GENERAL INFORMATION

Anything removed from a patient is considered a surgical specimen and must be submitted to Surgical Pathology. Although specimens usually consist of tissue, other specimens such as hardware, bullets, implants, aspirated coins, etc. which are surgically removed are considered surgical specimens.

Routine biopsy specimens are usually submitted in 10% buffered neutral formalin. Specimen containers should be large enough so that an adequate amount of formalin can be added (i.e., the specimen should be totally submerged). Large surgical specimens, especially those containing a tumor, should be submitted fresh without a fixative, and transported immediately to pathology. If such large surgical specimens are removed after hours, they may be refrigerated overnight.

Specimens from the operating room case are delivered to Pathology either by Patient Transport Services, or picked up by Lab Personnel until 5:00 PM. All specimens must be accompanied by a completed Tissue Examination Request ("surgical request form") and must be labeled with the following:

MSHA Patient

1. Patient name 2. Medical record number 3. Physician(s) 4. Type of specimen 5. Pertinent short history

Non-MSHA Patient

1. Patient Name

2. Address, SSN & Date of Birth

3. Physician(s)

4. Type of specimen

5. Pertinent short history

TYPES OF EVALUATIONS

1. ROUTINE: This type of evaluation applies to the majority of surgical specimens. Specimens received prior to 4:00 PM are processed overnight and biopsy slides are ready for histologic examination by 8:00 AM the following day. Slides from larger cases are ready by noon. Large specimens received fresh late in the day may require overnight fixation before processing. Histologic sections on these cases would, therefore, be available the second day after receipt of the specimen. 2. RUSH: A rush specimen is processed and sectioned for next day - “Early Call”, if received by noon…the next morning if received after noon. Rush cases received on Friday are available on Saturday morning. *NOTE: Rush designations should not be used to indicate a specimen that the surgeon wants delivered to the laboratory immediately.

3. FROZEN SECTION: Frozen sections allow the pathologist to render a preliminary diagnosis. They should be requested only when the diagnostic results would impact the surgical procedure. A frozen section cannot be performed on some specimens, such as bone and heavily calcified nodules which must undergo a decalcification process prior to sectioning.

4. IMMEDIATE EVALUATION: A surgeon may request immediate evaluation of a specimen to answer a specific question. This specimen will be called to the pathologist's attention upon arrival in the surgical pathology laboratory. For example, the surgeon may want the pathologist to open a colon to see if a tumor is present.

5. FRESH: Fresh specimens should be delivered immediately to Surgical Pathology with no fixative so that special studies may be performed. This commonly applies to tissue submitted for a lymphoma workup or estrogen/progesterone receptors and all tumors.

SPECIAL PROCEDURES

1. ELECTRON MICROSCOPY: Tissue to be submitted for electron microscopy should be cut into small pieces (1mm x 1mm), placed in Carson’s Fixative (located in Histology), and kept refrigerated. Do not use 10% buffered neutral formalin.

2. IMMUNOFLUORESCENCE: Specimens for immunofluorescence should be placed in saline and transported IMMEDIATELY to pathology or placed in Michel's media (located in Histology). If after hours, they may be placed in Michel's media and refrigerated.

3. MICROBIOLOGY CULTURES: When possible, and to avoid contamination, specimens for bacteriological, viral, AFB, or fungal cultures should be sent directly to the microbiology laboratory. (See the Microbiology section for collection information.)

4. ESTROGEN/PROGESTERONE RECEPTORS: The specimen should be placed in a sterile container with NO fixative and immediately transported on ice to surgical pathology. A 1x1xO.5 cm. piece of tumor is required for analysis.

5. LYMPHOMA WORKUP: Specimens from known or suspected cases of lymphoma should be submitted fresh, without fixative, so that appropriate studies may be performed. These may include flow cytometry, gene rearrangement, immunohistochemistry, etc. The specimen should be transported immediately to surgical pathology. If after hours, or on weekends, contact the pathologist on-call. While lymph nodes are the most common specimen to be handled in this manner, the same procedure applies to specimens of lymphoma from extra nodal sites such as, lung, or GI tract.

6. REVIEW OF OUTSIDE SLIDES: Patients referred to MSHA facility from other institutions often have had surgical procedures performed elsewhere. Histologic slides from the outside hospital should be reviewed by surgical pathology before further treatment is instituted here (i.e., further surgery, radiation therapy, etc.). The slides and a copy of the outside pathology report should be submitted with a complete Tissue Examination Request to the pathology secretary, Lower Level of JCMC. "Rush" review of outside slides can be requested; the final report will be available in 24 hours.

SURGICAL PATHOLOGY LABORATORY HOURS & AFTER HOURS PROCEDURE

The pathologist on-call or designated resident is normally present from 7:30 a.m. to 5 p.m. Monday through Friday. Any questions regarding a specimen may be directed to one of these two individuals. They may be reached by calling:

423-431-6385 - Pathology Secretary

If a late frozen section is anticipated, the pathologist on-call should be notified before 5 p.m. In the event of an emergency frozen section or other questions after hours or on weekends, the pathologist on-call may be reached through the laboratory.

Surgical Pathology reports are available through the Pathology secretary, 423-431-6389, Mon - Fri 8 a.m. - 5 p.m.

If the case has not been completed, you can discuss its status with the attending pathologist.