LifeBridge Health - NORTHWEST HOSPITAL CENTER   Anatomic Pathology

Section 2.0  Surgical Pathology

Surgical specimens are examined by the Pathologist Monday through Friday.  Most specimens brought to the Laboratory before 5:00 p.m.  Monday through Friday , are examined that day and processed overnight.

Routine small biopsy specimens are reported on the day following removal, provided they are received by the Lab before 5:00 p.m.  RUSH� specimens (those requiring special priority) are reported first (usually by 1:00 p.m.).  Large specimens may require an extra day of fixation and unusual cases requiring special studies may take several days before they are reported. If a rush specimen is submitted on a Friday for Saturday interpretation, please contact the oncall Pathologist. For emergency situations, it is possible to rapidly process small biopsies and report them the same day they are received.  Contact the pathologist in this event.

Submitted Specimens to the Laboratory

All specimens must be accompanied by a completed surgical pathology requisition (a surgical pathology requisition is shown on page 5 of this procedure). The requisition must be properly filled out and must include: patient name, Medical Record number, date of birth, specimen source, operative procedure, ordering physician, pertinent history and date/time of collection.  All specimens must be properly labeled, including specimen source in addition to patient identifying information.  It is important to supply the pathologist with the most pertinent clinical-operative data.  Blank or incompletely filled out slips may cause delays in reporting and make accurate diagnosis by the pathologist more difficult. When surgical specimens are delivered to the Laboratory by O.R. personnel, the accompanying requisition must be stamped by the Simplex clock in the Gross Room of the Anatomic Pathology Laboratory.

Small specimens must be placed in 10% formaldehyde (formalin) and submitted to the Lab.  Labeled bottles with fixative are supplied by the Laboratory.

Large specimens, for which it is impossible or not practical to place the entire specimen in formalin, must be delivered to the Histology lab and placed in the Histology refrigerator.  If such specimens are collected on evenings, nights, weekends or holidays, Laboratory staff will assist the O.R. tech or nurse in placing the specimen in the Histology refrigerator.

All specimens are accessioned  by Laboratory personnel.  Missing specimens, discrepancies or errors will be reported as soon as possible to the O.R. Nurse Manager so that corrective action can be initiated at once.

Gross Examination - Gross Diagnosis

The following specimens are usually examined only grossly and a gross diagnosis given, unless a microscopic examination is considered necessary by the pathologist or is requested by the surgeon or attending physician:

• Accessory digits
• Calculi - all urinary calculi are routinely sent to a reference laboratory for chemical analysis.  Chemical analysis will be done on other calculi when requested by the physician.
• Extraocular muscles from corrective surgical procedures (e.g. strabismus repair)
• Foreign bodies
• Ingrown fingernails and toenails
• Ligament or tendon fragments (traumatic laceration)
• Nasal bone and cartilage from rhinoplasty or septoplasty
• Optic lens (cataract)
• Prosthetic devices
• Teeth (other than trauma)

Specimens exempt from examination by the pathologist

The following specimens are exceptions to the rule that every specimen must be submitted to the laboratory for examination by the pathologist:

• Bone segments removed as part of a corrective or reconstructive orthopedic procedure
• Cataracts removed by phacoemulsification
• Dental appliances
• Fat removed by liposuction
• Foreign bodies such as bullets or other medico-legal evidence given directly to law enforcement personnel
• Intrauterine devices without attached soft tissue
• Medical devices such as catheters, gastrostomy tubes, myrigotomy tubes, stents, and sutures that have not contributed to patient illness, injury or death
• Middle ear ossicles
• Orthopedic hardware and other radio-opaque mechanical devices, provided there is an alternative policy for documentation of surgical removal
• Rib segments or other tissues removed only for purposes of gaining surgical access, provided the patient does not have a history of malignancy
• Saphenous vein segments harvested for coronary artery bypass

Specimens exempt from examination by the pathologist (continued):

• Skin or other normal tissue removed during a cosmetic or reconstructive procedure (e,g. blepharoplasty, adbominoplasty, trauma repair), provided it is not contiguous with a lesion and the patient does not have a history of malignancy
• Teeth (trauma cases)
• Therapeutic radioactive sources
• Normal toenails and fingernails that are incidentally removed

Note:
All specimens not specifically exempted in the list above must be submitted to the pathology department for examination. Submission of any of the specimens specifically exempted in the list above shall be considered a request for examination. The extent of examination and evaluation for those specimens is at the discretion of the pathologist, but usually will consist of gross examination only.

Amputated legs must be placed in the Morgue refrigerator.  The corresponding surgical pathology slip must be brought to the laboratory and given to Laboratory Service Assistant or respective supervisor who will ensure proper placement of the amputation specimen.

Frozen Sections

Frozen sections are routinely performed from 8:00 a.m. to 5:00 p.m., Monday through Friday.  For frozen sections at other hours, be sure to notify pathologist in advance to ensure availability.

Specimens for frozen sections must be submitted fresh in a closed container.  If it is small, it should be submitted covered with a wet gauze.  Specimen should not be placed in 10% formaldehyde.  The specimen should be brought directly to the pathologist.  Notify pathology secretary of frozen section.

Muscle Biopsy

Muscle biopsies are sent to a reference laboratory for routine as well as histochemical studies.

A strip of muscle approximately 3.0 x 0.5 cm. parallel to the direction of the muscle fibers should be obtained.  A muscle that is moderately but not severely weak should be used for the biopsy.

Place the biopsy in a piece of saline-moistened gauze and send immediately to the lab. The lab should be notified a day in advance of muscle biopsy.

Kidney Biopsy

Kidney biopsies are sent to a reference laboratory for processing and diagnosis.  Please call the Laboratory in advance so that arrangements can be made.  Place the biopsy in a piece of saline moistened teflon and bring immediately to the lab.  Adequate tissue should be obtained such that it can be divided into three parts by the pathologist for electron microscopy, immunoflourescent studies and routine histology.

Skin Biopsy

Skin biopsies requiring immunoflourescent studies should be submitted fresh (no fixative). The lab should be notified as soon as possible after collection.

Specimens Requiring Cultures:

Cultures can be taken in the OR under sterile conditions and submitted directly to the microbiology lab, or the specimen can be submitted fresh in a sterile container to the pathology lab and the pathologist notified of the need to take a piece of the specimen for cultures.  The specimen should not be placed in formalin.