GROSS & SPECIAL

TECHNIQUES

Rhoderick M. Cruz, MD,FPSP,MMHoA

Surgical Pathology Historical Perspective Timeline

1853 “The intervention of the microscope

Velpeau of Paris Faculty Is not at all necessary to decide whether
such and such a tumor, which has been
removed, is or is not of cancerous nature.”

1870 Introduced surgical biopsy as an

Carl Ruge & Johann Veit essential diagnostic tool.
University of Berlin

1889 …need to establish a microscopic

Friedrich von Esmarch
German Surgical
Congress
diagnosis before operating in
suspected cases of malignant
tumors requiring extensive
mutilating procedures.
 BIOPSY

• Incisional biopsy

• Excisional biopsy
 BIOPSY
General Rules for Biopsy Procedure:

1.The larger the lesion, the more the numerous the biopsies that
should be taken from it.

2. In ulcerated tumors, biopsy of the central ulcerated area may

show only necrosis and inflammation.

3. The biopsy should be deep enough that the relationship

between tumor and stroma can be properly assessed.

4. Deep seated lesions are sometimes accompanied by a

prominent peripheral tissue reaction.
 BIOPSY
5. When several fragments of tissue are obtained, they should all
be sent to the pathology department.

6. Crushing or squeezing of the tissue with forceps should be

avoided.

7. Once the biopsy is obtained, it should be placed immediately into

a container with an adequate volume of fixative.

8. Depending on the presumed or known nature of the lesion,

consideration should be given to the possible need for special
studies.
FROZEN SECTION
 FROZEN SECTION
Three (3) legitimate purposes of frozen section:

1. To establish the presence and nature of a

lesion.
2. To determine the adequacy of surgical margins.

3. To establish whether the tissue obtained

contains diagnosable or whether additional
sampling is indicated
DIAGNOSTIC CYTOLOGY
GROSS TECHNIQUES IN
SURGICAL PATHOLOGY
This presentation will discuss the current, basic workflow in most
Metro Manila routine histopathology laboratories with particular focus on the
.integration of automation

:By the end of this presentation, attendees should be able to

• Understand the current basic workflow in most Metro Manila routine

histopathology laboratories.

• Discuss the benefits and challenges in the integration of automation

in
routine histopathology.

• Describe briefly the next-generation Point-of-Care Anatomic

Pathology
workflow.

• Promote interactive learning session through a panel discussion.

 RECEIVING SPECIMEN

CURRENT AUTOMATION

Manual labeling of accession number and data Bar coding & Laboratory Information System
entry using log book
 PROCEDURES FOR SUBMITTING ROUTINE
SURGICAL PATHOLOGY SPECIMENS
• Specimens should be transported observing UNIVERSAL PRECAUTIONS.

• Tissue samples obtained at the operating room, clinics and referral from other
institutions should be submitted in containers of 10% buffered neutral formalin,
labeled with the name of the patient and tissue identification.

• Each specimen jar should be accompanied by a requisition form containing the same
information inscribed on the container, a short clinical history, ORDERING
PHYSICIAN'S NAME.

• Large specimens originating from the operating room should be sent to the Surgical
Pathology Laboratory unfixed. Do not mutilate or attempt to dissect such a specimen.

• DO NOT LEAVE FRESH, UNFIXED TISSUES AT ROOM TEMPERATURE.

 UNACCEPTABLE ROUTINE SURGICAL
PATHOLOGY SPECIMEN CRITERIA
•
Unlabeled specimens cannot be accepted.

• Mislabeled or misidentified specimens cannot be accepted.

• Unidentified specimens (cases in which the specimen is labeled with the patient's
name,but contains no identification of specimen type or source).

• Other conditions for non-acceptance include: insufficient quantity of specimen,

containers received "empty", improper storage (i.e. incorrect fixative, no fixative,etc.).
 FIXATION

CURRENT AUTOMATION

Traditional formalin fixation Accelerated microwave fixation

GROSS TECHNIQUES IN SURGICAL PATHOLOGY

“It is the gross aspect that shows the size, form, and nature of the process so
that it can be understood in a structural sense and in a clinical context.”
- In praise of the gross examination by
Chandler Smith
 GROSSING
AUTOMATION
CURRENT

Traditional Grossing Specially designed cutting tools, bar coding of tissue

cassettes and speech recognition system
GROSSING
 PROCESSING

Jeremiah’s Laboratory, Tondo, Manila

Manual Tissue Processing

 PROCESSING

Conventional Automated Tissue Processor Automated Microwave Tissue Processor

Fabella Hospital, Sta. Cruz, Manila

PKDF, Quezon City

 EMBEDDING

Manual SEMI-AUTOMATION

PKDF, Quezon City

Fabella Hospital, Sta. Cruz, Manila
 SECTIONING

FULLY MANUAL MOTORIZED

 STAINING

AUTOMATION
MANUAL

PKDF, Quezon City

Fabella Hospital, Sta. Cruz, Manila

 H and E Stain
H: Hematoxylin, “basic”
dye, stains acidic groups
(Heterochromatin,
Glycosaminoglycans)
blue.

E: Eosin, acidic dye.

Stains proteins red.
 Staining Terminology
• Acidophilia: Reaction of cationic groups
(protein amino grps.) with an acidic dye
– Proteins are acidophilic

• Basophilia: Reaction of anionic groups

(phosphate, sulfate) with a basic dye
– Only Heterochromatin, Nucleoli,
Ergastoplasm (RNA), and Extracellular
Sulfate Sugar Moieties are highly
basophilic
MOUNTING (COVER
SLIPPING)

CURRENT AUTOMATION
 INTERPRETATION

CURRENT AUTOMATION

TELEPATHOLOGY
CONVENTIONAL
Ready for a Test?