QCH-Notes Questions: liver biopsy NOT sponges? parathyroid - what is large? prostate - how to cone? how to submit seminal vesicles in toto with vas? sentinels - all at 2mm intervals except for melanoma? skin 4mm cut off, bisect pigmented lesions for punches, usually I choose closest but off center? Decal? how TODO: Bladder 182837 Uterus Bone template (knee, femoral head) 141951 colorectal resection template 169483 Bowel non-tumor templates? 175984 Bone Marrow bx 135521 reduction mammoplasty 74966 lumpectomy margins re-excisions 135645 "if margin is <2mm submit in toto, if 0.2-1.0 cm 1/cm, if >1cm 1/2cm IF WITH LUMPECTOMY, if post-surgery in toto breast template 182840 leep cone 185033 skin cyst 137103 describe presence or absence of sinuses? Biopsies needle biopsy breast 169467
Lipoma External and cut surface (homogeneous, lobulated, hemorrhagic, whorled, necrotic, white or cream coloured, firm, attached tissue) 1 per cm, 2 small sections can be submitted in one cassette unless clinical concern for malignancy or suspicious cut surface
Lipoma of cord 1 per 2 cm, 2 per cassette if ALL 3 dimensions of lipoma are 5 cm or greater then ink and 1 per cm. if sus or clinical mag as LIPOMA, 1 per cm 1 per cassette
Liver biopsy submit all tissue wrapped in tissue paper soaked in 10% NBF do NOT use blue sponges ?Dynacare cut through lens paper without opening?
Nasal polyps and contents Number of fragments, dimensions, type of tissue (polyps, fibrous, cart, bone, mucosa), translucent, gelatinous, rounded, cut surface; homo, glisteningly, gray pint, focal abnormalities one cassette - representative (no bone) (more if abnormal)
Prostate biopsies 169422 All tissue on blue sponges 4 cores in one cassette Using dropper stain the cores with blue ink spec 1-6 template
Gross Only Hernia Sac - GO Hydrocele - GO Pannus - GO IUD - GO (unless actinomyces) Varicose vein - GO (unless thromboses/occluded) Nasal suptum - GO (unless mucosa) Donuts - GO (unless received alone without resection)
Discard - No accessioning Bone bank bones Normal spleen (multiple organ donor) Teeth tissue not warranting further exam, fat, excess skin
Ovary 82438 normal/unremarkable - 1 section per ovary cysts - min 3 sections of cyst wall targeting lesions, max 1 per cm (large, >5cm) endometriosis - min 2 sections with hemorrhagic adhesions tumor - 3 sections min up to 1 per cm of tumor. at least sect of one normal ovary if present BRCA - in toto, serially sectioned through short axis Omentum - if received, one per 2 cm max 4 sectionsfdg
POC "Abortion Pregnancy Loss" and "fetus" template 1 cassette with placental and villous tissue with cord (if present) 2 cassettes if villi not present 4 cassettes if sus for molar If genetic studies requested: - sterile forceps and scissors from SPD/CSR - POC ?tissue if identified - ?placenta - blood clot placenta - placenta and cord Baby - skin (organ tissue) After sampling for genetics treat specimen as a surgical. Comment in gross "Tissue taken for cytogenetics, date, time, initials" Package in sterile saline, on ice to CHEO Pathology
Prostate Gland 169438 Left side - Black Right side - Green Apex and Base -> coned? slices divided into quadrants (right anterior, right posterior, left posterior, left anterior) - not anterior aspect of each section? seminal vesicles and vas in toto? if >70g consult pathologist: "A radical prostatectomy specimen may be submitted in its entirety or partially sampled in a systematic fashion. For partial sampling in the setting of a grossly visible tumor, the bladder neck margins and the junction of each seminal vesicle with prostate proper should be submitted. If there is no grossly visible tumor, a number of systematic sampling strategies may be used. One that yields excellent prognostic information involves submitting the posterior aspect of each transverse slice along with a mid anterior block from each side. The anterior sampling detects the T1c cases arising in the transition zone and extending anteriorly. The entire apical and bladder neck margins and the junction of each seminal vesicle with the prostate should also be submitted."
TURP 169458 in toto up to 8 cassettes (then for each additional 10g add 1 cassette) Same guidelines for TURBT
Sentinel lymph node section each node at 2mm intervals through the long axis (unless melanoma?) describe and measure sus gross metastasis and extranodal extension Melanoma - bisect longitudinally or trisect if too big for cassette Breast - 2 mm intervals and request 1 level QSENTB
Skin Ink curetting and shave biopsies, but margins aren't important - for diagnosis if < 4mm submit as is; if >4mm serially section 0.3 cm width; what if 4mm ? Punches < 4mm as is; >4mm bisect through long axis except if pigmented lesion: "(In pigmented lesions, where symmetry and long axis of the lesion conflict, the long axis of the lesion rules and an off center bisection is permissible.)" if not in 10% NBF, check for alopecia for Lymphoma
Spleen 169451 - if lesions are present consider possible lymphoproliferative - consult with pathologist (B5, snap freeze, etc) 2 rep sections of normal spleen, one to include laceration if identified 2 additional sections if lesion is identified, one to include hilum and one to include capsule hilar lymph nodes if present accessory spleen if present
Testis 82406 ink tunica vaginalis bivalve through epididymis yellow dot on req only (priority status to pathologist only?)
Appendix 74841 1 cassette: 1 rep longitudinal section of tip, 2 cross sections of more abnormal area, proximal margin notched
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