Special Techniques and Considerations

Immunofluorescence immunofluorescent examinations are required for the diagnosis of chronic blistering diseases and are useful in connective tissue diseases. The site of biopsy is important for immunofluorescence, particularly in the blistering disorders. In dermatitis herpetiformis a biopsy for immunofluorescence should be taken from clinically normal skin away from the area of blistering. In the other blistering disorders, perilesional skin is submitted. The skin should have an intact...

Neoplastic Conditions

Benign tumours these are rare, e.g., granular cell tumour. Human papilloma virus (HPV) a common aetiological agent associated with a spectrum of anal viral lesions, preneoplasia (anal intraepithelial neoplasia - AIN) and carcinoma, as well as concurrent lesions of the uterine cervix. HPV subtypes 16 18 are particularly neoplasia-progressive in this viral - AIN - carcinoma sequence. Anal margin perianal skin carcinoma commonly well-differentiated keratinising squamous carcinoma with predisposing...

Omentum and Peritoneum

The omental fat and peritoneal serosa may be involved by various inflammatory and neoplastic disorders. Inflammation acute due to appendicitis or a perforated viscus (GU, diverticulitis), or granulomatous, e.g., tuberculosis, fungal peritonitis (chronic ambulatory peritoneal dialysis (CAPD)) or after previous surgery. CAPD can also be associated with the rare condition of fibrous or scle-rosing peritonitis. Infarction spontaneous, idiopathic omental infarction in the right iliac fossa mimicking...

Inflammatory Lesions

Balanitis circumscripta plasmacellularis ( Zoon's balantitis) occurs in uncircumcised men with an unknown aetiology (possibly autoimmune). It consists grossly of well-defined brown red plaques, solitary or multiple, and clinically resembles erythroplasia of Queyrat. Balanitis xerotica obliterans (BXO) this is the male equivalent of lichen sclerosus et atroph-icus of vulva. It may cause narrowing of the urethral meatus or phimosis. There is a weak association with carcinoma of the foreskin. The...

Pathological Conditions

A variety of tumours, both benign and malignant, may arise within the retroperitoneum. The commoner lesions are discussed here. Liposarcoma arising within the retroperitoneal fat, well-differentiated liposarcoma, particularly the sclerosing subtype, represents one of the commonest histological subtypes. There is a very low risk of metastasis with this type of lesion, which indeed has been described as an atypical lipoma at other sites. However, such lesions can be difficult to excise from the...

Adult Tumours

Oncocytoma represents 4 of renal tumours and usually occurs in adults over 50 as an incidental finding. It has a benign behaviour if strict diagnostic criteria are followed. Grossly it is circumscribed, brown-yellow, with a stellate central scar in larger lesions. It may be bilateral or multifocal and can invade the renal capsule. Histologically it has a sheeted or nested pattern of uniform cells with intensely eosinophilic and coarse granular cytoplasm. Patterns not allowed include papillary...

Clinical Presentation

Bladder tumours most commonly present with the painless passage of blood in the urine (haema-turia), sometimes with amorphous clots. This is a serious symptom necessitating immediate urologic investigation, particularly in the adult. Haematuria occurring at the end of micturition Figure 29.1. Anatomy of the bladder. Reproduced from Hermanek P, Hutter RVP, Sobin LH, Wagner G, Wittekind Ch (eds.). TNM Atlas illustrated guide to the TNM pTNM classification of malignant tumours, 4th edition....

Benign Tumours

Fibroadenoma this is the commonest benign tumour of the breast, most often encountered in premenopausal women who present with a palpable, painless and mobile discrete lump. Nonoperative diagnosis can be confidently made by the triple approach except in large lesions where excision may be advised to exclude a low-grade phyllodes tumour. Proliferative lesions (radial scar complex sclerosing lesion, intraduct papilloma, nipple adenoma, myoepithelioma) these lesions are due to epithelial...

Specimen Handling

usually multiple fragments, free floating in fixative, non-orientated. place in cassette between foam insert pads or loosely wrap in moist filter paper. align in the block at the embedding stage as this facilitates microscopic assessment and fragments are not missed. separate specimens use separate cassettes and site identification labels appropriate to the request form information. cut through multiple levels. this allows better assessment of mucosal architecture and site distribution of...

Resection Specimens

Groin hernias - in uncomplicated groin hernias the principle of surgery is to reduce the hernia sac and repair the defect in the abdominal wall. This can be done by either suturing or introducing a prosthetic mesh. In complicated hernias in which the small bowel may be incarcerated, the hernia sac needs to be opened and the viability of the intestine assessed. If it is in question then a small-bowel resection may be required. Abdominal wall tumours - primary abdominal wall tumours such as...

Anterior Mediastinal Masses

Neurogenic tumours-neurofibroma, neurilemmoma (schwannoma),ganglioneuroma, ganglioneuroblastoma, malignant schwannoma, neuroblastoma, paraganglioma Unilocular thymic cysts of developmental origin and occur more often in the neck than the mediastinum. The lining may be flattened, cuboidal, columnar or (rarely) squamous epithelium with thymic tissue in the wall. Multilocular thymic cysts acquired and thought to be secondary to inflammation. Some cases are seen in HIV infection. They can mimic an...

Nonneoplastic Conditions

The oral mucosa is affected by a bewildering number of non-neoplastic conditions that are the subject of many textbooks. These are divided according to their clinical presentation as either lumps, ulcers or white red patches. Lumps most discrete mass lesions of the oral mucosa represent forms of fibrous tissue overgrowth (fibroepithelial polyp) as a consequence of low-grade chronic trauma. The term fibrous epulis is reserved for lesions on the gums while those associated with dentures can be...

Histopathology Report

Type and side of specimen. specimen size dimensions (cm), weight (g). tumour type. tumour grade I, II, III (see Table 11.1 for grading system). DCIS present no, yes (within around away from tumour). DCIS type. DCIS nuclear grade (low, intermediate, high). size of invasive component (cm). size of DCIS. size of invasive + DCIS. nearest margin medial, lateral, inferior, superior, deep, superficial (skin). distance from margin invasive DCIS. lymphovascular invasion not seen present within or...

Blocks for histology Figure 332

shave section from shaft margin (including skin, erectile bodies and urethra). samples of foreskin to include associated conditions. sample four sections of tumour to demonstrate depth of invasion, relationships to the adjacent surface epithelium, corpora cavernosa, corpus spongiosum and urethra. sample two to three transverse sections through the shaft at different levels. Blocks of foreskin, Blocks of shaft skin, Blocks of foreskin, Blocks of shaft skin, proximal resection margin of the...

Lymphovascular Supply

Embryologically the gastrointestinal tract is divided into three segments (fore, mid and hindgut) with each region being supplied by its own artery Coeliac artery supplies the foregut (distal oesophagus to the mid-portion of the second part of the duodenum). Superior mesenteric artery supplies the midgut (mid-portion of the second part of the duodenum to the junction of the proximal two thirds and distal third of the transverse colon). Inferior mesenteric artery supplies the hindgut (distal...

Blocks for Histology

Ulceroinflammatory conditions (Figure 5.8) sample by circumferential transverse sections the proximal and distal limits of resection. sample macroscopically normal bowel. sample representative longitudinal blocks (a minimum of six) of any focal abnormality that is present to include its edge and junction with the adjacent mucosa, e.g., ulceration, stricture, fistula, perforation, pseudomembranes, inflammatory polyps, serosal adhesions or constriction bands. Also - CIBD sequential labelled...

Anatomy

Arytenoid Cartilages Position

The pharynx connects the nasal cavities and mouth with the larynx and oesophagus. It is divided into three functional parts, namely the nasopharynx, the oropharynx and the hypopharynx (Figure 15.1). The nasopharynx lies behind the nasal cavities and above the level of the soft palate. The roof and posterior wall relate closely to the skull base and the first cervical vertebra. The lateral wall is an extension of fascia from the skull base called the pharyngobasilar fascia. The Eustachian tube...

The Core Data in Histopathology Specimens

Specimen dissection must be geared to provide information relevant to the clinician who is managing the patient. Reports must be timely, i.e., prompt, but in the context of an adequate period of fixation so that acquisition of accurate data is not compromised. The report content must not only come to an interpretationally accurate diagnosis but also be qualified by assessment of various prognostic indicators. In the field of surgical cancer pathology this is reflected by the trend towards...

Gastrointestinal Specimens

Albores-Saavedra J, Henson DE, Klimstra DS. Tumors of the gall bladder, extrahepatic bile ducts and ampulla of vater. Atlas of tumor pathology. 3rd series. Fascicle 27. Washington AFIP, 2000 Bateman AC. How to handle and report pancreatic specimens. CPD Cellular Pathology 2001 3 94-98 Beckingham IJ (ed). ABC of liver, pancreas and gall bladder diseases. London BMJ Books, 2001 Biddlestone LR, Bailey TA, Whittles CE, Shepherd NA. The clinical and molecular pathology of Barrett's oesophagus. In...

Dissection

Cancer resections for optimal demonstration of the deepest point of tumour spread, its relationship to the CRM and correlation with ELUS CT cross sectional imaging multiple, serial, 3-4 mm thick slices of the cancer in the transverse axis are recommended. The slices can then be laid out in sequence and a photographic or digital record provided. Generally, four or five blocks of the tumour and wall are selected to adequately define the pT stage. Some pathologists leave the tumour segment...

Resections Specimens

Corpus Carcinom

The uterus is usually removed together with the cervix as part of a hysterectomy. Occasionally the cervix is left in situ and a subtotal hysterectomy is performed. Myomectomies may also be performed, especially for uterine fibroids. the specimen is weighed g . the specimen is measured in three dimensions cm , i.e., superior to inferior, medial to lateral, anterior to posterior. the specimen is orientated. The peritoneal reflection extends lower on the posterior aspect of the uterus than...

Volvulus Pneumatosis Coli Rectal Stump Rectal Mucosa in Prolapse

measurements length x maximum diameter cm . - volvulus - dilatation, thinning, melanosis, stercoral ulceration, ischaemia, perforation. - pneumatosis - mucosal cobbling, blebs or gas cysts, inflammation, ulceration, perforation. - rectal stump - mucosal granularity, ulceration, polyps, fistulae, tumour. - rectal mucosal prolapse - mucosal granularity, thickening, induration, ulceration. sample six blocks minimum macroscopically normal and abnormal areas as indicated. sample mesenteric lymph...

Lymphovascular Drainage

Lymph Nodes Near Ribs

The neck contains many lymph nodes subdivided into groups and located both superficially and deep within the neck. While individual nodes can be described with reference to adjacent anatomic structures it is common practice, particularly in oncology, to divide the node groupings in the neck into six levels Figure 19.2 . Parotid gland and the periparotid lymph nodes Parotid gland and the periparotid lymph nodes -Suboccipital nodes Retroauricular nodes Mastoid process Inferior belly of omohyoid...

Clinical Investigations

FBP - occasionally chronic bleeding can lead to iron deficiency anaemia. Serology - if a syphilitic ulcer is suspected. Blood glucose - in those with recurrent anorectal sepsis to rule out diabetes mellitus. Microbiology - pus from an abscess should be cultured and antibiotic sensitivities obtained. Proctoscopy - used to inspect the anus and anorectal ring. Biopsy of lesions above the dentate line can be taken without anaesthesia. Sigmoidoscopy colonoscopy - should be undertaken when an...

Surgical Pathology Specimens Laboratory Protocols

Punch Biopsy Alopecia

Punch, ellipse or shave biopsy embedded intact. Figure 37.1. Punch, ellipse or shave biopsy embedded intact. Figure 37.2. Punch, shave or ellipse bisected and embedded. Figure 37.2. Punch, shave or ellipse bisected and embedded. Diagnostic punch biopsy diagnostic punch biopsies come in a variety of sizes ranging from 2 mm to 8 mm. The smaller-sized punch biopsies are usually for diagnostic purposes. The size of the punch is recorded and a description of any lesion seen. Small...

Resection in Neoplastic Conditions

Right Colectomy

Adenomatous polyps as discussed above, the majority of adenomatous lesions can be removed by endoscopic techniques. However, large sessile polyps gt 5 cm in diameter and occupying more than one third of the colon circumference should be removed by a localised resection. Sessile adenomas in the rectum can be removed by transanal submucosal resection. In this procedure adrenaline solution is infiltrated into the submucosa around the lesion and the mucosa is incised rectal stump CIBD, diversion...

Pelvic and Retroperitoneal Specimens

ACTH adrenocorticotrophic hormone MEN multiple endocrine neoplasia syndrome RPLND retroperitoneal lymph node dissection basal cell papilloma seborrhoeic keratosis dysplastic atypical melanocytic naevus pityriasis lichenoides et varioliformis acuta pruritic urticarial papules and plaques of pregnancy

Resection in Nonneoplastic Conditions

Colectomy With Hartmann Pouch

Hartmann's procedure - this is one of the most commonly used emergency operations for colorectal disease. Although this was initially devised for the elective treatment of proximal rectal tumours, it is now usually used in the emergency setting to treat conditions such as perforated diverticular disease most commonly , perforated tumour, etc. The procedure itself is defined as resection of the sigmoid colon and a variable length of proximal rectum if required with the fashioning of a terminal...

Abdominal Wall and Umbilicus

Various conditions can affect the abdominal wall and result in both FNAC and histopathology specimens. Secondary carcinoma commonly due to either gastrointestinal or gynaecological cancer involvement, can be by direct spread at presentation or because of a subsequent metastatic recurrence. The former is not infrequently seen with a perforated bowel cancer and the inner layers of the abdominal wall may be dissected off separately or in continuity with it. The latter tends to be encountered as an...

Contributors

Consultant Pathologist Histopathology Laboratory Belfast City Hospital Trust Belfast UK Consultant ENT Surgeon Royal Victoria Hospital Belfast UK Specialist Registrar in Histopathology Histopathology Laboratory Belfast City Hospital Trust Belfast UK Consultant Pathologist Institute of Pathology Royal Victoria Hospital Belfast UK Mr Derek J Gordon Consultant Plastic Surgeon Ulster Hospital Belfast UK Consultant Pathologist Department of Pathology Royal Victoria Hospital Belfast UK Consultant...

Blocks for histology Figure

sample the proximal and distal limits of resection - complete circumferential transverse sections duodenum, oesophagus or multiple circumferential blocks mid-stomach . alternatively, if separate anastomotic doughnuts are submitted - one complete circumferential transverse section of each. count and sample all lymph nodes lesser greater omenta, splenic hilum and process separately any named lymph nodes. sample a minimum of four blocks of tumour and wall to show any serosal involvement and the...