Verify that you are talking to that person, or someone who can immediately convey the diagnosis to that person		*'''Verify''' that you are talking to that person, or someone who can immediately convey the diagnosis to that person. You may request to talk directly to the surgeon if a conversation is warranted.
	*Tell the patient identity {{Moderate-begin}}with at least two different identifiers, such as name and date of birth{{Moderate-end}}		*Tell the patient '''identity''' {{Moderate-begin}}with at least two different identifiers, such as name and date of birth{{Moderate-end}}
	*{{Moderate-begin}}Ask for a readback of your diagnosis{{Moderate-end}}		*{{Moderate-begin}}Ask for a '''readback''' of your diagnosis. This is particularly important in cases with multiple specimens, and when it needs to be stated that a more specific diagnosis is deferred until standard slides have been evaluated.{{Moderate-end}}<ref>{{cite journal\| author=Wiggett A, Fischer G\| title=Intraoperative Communications Between Pathologists and Surgeons: Do We Understand Each Other? \| journal=Arch Pathol Lab Med \| year= 2023 \| volume= 147 \| issue= 8 \| pages= 933-939 \| pmid=36343374 \| doi=10.5858/arpa.2020-0632-OA \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=36343374 }} </ref>
	*State your diagnosis		*'''State''' your diagnosis succinctly. If necessary in cases with limited diagnostic tissue, you may state that additional tissue is required for a more certain report.
	*{{Moderate-begin}}Make sure the clinician reads the diagnosis back to you.{{Moderate-end}}		*{{Moderate-begin}}Make sure the clinician reads the diagnosis '''back to you'''.{{Moderate-end}}
	Example:		Example:
	{\|class=wikitable		{\|class=wikitable
	\|		\|
	*Hello, this is from pathology. I have a frozen section result for Dr. (name of the clinician)		*Hello, this is from pathology. I have a frozen section result for Dr. (name of the clinician)
	*This is Dr. ____, and I have a diagnosis on (patient name and date of birth){{Moderate-begin}}, so if you could please read back to me after,{{Moderate-end}} the diagnosis is (diagnosis)		*This is Dr. ____, and I have a diagnosis on (patient name and date of birth){{Moderate-begin}}, if you could please read back to me after,{{Moderate-end}} the diagnosis is (diagnosis)
	\|}		\|}

Mikael Häggström: Mikael Häggström moved page Emergent pathology to Emergency pathology: Corrected

2023-02-06T02:32:22Z

Mikael Häggström moved page Emergent pathology to Emergency pathology: Corrected

← Older revision	Revision as of 22:32, 5 February 2023
(No difference)

Mikael Häggström: /* Performing frozen sectioning */ Wording

2023-02-06T01:45:18Z

Performing frozen sectioning: Wording

← Older revision		Revision as of 21:45, 5 February 2023
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	File:Frozen sectioning 8 using freeze spray.jpg\|Use freeze spray to quicken the freezing if available		File:Frozen sectioning 8 using freeze spray.jpg\|Use freeze spray to quicken the freezing if available
	File:Frozen sectioning 9 Breaking off embedding medium that reach below the chuck's plate.jpg\|Breaking off any embedding medium that reaches below the chuck's plate		File:Frozen sectioning 9 Breaking off embedding medium that reach below the chuck's plate.jpg\|Breaking off any embedding medium that reaches below the chuck's plate
	File:Frozen sectioning 10 Fastening the chuck on the cryotome and cutting relatively thick sections until the full tissue surfaces of interest are exposed.jpg\|Fasten the chuck on the cryotome ~~and cut relatively thick sections until the full tissue~~ surfaces ~~of interest are exposed~~		File:Frozen sectioning 10 Fastening the chuck on the cryotome and cutting relatively thick sections until the full tissue surfaces of interest are exposed.jpg\|Fasten the chuck on the cryotome. Epithelial surfaces should be oriented vertically, like a picket fence.
	File:Frozen sectioning 11 Setting the thickness to for example 5 micrometer and sectioning while holding the section down to prevent it from folding onto itself.jpg\|Generally set the thickness to 5μm, and advance the specimen over the blade while holding the section down to prevent it from folding onto itself		File:Frozen sectioning 11 Setting the thickness to for example 5 micrometer and sectioning while holding the section down to prevent it from folding onto itself.jpg\|Generally set the thickness to 5μm, and advance the specimen over the blade while holding the section down to prevent it from folding onto itself
	File:Frozen sectioning 12 Continuing until all the tissue of interest is in the section.jpg\|~~Contine~~ until all the tissue of interest is in the section		File:Frozen sectioning 12 Continuing until all the tissue of interest is in the section.jpg\|Continue until all the tissue of interest is in the section. Leave at least a small part connected to the chuck to avoid folding.
	File:Frozen sectioning 13 Putting a glass slide on the tissue.jpg\|Put a glass slide on the tissue (this case is actually borderline too spread out to fit on one slide). It is now ready to be put in staining solutions:		File:Frozen sectioning 13 Putting a glass slide on the tissue.jpg\|Put a glass slide on the tissue (this case is actually borderline too spread out to fit on one slide). It is now ready to be put in staining solutions:
	</gallery>		</gallery>

Mikael Häggström: /* Thawing */ heights

2022-12-18T16:15:58Z

Thawing: heights

← Older revision		Revision as of 12:15, 18 December 2022
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	===Thawing===		===Thawing===
	<gallery mode=packed>		<gallery mode=packed heights=200>
	File:How to not thaw frozen block.jpg\|When no more frozen sections are needed for a block, do not use water directly on the sample, as it may get flushed away.		File:How to not thaw frozen block.jpg\|When no more frozen sections are needed for a block, do not use water directly on the sample, as it may get flushed away.
	File:How to thaw frozen block.jpg\|Rather, apply hot water to the stem of the chuck, while slightly tilting your grip of the top to apply pressure towards making the block slide off the chuck. As soon as you feel it starting to move, move away from the sink and finish sliding the block off the chuck.		File:How to thaw frozen block.jpg\|Rather, apply hot water to the stem of the chuck, while slightly tilting your grip of the top to apply pressure towards making the block slide off the chuck. As soon as you feel it starting to move, move away from the sink and finish sliding the block off the chuck.

← Older revision		Revision as of 19:57, 13 October 2023
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	File:Frozen sectioning 11 Setting the thickness to for example 5 micrometer and sectioning while holding the section down to prevent it from folding onto itself.jpg\|Generally set the thickness to 5μm, and advance the specimen over the blade while holding the section down to prevent it from folding onto itself		File:Frozen sectioning 11 Setting the thickness to for example 5 micrometer and sectioning while holding the section down to prevent it from folding onto itself.jpg\|Generally set the thickness to 5μm, and advance the specimen over the blade while holding the section down to prevent it from folding onto itself
	File:Frozen sectioning 12 Continuing until all the tissue of interest is in the section.jpg\|Continue until all the tissue of interest is in the section. Leave at least a small part connected to the chuck to avoid folding.		File:Frozen sectioning 12 Continuing until all the tissue of interest is in the section.jpg\|Continue until all the tissue of interest is in the section. Leave at least a small part connected to the chuck to avoid folding.
	File:Frozen sectioning 13 Putting a glass slide on the tissue.jpg\|Put a glass slide on the tissue (this case is actually borderline too spread out to fit on one slide). It is now ready to be put in staining solutions:		File:Frozen sectioning 13 Putting a glass slide on the tissue - version 2.jpg\|Put a glass slide on the tissue (this case is actually borderline too spread out to fit on one slide). It is now ready to be put in staining solutions:
	</gallery>		</gallery>
	[[File:Time in solutions for frozen sections.jpg\|thumb\|350px\|center\|Minimal time in solutions for frozen sections.]]		[[File:Time in solutions for frozen sections.jpg\|thumb\|350px\|center\|Minimal time in solutions for frozen sections.]]

← Older revision		Revision as of 21:45, 5 February 2023
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	File:Frozen sectioning 8 using freeze spray.jpg\|Use freeze spray to quicken the freezing if available		File:Frozen sectioning 8 using freeze spray.jpg\|Use freeze spray to quicken the freezing if available
	File:Frozen sectioning 9 Breaking off embedding medium that reach below the chuck's plate.jpg\|Breaking off any embedding medium that reaches below the chuck's plate		File:Frozen sectioning 9 Breaking off embedding medium that reach below the chuck's plate.jpg\|Breaking off any embedding medium that reaches below the chuck's plate
	File:Frozen sectioning 10 Fastening the chuck on the cryotome and cutting relatively thick sections until the full tissue surfaces of interest are exposed.jpg\|Fasten the chuck on the cryotome ~~and cut relatively thick sections until the full tissue~~ surfaces ~~of interest are exposed~~		File:Frozen sectioning 10 Fastening the chuck on the cryotome and cutting relatively thick sections until the full tissue surfaces of interest are exposed.jpg\|Fasten the chuck on the cryotome. Epithelial surfaces should be oriented vertically, like a picket fence.
	File:Frozen sectioning 11 Setting the thickness to for example 5 micrometer and sectioning while holding the section down to prevent it from folding onto itself.jpg\|Generally set the thickness to 5μm, and advance the specimen over the blade while holding the section down to prevent it from folding onto itself		File:Frozen sectioning 11 Setting the thickness to for example 5 micrometer and sectioning while holding the section down to prevent it from folding onto itself.jpg\|Generally set the thickness to 5μm, and advance the specimen over the blade while holding the section down to prevent it from folding onto itself
	File:Frozen sectioning 12 Continuing until all the tissue of interest is in the section.jpg\|~~Contine~~ until all the tissue of interest is in the section		File:Frozen sectioning 12 Continuing until all the tissue of interest is in the section.jpg\|Continue until all the tissue of interest is in the section. Leave at least a small part connected to the chuck to avoid folding.
	File:Frozen sectioning 13 Putting a glass slide on the tissue.jpg\|Put a glass slide on the tissue (this case is actually borderline too spread out to fit on one slide). It is now ready to be put in staining solutions:		File:Frozen sectioning 13 Putting a glass slide on the tissue.jpg\|Put a glass slide on the tissue (this case is actually borderline too spread out to fit on one slide). It is now ready to be put in staining solutions:
	</gallery>		</gallery>