1.3b - Anatomic Pathology - Surgical Pathology General Information

ANATOMIC PATHOLOGY -- SURGICAL PATHOLOGY
Surgical Pathologists:
John C. Lee, MD (ext 35944)
Marie Lithgow, MD (ext 36073)
Meera Mahalingam, MD (ext 35992)
Hongbo Yu, MD (ext 35898)
Xuihong Xu, MD (ext 36692)
Shyam Prajapati, DO  (ext 35429)
Merry Spradling, MD (ext 35020)

Anatomic Pathology Manager
Adrianne Kingman (ext 35955)

Pathologist Assistant:
Ashlei Vohnoutka (ext 34214)

Laboratory Manager:
Arthur McGee  (Ext. 35993)

Histology Supervisor:
Jun Wang (Ext.34127)
 
GENERAL INFORMATION AND REQUIREMENTS:
In the Histology Laboratory, tissue sections from biopsies and excisions are stained with hematoxylin and eosin (H&E) for routine microscopic examination. Special histochemical and immuno-histochemical studies may also be performed, at the discretion of staff Pathologists, after a review of the routine light microscopy. The following general guidelines should be followed when sending patient specimens to the Histology Laboratory. Specific questions regarding appropriate preparation and/or preservation of specimens should be referred to the laboratory (BG 3, RM 1A116A: x35946, 1C114: x35948 gross room).

1. Maximum precautions are necessary to avoid exposure to potentially infectious agents when delivering patient specimens to the laboratory. Specimens must be placed in appropriate leak-proof containers (depending on the size of the biopsy or excision) and placed in plastic Biohazard bags.
2. All specimen containers must be labeled with the patient’s full name, full social security number, collection date and specimen site. The latter is especially important when multiple specimens are sent on the same patient from the same surgical procedure.
3. All specimens must be accompanied by a properly completed Tissue Examination Request, SF515/ Electronic recommended* with the following information:
   1. Patient's full name and full social security (use address or graph plate to imprint the Handwritten requisition form)
   2. Physicians name and provider number (Note: this must be legible)
   3. Date the specimen was obtained
   4. Specimen type
   5. Pertinent clinical history
   6. Additional information (i.e. request for RUSH diagnosis, etc.)
4. Fixatives (neutral buffered formalin [NBF] or RPMI fixative) can be obtained from the Histology Laboratory. Note: All tissue fixatives are for tissue preservation only and are not for therapeutic purposes.

*An Electronic Surgical Pathology Requisition can be used in the GUI system by clicking on  “ORDERS”;  “LABORATORY MENU”;  “TISSUE EXAMINATION SURGICAL PATHOLOGY” (Found under “All Locations” on the Main LAB Menu). Follow the prompts to fill out the form.  A hard copy of the form MUST be printed and sent with the specimen.

SUBMISSION OF SPECIMENS:
NOTE: ALL specimens removed from VA patients must be submitted to the pathology department for routine examination unless exemption has been approved and documented through the medical staff office.

During the hours of 8:00 a.m. to 4:30 p.m., the specimen with the requisition is delivered to the main laboratory in West Roxbury, room 1B124, Building #3.

1. ALL  FROZEN SECTION SPECIMENS should be delivered to the The Frozen Section room, 1C109, Building #3. *PLEASE NOTE: ALL FROZEN SECTION SAMPLES ARE TO BE LABELED WITH THE BRIGHT PINK STICKER WHICH STATES “FROZEN SECTION”.
2. During off-hours and weekends, all surgical specimens must be delivered to the main laboratory in West Roxbury, room 1B124, Building #3 (Send-Out Lab area). On the occasion that the specimen is too large (limbs) for the designated refrigerator in the main laboratory, the refrigerator in the surgical cutting room, room 1C114, Building #3, can be used. Laboratory personnel in the main laboratory can direct couriers to the cutting room refrigerator. ALL FROZEN SECTION SPECIMENS should be delivered to the The Frozen Section room, room 1C109, Building #3.
3. Specimens (JP) should be delivered directly to the send-out desk on the 2nd floor lab area, B wing, B2-65 of the Boston campus for transport to West Roxbury Anatomic Pathology. Those taken after hours or on the weekends should be placed in the appropriately designated refrigerator, the 2nd floor, B wing. FROZEN SECTION samples are delivered to room B2-56. 
4. Specimens (BRK) should be delivered directly to Brockton laboratory (Bldg 3, first floor, room A-123) during lab hours for transport to West Roxbury Anatomic Pathology. After hours and weekend samples should be delivered to Urgent Care for transport to West Roxbury Anatomic Pathology. 
5. Samples from other VA Laboratories in Visn 1 can be transported refrigerated or at room temp. Under no circumstances should surgical and cytology specimens be left in any other areas except the areas described above.

Note: When submitting surgical pathology specimens for which the clinical differential diagnosis includes Creutzfeld-Jakob Disease (CJD), both the specimen container and the accompanying requisition must be clearly labeled “CJD”.

SPECIFIC TISSUE SUBMISSION INSTRUCTIONS:
1. Small Tissue Biopsies: (i.e. skin biopsies, GI polyps, needle core biopsies)
Place the specimens promptly into a 40 ml pre-filled NBF screw-top container, properly labeled with the patient's full name and full social security (use addressograph printed labels) and tissue source. Deliver to the main laboratory in West Roxbury, room 1B124, Building #3.

2. Large Tissue Specimens:
During working hours (Mon-Fri, 8:00 am to 4:30 PM), large specimens such as kidney, spleen, lungs and bowel segments should be submitted promptly to the laboratory without fixative in a closed container with saline-moistened towels to prevent drying artifacts to the specimens. During evenings and weekends, all large specimens should be refrigerated (without fixative), in the fresh state, until delivered to the laboratory (RM 1B124, building 3).

3. Bone Marrow Biopsies and Aspirates:
a. Place the core biopsies into a 40 ml pre-filled NBF screw-top container, properly labeled with the patient's name and full social security (use addressograph printed labels) and tissue source.
b. For the aspirates, label clean glass microscope slides in pencil on the frosted end with the patient's name and full social security number. Smear the aspirates on the labeled side of the slides and air dry before submitting the specimen to the laboratory.

4.  Lymph Node for Lymphoproliferative Disorder:
a. The specimen should be received fresh (without fixative-saline is acceptable) in a screw-top container labeled with the patient’s full name and full social security number. The tissue examination form must also accompany the specimen.
 
 b. The specimen should be sent immediately since the tissue is fresh.
           
c. Once the tissue is examined by the Pathologist:
i.  If lymphoma is suspected, 2 air dried touch slides are made and should reflect the major cell distribution seen in the biopsy specimen.
ii. The specimen for flow cytometry should be placed in nutrient media (ex: RPMI-1640) and minced to maximize cell contact with the media. Under NO circumstances should this piece be fixed. If an additional piece is sent to the West Roxbury histology lab for analysis, please package the 2 separately. Lymph nodes will be transported with refrigerant pack (do not allow specimen to contact the pack).

5. Frozen Tissues for Intraoperative Diagnosis:
a. Always notify the #3 pathologist according to the pathology schedule (sent monthly to the OR) whenever unscheduled frozen section tests are needed and whenever fresh specimens are being sent down from the Operating Room via the frozen section pager.
b. All tissues for frozen sections must be sent fresh, properly labelled with patient full name and full social security and with a properly completed SF515 (Tissue Examination Request) with affixed pink FROZEN SECTION STICKER. The requesting physician’s name and telephone number must also be listed on the requisition, along with any special instructions regarding areas to be examined (ie. margins only).
 
Note: Frozen sections will NOT be performed on brain tissue for which the clinical differential diagnosis includes Creutzfeldt-Jakob Disease (CJD).

6. Tissues for Special Studies (Immunohistochemistry)
These specimens may require special handling and tissue fixation and should be submitted fresh whenever possible. Call the Histology Laboratory (x5946, 5940) for information. 

7. Renal Biopsies

1. For planned renal biopsies performed on renal disease patients, contact (via emai) VHABHSRenalBiopsy@va.gov email group and on-call pathologist (pager 51145). FOR ASSURANCE OF SAME DAY DELIVERY TO BWH PLEASE SCHEDULE IN THE MORNING IF POSSIBLE.
2. Page the on-call pathologist (51145) just prior to the biopsy procedure and just prior to the renal core collection.
3. The on-call pathologist will attend the biopsy procedure in the CT scan suite for the purpose of assessing adequacy of the renal biopsy at the time of the procedure (presence of glomeruli). The on-call pathologist will prepare the specimen and place the specimen in the correct fixatives for sending to Brigham and Women’s Hospital (via courier) for processing and reporting.
4. The specimen containers and the accompanying requisition must be labeled with the patient’s full name and full social security number and specimen source by the radiology staff, prior to the biopsy procedure.
5. The requisition must stipulate that the specimen is a renal biopsy to be sent to Brigham and Women’s Hospital Renal Pathology Department.
6. The renal biopsy specimen will be delivered by the on-call pathologist to room 1C-114 building #3, WR.
7. Upon receipt in the Histology Lab, the renal biopsy specimen will be accessioned and sent, via courier, to Brigham and Women’s Hospital (BWH) Renal Pathology Department for processing and reporting. The BWH renal biopsy report will be added to the VA BHS accession (patient medical record) as a supplemental report upon receipt of report from BWH (approximately 2 week TAT).
8. Under no circumstances should the renal biopsy be transported from VA BHS to BWH by means other than the Lab assigned courier service.

GROSS ONLY SPECIMENS
1. The specimen is accessioned in the usual manner.
2. The specimen is thoroughly examined for the presence of any human tissue. In the
event that significant amounts of soft tissue are present, the pathologist will consider
submitting for histologic examination.
3. The following items may be entered as “gross only” specimens:
a. Catheters
b. artificial valves
c. prostheses
d. teeth
e. lens (eye)
f. all hardware
g. nasal septum
h. foreign bodies (unless requested)
i. calculus (gall stones and renal stones)


RESULTS:
Surgical and Cytology specimens will be accessioned and prepared in a timely manner in order to provide diagnostic results for patient treatment. (Anatomic Pathology hours 8:00am-4:30pm)
 

Surgical Pathology