Pathology in HistoPathology -...

Pathology inHistoPathology

Dr. Meera GovindarajanR & D Histopath Lab

Chennai

Dr. Meera GovindarajanR & D Histopath Lab

Chennai

When does that occur

• Report is not ready• Report is vague• Insufficient material or report is

ambiguous• Histopathology diagnosis does not

correlate with the clinical findings

• Report is not ready• Report is vague• Insufficient material or report is

ambiguous• Histopathology diagnosis does not

correlate with the clinical findings

Factors which influence the outcome of thequality of Histopathological reports

ProblemsAt the

Clinical end

TechnicalProblems

in thelaboratory

Lack ofClinicopathological

Co-relation

Problems at the Clinical end1.Lack of sufficient material in biopsy or

cytological specimen

Liver biopsy of a largemass in the right Lobe

Histology revealed onlySkin and muscle tissue

No liver tissue seen

Liver biopsy of a largemass in the right Lobe

Histology revealed onlySkin and muscle tissue

No liver tissue seen

Problems at the Clinical end1.Lack of sufficient material in biopsy or

cytological specimen

Nearly 20 slides ofFNAC from Thyroidreceived.

All slides revealed onlyblood. No cellularmaterial seen in any ofthe 20 smears.

No report possible

Nearly 20 slides ofFNAC from Thyroidreceived.

All slides revealed onlyblood. No cellularmaterial seen in any ofthe 20 smears.

No report possible

Problems at the Clinical endSpecimen on the Right is unfixed. Fallopian tube was left in Salinefor 3 days prior to handing it over to The Lab. Well fixed ( In 10%

Formalin) Normal Fallopian tube for comparison

Problems at the Clinical endTumor removed from the base of the brain in 40 year old

woman. Slide on the right shows tissue damaged bycauterization. Picture on the right from the same case.

Problems at the Clinical endInherent problem with the tissue

Abdominal tumor in a68 year old woman,possibly arising fromovary.

Total infarction of thetissue seen onHistology

No Report possible

Abdominal tumor in a68 year old woman,possibly arising fromovary.

Total infarction of thetissue seen onHistology

No Report possible

38 year old woman with vague breast mass, reported suspicious onmammography. FNAC done. Out of the 3 slides only one was sent

to us. The other cytologist reported the smear as benign. A secondsurgeon was consulted and Lumpectomy performed.

The lump was divided into two parts and sent to 2 morePathologists.

Both reported it as Benign Fibrocystic disease. Problem are as follows1.: two surgeons, 4 pathologists have been

involved.2: Material has been divided into 4 parts

and not a single Pathologist hadanalyzed it completely.

3: One of FNAC slide revealed atypical cellswith features of malignancy. This findinghad been ignored and no attempt madeto search for in situ/Infiltrating foci.

4. In-situ foci may have been lost duringcutting of the lump into 2 parts or due toincomplete histological examination ofthe lump as the Pathologist was unawareof the cytological findings

Problem are as follows1.: two surgeons, 4 pathologists have been

involved.2: Material has been divided into 4 parts

and not a single Pathologist hadanalyzed it completely.

3: One of FNAC slide revealed atypical cellswith features of malignancy. This findinghad been ignored and no attempt madeto search for in situ/Infiltrating foci.

4. In-situ foci may have been lost duringcutting of the lump into 2 parts or due toincomplete histological examination ofthe lump as the Pathologist was unawareof the cytological findings

Result of this confusion

Patient was operated for Lumpin the breast after 6 months in

Bombay hospital anddiagnosed as Infiltrating duct

carcinoma.

Patient was operated for Lumpin the breast after 6 months in

Bombay hospital anddiagnosed as Infiltrating duct

carcinoma.

Technical Problems arising in thelaboratory

1. Lack of good quality Chemicals forprocessing

2. Lack of good quality instruments and Knifefor cutting 5 micron sections.

3. Poor Staining4. Lack of efficient quick processing

techniques.

1. Lack of good quality Chemicals forprocessing

2. Lack of good quality instruments and Knifefor cutting 5 micron sections.

3. Poor Staining4. Lack of efficient quick processing

techniques.

Poorly processed tissue cut with blunt knife with nicks.The diagnosis is not evident. (x100) . Slide diagnosed asDiffuse NHL was given for opinion without providing anyclinical history.

The block was reprocessed using Microwave and recut into5 micron sections. The diagnosis was Tuberculous

Osteomyelitis. (x100)

Processing times can be shortened by usingbetter techniques

Frozen section – Cryostat – for urgentspecimen – Costly – suitable in largehospitals

Microwave Quick processing – cheapand produces paraffin embeddedblocks for IHC.

Tissue processors – Suitable for largevolumes of specimen.

Microwave routine processing forlarge volumes of specimen

10 mins

32 mins

24-28hours

2-6hours

Frozen section – Cryostat – for urgentspecimen – Costly – suitable in largehospitals

Microwave Quick processing – cheapand produces paraffin embeddedblocks for IHC.

Tissue processors – Suitable for largevolumes of specimen.

Microwave routine processing forlarge volumes of specimen

10 mins

32 mins

24-28hours

2-6hours

FNAC from Breast mass with biopsy of themass for quick diagnosis

FNAC of breast mass another case with biopsy of the massfor quick diagnosis

Testicular tumor sections with quick processing

Problems faced by Pathologist

Pathology is a very vast subject involving allspecialities of medicine. Research is

progressing fast in immuno/molecularpathology. Extensive updating of information

is required at all times. Keeping pace withthis science is not easy.

Lack of information regarding age/ sex/ site ofbiopsy and clinical findings.

Lack of sufficient material for analysis. Lack of experience when faced with difficult

cases. Very unusual cases which are difficult to

analyze.

Pathology is a very vast subject involving allspecialities of medicine. Research is

progressing fast in immuno/molecularpathology. Extensive updating of information

is required at all times. Keeping pace withthis science is not easy.

Lack of information regarding age/ sex/ site ofbiopsy and clinical findings.

Lack of sufficient material for analysis. Lack of experience when faced with difficult

cases. Very unusual cases which are difficult to

analyze.

Problems arising due to lack of clinicopathologicalcorrelation

Both slides show smallcell malignant tumor.

Diagnosis requires:1.clinical history,2. age/sex of patient3.Ct scan Ultrasoundresults.

Without relevantinformation Diagnosis isnot possible.

Both slides show smallcell malignant tumor.

Diagnosis requires:1.clinical history,2. age/sex of patient3.Ct scan Ultrasoundresults.

Without relevantinformation Diagnosis isnot possible.

Biopsy of various organs can appear similar. Siteof biopsy is essential for accurate analysis.

Beware of Imposters

Suggestions for achieving accuratediagnosis

Complete evaluation of clinical picture withrelevant investigations.

Guided biopsies with sufficient material. Eg.2cm for liver: 6 linear bits each at least 4mmfor prostate etc.

Never cut the specimen when it is fresh.Never send samples to 2 or more Labs.Take a second opinion later with the entirematerial.

Complete evaluation of clinical picture withrelevant investigations.

Guided biopsies with sufficient material. Eg.2cm for liver: 6 linear bits each at least 4mmfor prostate etc.

Never cut the specimen when it is fresh.Never send samples to 2 or more Labs.Take a second opinion later with the entirematerial.

correct fixation procedures and transport to thelaboratory.

Submit material to Laboratories which practice qualitycontrol.

Know your Pathologist. Always discuss the cases.Provide information to them. Allow them time to refer toBooks and Literature when necessary.

Take a second opinion by submitting the entirematerial to the second Pathologist

correct fixation procedures and transport to thelaboratory.

Submit material to Laboratories which practice qualitycontrol.

Know your Pathologist. Always discuss the cases.Provide information to them. Allow them time to refer toBooks and Literature when necessary.

Take a second opinion by submitting the entirematerial to the second Pathologist

CLINICAL-PATHOLOGICALCORRELATION IS A MUST FORACCURATE FINAL DIAGNOSIS

Thank You