Difference between revisions of "Pathology for clinicians and medical students"
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Important points for everyone who may send specimens to pathology: | Important points for everyone who may send specimens to pathology: | ||
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| − | :* | + | ==Fixation== |
| + | <!--Also in Fixation article | ||
| + | -->Within an hour after removal from the body,<ref>{{cite web|url=https://www.uclahealth.org/pathology/workfiles/Education/Residency%20Program/Gross%20Manual/Mastectomy%2006.03.20.pdf|title=Breast pathology grossing guidelines|website=UCLA Health|accessdate=2021-09-09}}</ref> tissue samples should generally be placed in vessels with the correct fixing solution, with a volume that allows them to lie freely in the solution.<ref name=kvast>{{cite web|url=http://www.svfp.se/foreningar/uploads/L15178/kvast/hud/Handlaggning%20av%20hudprover%20%20provtagningsanvisningar%20utskarningsprinciper%20och%20snittning%2020150325.pdf|title=Handläggning av hudprover – provtagningsanvisningar, utskärningsprinciper och snittning (Handling of skin samples - Instructions for sampling, cutting and incision|author=Katarzyna Lundmark, Krynitz, Ismini Vassilaki, Lena Mölne, Annika Ternesten Bratel|accessdate=2019-09-09|website=KVAST (Swedish Society of Pathology)}}</ref> The standard fixation fluid is generally 10% neutral buffered '''formalin''', which is roughly equivalent to 4% formaldehyde.<ref>{{cite web|url=https://microscopy.duke.edu/guides/paraformaldehyde-formaldehyde-formalin|title=Paraformaldehyde, Formadehyde and Formalin|website=Duke University|accessdate=2019-12-17}}</ref> | ||
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| + | The main exception to using formalin are mainly: | ||
| + | *A '''[[tophus]]''' or other specimen suspicious for gout versus pseudogout should be sent in alcohol or dry, since formalin will dissolve the crystals. | ||
| + | *[[Lymph node]]s (or other lymphoid aggregates) with a suspicion of '''lymphoma''', where samples are generally put in a special solution for flow cytometry. | ||
| + | *[[Products of conception]] with a need to take samples for '''genetic testing'''. | ||
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| + | ==Skin== | ||
| + | [[File:Recommended marking stitch.jpg|thumb|190px|When marking the orientation of specimens, including skins, make the knot away from the tissue so that the pathologist can remove it without potentially cutting through the tissue.]] | ||
| + | '''Orientation''' of skin excisions should generally be marked when there is a substantial likelihood of needing to excise further, and it is in a location where it is inconvenient to perform re-excision in all directions indiscriminately. Otherwise, skin lesions with only a mild suspicion of cancer (such as [[dark skin focalities]] in general) can usually be excised unoriented. Orientation can be made with one or two (one short and one long) sutures, designated lateral, medial etc, or o’clock positions. The direction of the margin marked by any suture should not be ambiguous (like on the border between two of them). | ||
{{Bottom}} | {{Bottom}} | ||
Revision as of 18:48, 10 September 2021
Author:
Mikael Häggström [note 1]
Important points for everyone who may send specimens to pathology:
Fixation
Within an hour after removal from the body,[1] tissue samples should generally be placed in vessels with the correct fixing solution, with a volume that allows them to lie freely in the solution.[2] The standard fixation fluid is generally 10% neutral buffered formalin, which is roughly equivalent to 4% formaldehyde.[3]
The main exception to using formalin are mainly:
- A tophus or other specimen suspicious for gout versus pseudogout should be sent in alcohol or dry, since formalin will dissolve the crystals.
- Lymph nodes (or other lymphoid aggregates) with a suspicion of lymphoma, where samples are generally put in a special solution for flow cytometry.
- Products of conception with a need to take samples for genetic testing.
Skin
Orientation of skin excisions should generally be marked when there is a substantial likelihood of needing to excise further, and it is in a location where it is inconvenient to perform re-excision in all directions indiscriminately. Otherwise, skin lesions with only a mild suspicion of cancer (such as dark skin focalities in general) can usually be excised unoriented. Orientation can be made with one or two (one short and one long) sutures, designated lateral, medial etc, or o’clock positions. The direction of the margin marked by any suture should not be ambiguous (like on the border between two of them).
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
Main page
References
- ↑ . Breast pathology grossing guidelines. UCLA Health. Retrieved on 2021-09-09.
- ↑ Katarzyna Lundmark, Krynitz, Ismini Vassilaki, Lena Mölne, Annika Ternesten Bratel. Handläggning av hudprover – provtagningsanvisningar, utskärningsprinciper och snittning (Handling of skin samples - Instructions for sampling, cutting and incision. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-09.
- ↑ . Paraformaldehyde, Formadehyde and Formalin. Duke University. Retrieved on 2019-12-17.
Image sources
