Emergency pathology: Difference between revisions

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{{Comprehensiveness}}

==Frozen sections==

===Preparation===

Prepare at least the following:

[[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:

:*'''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.

:*'''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.

File:Frozen sectioning 1 putting embedding medium on chuck.jpg|You can theoretically put a specimen directly on the chuck plate, but to reduce the risk of tearing, put embedding medium on empty chucks

File:Frozen sectioning 2 waiting until bottom is frozen.jpg|Wait until the embedding medium is frozen at the bottom

File:Frozen sectioning 4 putting conductor on chuck.jpg|Place the conductor on top of the chuck. You now have a prepared chuck with a smooth surface.

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{{Moderate-begin}}If you don't have a conductor, or if the embedding medium completely hardened before you applied it, perform cryotomy of the embedding medium to get a larger and smoother top.{{Moderate-end}}

*Inspect the '''H&E staining''' containers and refill if necessary.

File:Setup for HE staining of frozen section slides.jpg|Example of material needed for H&E staining of frozen sections: Staining fluids, glass slides, pencil to mark slides (the ink of pens will generally be washed off in the fluids), slide dipper, timer, cover slips and immersion oil.

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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 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  

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While most frozen sections can be predicted from schedules of the operating room and thereby be looked up beforehand, suspected malignant skin excisions often come from outside the main surgery department, even more indicating memorization of how to handle them.

{{Tissue selection from suspected malignant skin lesions}}

Although these are generally given on schedules of the operating room, any pathologist may end up suddenly covering for another one, and subsequently be presented with the frozen section case without having had the time to look it up beforehand.

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