Emergency pathology: Difference between revisions
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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 | </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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*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.{{ | :*'''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. | ||
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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== | ||