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United States Government Work, uncopyrighted, public-domain,
DRAFT COPY ONLY. This document does not necessarily represent the views
or policies of any United States Government agency.
This document is provided "as is", without warranty of any kind,
express or implied, including but not limited to the warranties
of merchantability, fitness for a particular purpose and
non-infringement. In no event shall the authors be liable
for any claim, damages or other liability, whether in an
action of contract, tort or otherwise, arising from, out of,
or in connection with the document or the use or other dealings
made with the document.
See also: Main objectives: 1.
Receipt of Specimens: 2,
3.
Specimen Accessioning. 4,
6.
VistA® Computer: 1,
7.
Frozen section policies: 25,
26, 27,
41, 86.
PRINCIPLE OF THE TEST.
The Histology Laboratory is responsible for processing all tissues
obtained at surgery, outpatient clinics, and postmortems in this hospital.
Instructions for proper handling of specimens must be available
at these locations.
SPECIMEN REQUIRED.
All human tissue excised at surgery, outpatient clinics,
fresh or in fixative, along with a filled-out Tissue Examination Form
(U. S. Standard Form 515, USSF515).
REAGENTS, INSTRUMENTATION.
Plastic containers.
Tissue Tek VIP®5 Vacuum Infiltration Processor.
Neutral 10% buffered formalin.
70% Flex Solution.
80% Flex Solution.
95% Flex Solution.
100% Flex Solution.
Clearing Solution.
Paraffin.
Decalcifying solution (RDO),
Hematoxylin and eosin stain.
Microtome.
Water bath.
Alcoholic iodine solution.
5% sodium thiosulfate.
13% Thioacetamide.
Fluted filter paper.
STEP-BY-STEP DESCRIPTION.
1. Requisitions are prepared and specimens labeled in the Operating Room
or other location where the biopsy or surgical procedure was performed.
Requisitions must include specific patient identification,
source of organ/tissue, name of submitting physician(s), pertinent
clinical information, pre- and/or postoperative diagnosis, and date
specimen obtained. These are data entry fields that are present on
the Tissue Examination Form
(U. S. Standard Form 515, USSF515).
2. An instruction manual for histology and cytology is distributed
to the Operating Room Suite and to the clinical wards.
This manual is available on the VA Intranet.
See CYTOLOGY AND HISTOLOGY PROCUREMENT MANUAL FOR WARDS, CLINICS, AND TREATMENT ROOMS.
3. All tissues and all objects removed
from inside the bodies of patients
(e.g., foreign bodies, gallstones) should be submitted to the histology
laboratory for accessioning and examination. The histology laboratory
is located in room 4D-124. Its hours of operation are 8:00 to 4:30,
Monday through Friday. Arrangements should be made for tissues procured
after-hours as described in the following section.
4. Specimens are normally submitted in plastic cups (small specimens
can be submitted in plastic sputum cups) in 10% buffered formalin, and
labeled with the name of the fixative. Cardboard cups (such as those
used for stool collection) are not water-tight and should not be used
to deliver tissue. Formalin can be picked up from the histology laboratory.
Services that require large volumes of formalin are advised to purchase
their own supply. The required minimum ratio of formalin-to-tissue
that permits adequate fixation is 10:1 (i.e., 10 times more formalin than
tissue). This means that specimens must be submitted in containers at
least ten times the volume of the specimen to accompany a sufficient
amount of formalin. In addition, formalin cannot penetrate through very
thick , dense tissue regardless of the amount of formalin present, and
large tissues whose delivery to the histology section may be delayed
should be refrigerated and/or cut to allow sufficient penetration of
formalin to tissue surfaces.
5. Specimen containers must have a patient label attached.
Specimen containers are always submitted with a completed
United States Standard Form 515
(Tissue Examination Form, USSF515).
A physician's signature and a short history is required.
A description of the lesion is useful, especially when only a
small portion of the lesion is biopsied. Duration of the lesion, age of
the patient and clinical differential for the lesion are always
appreciated and many times necessary. Specimens arriving with
incomplete forms are not accessioned (and not processed) until the forms
are completed. The department makes reasonable attempts to contact the
responsible physician.
We appreciate prompt compliance when we request
additional information.
6. The above instructions are applicable
to most submissions to our department.
The exceptions are as follows:
6.1. Bone marrow submissions.
Arrangements for bone marrow submissions are
made through the hematology section and the pathologist
in charge of hematology (Dr. James M. Sorace,
beeper 410-447-4453).
Bone marrow cores should only be submitted
during the normal hours of operation of the laboratory,
as they require the immediate attention of technicians
in hematology as well as histology.
6.2. Specimens needing procedures not offered
in our department. Occasionally, physicians will prefer
that a specialized outside laboratory perform
a specialized diagnostic test on tissues from VA patients.
Before making such arrangements,
the clinician must notify the Chief, Anatomic Pathology (Dr. Lee, ext. 5314)
of their intention. The Chief, Anatomic Pathology
will determine whether the clinician can waive the usual hospital
requirement that all tissues be received and diagnosed by VA Pathology.
In general, permission for bypassing pathology will only be given for tests
not performed at the VA pathology laboratory,
and in a laboratory known to be a good laboratory.
In all such cases, the clinician is responsible for
supplying a copy of the report produced by the outside laboratory to the
pathology department. The department making these arrangements must pay
for the special services, and no bill should be sent to pathology.
6.3. Occasionally, the pathologist who receives a specimen
may determine that special studies need to be performed
at an outside laboratory, in which case the pathologist
will make arrangements with the outside laboratory to perform
the studies, and will make prior arrangements for pathology funding of
the tests (if costs are incurred)
with the Chief, Pathology & Laboratory Medicine Service (113).
No costs to Pathology should be arranged
by a pathologist without first arranging funding through
the Chief, Pathology & Laboratory Medicine Service.
6.4. Frozen Sections:
See PROCEDURE 25: FROZEN SECTION PROCEDURES (INTRAOPERATIVE CONSULTATIONS).
6.5. Aspirations. Aspirations are always considered cytology specimens,
and should only be submitted to the cytology laboratory.
6.6. Large Specimens. Large specimens (such as amputation stumps)
are submitted refrigerated, rather than formalin-fixed. When submitted
to histology, the USSF515 form should be left on the accession desk.
The actual specimen (wrapped and clearly labeled) should be placed in the
morgue cold room, Room 4D-125.
6.7. All specimens are submitted for microscopic examination, except
for amputations due to peripheral vascular disease; degenerative joint
disease; bunions; and hernia sacs; and metal or plastic prosthetic devices.
REFERENCES.
1. Berte LM, Charlton BJ, Kirkley B, Schiffgens J,
Wilson JI, Woodcock SM.
Clinical Laboratory Technical Procedure Manuals;
Approved Guideline -- Fourth Edition.
NCCLS Document GP2-A4. 2002;2(5):.
ISBN 1-56238-458-9, 64 pages.
National Committee for Clinical Laboratory Standards (NCCLS).
940 West Valley Road, Suite 1400. Wayne, PA 19087-1898.
... presents the important components of writing and managing procedures
for the clinical laboratory.
2. Hoeltge GA, Dynek DA, Delahunty DC, McClatchey KD,
Rabinovitch A, Robinowitz M, Travers EM.
National Committee for Clinical Laboratory Standards (NCCLS).
Clinical Laboratory Technical Procedure Manuals. Third Edition.
Approved Guideline GP2-A3. 1996;16(15):.
3. Rosai J.
Rosai and Ackerman's Surgical Pathology. Ninth Edition.
St Louis: C.V. Mosby. 2004;:.
ISBN: 0323013422, 3080 pages.
4. Mills SE, Carter D, Greenson JK, Oberman HA,
Reuter VE, Stoler MH, eds.
Sternberg's Diagnostic Surgical Pathology. Fourth Edition.
New York: Lippincott Williams & Wilkins. 2004;:.
ISBN: 0781740517, 3089 pages.