LifeBridge Health - Department of Pathology Anatomic Pathology

ALPHABETICAL LISTING OF ALL ANATOMIC PATHOLOGY TESTS

Acid Fast Stain:
If a mycobacterial process (AFB, tuberculosis, MAI) is suspected, please indicate this fact on the requisition form and request the special stain. See Special Stains

Aspiration Biopsy, Culture:
See Culture, Aspiration

Aspiration Biopsy, Cytology:
See Cytology, Fine Needle Aspiration

Autopsy:
Hospital Inpatient: See Autopsy Pathology - Adult Autopsy

Outside Patient: Autopsy examination will be provided for patients who die outside the hospital if they are previous patients of Sinai Hospital. See Autopsy Pathology - Adult Autopsy

Medical Examiner Cases: See Medical Examiner Case Definition

Anatomy Board Cases: See Anatomy Board Case Definition

Fetal Demise: See Autopsy Pathology - Fetal Demise

Biopsy, Tissue:
See Histopathology

Biopsy Culture, Tissue:
See Culture, Tissue

Body Fluid Culture:
See Microbiology

Body Fluid Cytology:
Cytology, Body Fluids

Breast Biopsy:
If a breast biopsy requires evaluation for neoplasm, hormone receptors, gross examination, margin clearance, DNA analysis and/or frozen, then the sample must be submitted fresh on ice to Surgical Pathology. Prior notification   is required and pertinent history must be provided which includes radiographs and radiology report if available. The specimen will be examined by the Pathologist to determine adequacy, appropriate sampling and division for special studies.

Bronchoalveolar Lavage (BAL):
See Cytology, Bronchial

Brushings, Bronchial:
See Cytology, Bronchial

Calculus, Chemical Analysis:
Stones (calculi) should be submitted in the fresh state. The requisition form should indicate a request for stone analysis. The following stone categories are routinely submitted for chemical analysis: kidney, ureter, bladder.

Cancer Karyotype: Bone Marrow, Lymph Node, Solid Tumor:
See Cytogenetic Analysis

Cervical Smear:
See Cytology, Gynecologic

Chromosome Analysis:
See Cytogenetic Analysis

Culture, Aspirations:
See Microbiology

Culture, Body Fluids:
See Microbiology

Culture, Respiratory Tract:
See Microbiology

Culture, Tissue:
If an infectious process is suspected in an operative (surgical) tissue specimen, indicate the potential infectious agent on the requisition form and request microbiological cultures. The specimen must be submitted fresh (unfixed) to surgical pathology. A request for intraoperative consultation is required. The Pathologist will provide a gross evaluation of the specimen and will select appropriate material for culture.. Microbiological studies that may be requested include: bacterial aerobic and anaerobic culture, mycobacterial (AFB) culture and AFB fluorescence, fungal culture, viral culture and Pneumocystis stain. Results will be correlated with the microscopic findings and complementary special stains for microorganisms. Frozen section examination in infectious and biohazardous cases is discouraged because of the contamination of instruments.

Cytogenetic Analysis:
Specimens for cytogenetic analysis require special technical handling. The specimen must be submitted fresh and sterile to Surgical Pathology and/or Pathology Central Receiving. Prior notification and discussion of the case is needed for appropriate processing of these specimens. Examples of categories of specimen that may be submitted for study include but are not limited to: Bone Marrow, Fetal Tissue, Products of Conception, Lymphoma, Solid Tumor, Peripheral Blood and Amniotic Fluid. A special cytogenetic request form, transport media and procedural protocol can be obtained from Central Receiving.

Blood: Requires 5-10 ml of peripheral blood in preservative free of sodium heparin. Use green top vacutainer tube. For new born infants, 1-2 ml may be adequate.

Hematologic Blood: Requires 5- 1 0 ml in sodium heparin or green top tube. WBC count should accompany the specimen.

Bone Marrow: Requires 1-5 ml of the aspirate in a syringe coated with 0. I ml of sodium heparin. Specimen may be transferred into a sterile tube for transport. @

Amniotic Fluid: Requires 20-30 ml of AMF in sterile 50 ml tube (used for prenatal diagnosis).

Chorionic Villus Sampling: Requires 10-20 mgm of tissue in transport media in a sterile container (used for prenatal diagnosis).

Skin Biopsy: Requires a 5 mm biopsy (punch or shave) of tissue in sterile tube containing cytogenetics transport media.

Products of Conception: Requires a 5 mm biopsy of unmacerated fetal tissue, chorionic villi and/ or fetal membranes. In autopsy cases, lung, gonad, thymus, heart and skin may be used. Place the tissue in cytogenetics transport media with each tissue type in a separate container. Warning: do not use any fixative or formalin. Fixed tissues cannot be cultured.

Solid Tumor: After gross pathologic evaluation, place the tumor sample and normal tissue counterpart if available into separate tubes. Use tumor transport media available in Surgical Pathology refrigerator.

Transportation: All specimens must have a Request for Chromosome Study form (available from Pathology Central Receiving). The form must be completed by the referring physician or his designate. Tissue samples from Surgical Pathology must indicate the responsible pathologist. All specimens are submitted through Pathology Central Receiving at 601-5116 EXCEPT for products of conception, fetal tissues, still births and tumors which are   sent directly to Surgical Pathology (601-5963).

Results: The final   report is taxed and mailed to the referring physician(s). Each report will contain a Summary of Data, Cytogenetic Diagnosis, Interpretation and Comments as necessary.

Cyst Fluid Cytology:
See Cytology, Cyst Fluid

Cytology, Ascitic Fluid:
See Cytopathology Section

Cytology, Body Fluids:
See Cytopathology Section

Cytology, Brain (cyst fluid, mass):
See Cytopathology Section

Cytology, Breast (mass, cyst fluid, discharge):
See Cytopathology Section

Cytology, Bronchial (brushing, lavage, washing):
See Cytopathology Section

Cytology, Cerebrospinal Fluid (CSF):
See Cytopathology Section

Cytology, Cyst Fluid:
See Cytopathology Section

Cytology, Cultures:
See Microbiology

Cytology, Effusions:
See Cytopathology Section

Cytology, Fine Needle Aspiration (Radiologic, Non-Radiologic, Intraoperative):
See Cytopathology Section

Cytology, Esophagogastrointestinal:
Types: Esophagus, stomach, duodenum, bile duct, pancreatic duct, colon See Cytopathology Section

Cytology, Gynecologic:
See Cytopathology Section

Cytology, Herpes:
See Cytopathology Section

Cytology, Joint Fluid:
See Cytopathology Section

Cytology, Pelvic and Peritonea]:
See Cytopathology Section

Cytology, Respiratory (brushing, lavage, washing):
See Cytopathology Section

Cytology, Special Stains (Pneumocystis and Fungus):
If an infectious process is suspected, indicate possible agents on the requisition form and request appropriate evaluation with special stains. See Cytopathology Section

Cytology, Sputum:
See Cytopathology Section

Cytology, Thyroid:
See Cytopathology Section

Cytology, Tzanck Preparation:
See Cytopathology Section

Cytology, Urine:
See Cytopathology Section

Cytology, Urinary Tract:
Types: Urine - voided and catheterized, bladder washings, ureter, renal pelvis, kidney See Cytopathology Section

Cytometry, Flow:
If a specimen potentially requires flow cytometry (example: lymphoma), indicate the need on the requisition form and submitted the material fresh and unfixed. Contact the Flow Cytometry Section of Clinical Pathology or the department in advance for further instructions.

DNA Analysis:
If a specimen requires DNA analysis (examples: breast and colon neoplasms), indicate the need on the requisition form. The specimen may be submitted fresh to surgical pathology and the appropriate tissue sample will be selected. Alternatively, if the specimen size is limited, analysis may be performed on paraffin embedded tissues. For consultation and further information, contact the department.

Electron Microscopy:
The Department of Pathology provides a full service electron microscopy laboratory for ultrastructural evaluation of surgical pathology specimens. Prior notification is required and the specimen must be submitted fresh (unfixed) to surgical pathology. The pathologist will provided a gross evaluation of the specimen and will select appropriate tissues for study. Contact the department for further information and answers to any questions.

ERA/PRA Hormone Receptor Assay:
See Hormone Receptor Assay

Fine Needle Aspiration Cytology:
See Cytology, Fine Needle Aspiration

Flow Cytometry:
See Cytometry, Flow

Frozen Section Examination:
The Department of Pathology provides frozen section examination 24 hours/day, 7 days/week. During regular working hours, prior notification must be given to Surgical Pathology at x5963. The accessioning receptionist will require completion of a frozen section form prior to processing the specimen. The specimen must be delivered fresh to Surgical Pathology either by a transporter or through the pneumatic tube system. The specimen must be labeled completely and must be accompanied by a Surgical Pathology Consultation Request form. Pertinent information related to orientation and specific clinical issues must be clearly indicated on the form. The pathologist will report the results of the examination directly to the surgeon, his physician designate or the nursing staff as appropriate.

Frozen section examination after hours, at night, on weekends or holidays must be arranged in advance as soon as the potential need arises. The Pathologist on call is contacted through the page operator of the hospital and must be notified with sufficient "lead time" to arrive at the hospital as needed. If the attendance of the Pathologist is requested and then the need is canceled, the Pathologist must be notified through the page operator of the hospital.

Gross Consultation, Surgical:
See lntraoperative Consultation

Gross Examination, Intraoperative:
See lntraoperative Consultation

Gross Surgical Examination:
See Intraoperative Consultation

Heart Biopsy:
Contact the department for consultation.

Helicobacter Analysis, Tissue:
If evaluation of gastric biopsies for Helicobacter is required, indicate the need on the requisition form and request the special stain (Diff Quik).

Histochemistry Stains:
The Department of Pathology offers a wide variety of special histochemistry stains. If a specific clinical issue requires investigation (example: amyloid, Helicobacter), indicate the need on the requisition form. For further information or to answer any questions, contact the department.

Histopathology:
Microscopic Pathology: Surgical Pathology - General

Surgical Pathology: Surgical Pathology - General

Frozen Section Examination: See Frozen Section Examination

Intraoperative Consultation: See lntraoperative Consultation

Hormone Receptor Assay:
Hormone receptor assays can be performed either on fresh (unfixed) tissue or on paraffin embedded blocks. The specimen should be submitted fresh to Surgical Pathology and an intraoperative consultation should be obtained. The Pathologist will examine the gross specimen and select appropriate material for submission. Delays in submission will modify the results of this study. If in the judgment of the Pathologist, insufficient fresh tissue is available for study or if studies become necessary after the results of microscopic evaluation, then paraffm embedded blocks can be submitted for hormone receptor assay. For any additional information and answers to questions, contact the department.

Immunofluorescence, Tissue (Skin, Kidney, Lung, Heart):
The specimen must be submitted fresh (unfixed) to Surgical pathology and an intraoperative consultation should be requested. The specimen must accompanied by a requisition form that includes all pertinent clinical information needed to perform an appropriate evaluation. Prior notification is required. For further information and answers to any questions, contact the department.

Immunohistochemistry:
The Department of Pathology offers a wide variety of immunohistochemistry stains. If a specific clinical issue requires investigation (example: characterization of tumors and lymphoma), please indicate the need on the requisition form. A complete listing of the analytes available for use is kept on file in the Histology section of the department. For further information or answers to any questions, please contact the department.

Immunoperoxidase, Tissue:
See Immunohistochemistry

Intraoperative Gross Consultation:
The Department of Pathology provides gross examination of surgical specimens 24 hours/day, 7 days/week. During regular working hours, prior notification must be given to Surgical Pathology at 601-5963. The accessioning receptionist will require completion of a consultation form prior to processing the specimen. The specimen must be delivered fresh (unfixed) to Surgical Pathology either by a transporter or through the pneumatic tube system. The specimen must be labeled completely and must be accompanied by a Surgical Pathology Consultation Request form. Pertinent information related to orientation and specific clinical issues must be clearly indicated on the form. The pathologist will report the results of the examination directly to the surgeon, his physician designate or the nursing staff. In special circumstances at the request of the surgeon, the pathologist will come to the operating room and render an intraoperative evaluation of the specimen.

Gross intraoperative examination after hours, at night, on weekends or holidays must be arranged in advance as soon as the potential need arises. The Pathologist on call is contacted through the page operator of the hospital and must be notified with sufficient "lead time" to arrive at the hospital as needed. If the attendance of the Pathologist is requested and then the need is canceled, the Pathologist must be notified through the page operator of the hospital.

Iron, Tissue, Quantitative:
If a quantitative iron determination on tissue is needed, the specimen must be submitted fresh (unfixed) and an intraoperative consultation must be obtained.

Karyotype Analysis:
See Cytogenetic Analysis.

Kidney Biopsy:
See Renal Biopsy

Lymph Node Biopsy:
If a specimen is felt to be potentially lymphomatous in character, the tissue should be submitted fresh (unfixed) to Surgical Pathology and an intraoperative consultation is required. The tissue will be divided appropriately for histology, special fixation, culture, cytology, immunohistochemistry, electron microscopy, flow cytometry and cytogenetics as needed.

Lymphoma Panel/Profile:
See Lymph Node Biopsy

Muscle Biopsy:
Muscle biopsies require special technical handling. The specimen must be submitted fresh (unfixed) to Surgical Pathology and an intraoperative consultation is required. Ideally, the specimen should be obtained with muscle clamps and should be appropriately oriented. Alternatively, the specimen can be pinned on a wooden blade. Pertinent clinical history is essential in order to accurately divide and assess the pathologic process of the muscle. Studies include histology, muscle histochemistry, special stains, immunofluorescence and electron microscopy as needed. For further information or answers to question, contact the department.

Nerve Biopsy:
Contact the department for consultation.

Necropsy:
See Autopsy

Needle Biopsy Cytology
See Cytology, Fine Needle Aspiration

Nipple Discharge Cytology
See Cytology, Breast

Operative Consultation:
See lntraoperative Consultation

Outside Slide Review:
Requests for review of outside or referral slide material should be made through the Anatomic Pathology Office at 601 - 5090. It is the responsibility of the requesting physician to have this material forwarded to the department. The department will attempt to assist in the disposition of these requests. A surgical pathology report will be issued following the completion of the study. In special circumstances, additional materials such as blocks may be required from the referring institution. Where appropriate, selected slides may be retained in the department files for later reference. Copies of final report will be provided to the referring physician and the pathology department representing the source of this material.

PAP (Papanicolaou) Smear:
See Cytology, Gynecologic

Pathologist Consultation:
See lntraoperative Consultation, Frozen Section Consultation or Outside Slide Review

Photography:
The department maintains a complete photography service. If photographs are required of a gross surgical pathology specimen, please indicate the request on the requisition form or obtain an intraoperative consultation.

Pleural Fluid Cytology:
See Cytology, Effusions

Pneumocystis, Tissue and Cytology:
If Pneumocystis infection is a clinical consideration, indicate the need for special stains on the requisition form.

Prostate Needle Biopsy:
If a sextant needle biopsy survey of the prostate is submitted, follow the standardized protocol established by the Department of Pathology and Division of Urology. Because of the nature of the specimen, additional sections and immunohistochemistry studies may be required and could delay the fmal report, Forms and further information can be obtained by calling the department.

Postmortem Examination:
See Autopsy

Renal Biopsy:
The department must be contacted in advance for scheduling of renal biopsies. The Pathologist or his designate will assist the nephrologist or radiologist by evaluating and dividing the biopsy specimen intraoperatively at the time of acquisition. The specimen will be allocated for histology, special stains, immunofluorescence and electron microscopy as appropriate for the quantity of tissue and clinical setting. A detailed renal biopsy protocol can be obtained from the department which outlines all required pertinent clinical history and laboratory information. For cases submitted from outside institutions, prior arrangement is required and certain time restrictions exist. The referring institution is responsible for the safe and appropriate transportation of the specimen. The specimen must be transported immediately in the fresh (unfixed) state on a moist, saline soaked telfa pad. All pertinent patient demographic, billing and clinical information must be included. A preliminary report of the light microscopic findings will be reported by the Pathologist on the next working day.

Renal Stone, Chemical Analysis:
See Calculus, Chemical Analysis

Skin Biopsy, Tissue:
Provide a pertinent clinical differential diagnosis on the tissue requisition form to assist in the appropriate handling of the specimen (example: tumor clearance, alopecia).

Skin Biopsy - Immunofluorescence:
The tissue must be submitted fresh (unfixed) and an intraoperative consultation must be obtained so that the specimen may be divided in an appropriate manner.

Special Stains:
See Histochemistry

Spinal Fluid Cytology:
See Cytology, CSF

Sputum Cytology:
See Cytology, Sputum

Stone, Chemical Analysis:
See Calculus, Chemical Analysis

Storage, Tissue, Reference:
Portions of surgical pathology specimens can be frozen for later reference as clinically needed as long as this storage does not interfere with the pathologic evaluation of the material. Consultation with the Pathologist is required and an intraopemtive consultation is required.

Surgical Pathology Consultation:
See Intraoperative Consultation, Gross Examination, Frozen Section Examination and Outside Slide Review as appropriate

Thorocentesis Cytology:
See Cytology, Effusions

Thyroid Cytology:
See Cytology, Thyroid

Tissue Examination:
See Intraoperative Consultation or Histopathology

Urinary Tract Cytology:
See Cytology, Urinary Tract

Vaginal Smear:
See Cytology, Gynecologic

Viral Culture, Tissue:
See Culture, Tissue

Washings, Bronchial:
See Cytology, Bronchial

Washings, Pelvic and Peritoneal:
See Cytology, Pelvic and Peritoneal