Pathology in HistoPathology. Dr. Meera Govindarajan R & D Histopath Lab Chennai

Transcription

1 Pathology in HistoPathology Dr. Meera Govindarajan R & D Histopath Lab Chennai

2 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

3 Factors which influence the outcome of the quality of Histopathological reports Problems At the Clinical end Lack of Clinicopathological Co-relation Technical Problems in the laboratory

4 Problems at the Clinical end 1.Lack of sufficient material in biopsy or cytological specimen Liver biopsy of a large mass in the right Lobe Histology revealed only Skin and muscle tissue No liver tissue seen

5 Problems at the Clinical end 1.Lack of sufficient material in biopsy or cytological specimen Nearly 20 slides of FNAC from Thyroid received. All slides revealed only blood. No cellular material seen in any of the 20 smears. No report possible

6 Problems at the Clinical end Specimen on the Right is unfixed. Fallopian tube was left in Saline for 3 days prior to handing it over to The Lab. Well fixed ( In 10% Formalin) Normal Fallopian tube for comparison

7 Problems at the Clinical end Tumor removed from the base of the brain in 40 year old woman. Slide on the right shows tissue damaged by cauterization. Picture on the right from the same case.

8 Problems at the Clinical end Inherent problem with the tissue Abdominal tumor in a 68 year old woman, possibly arising from ovary. Total infarction of the tissue seen on Histology No Report possible

9 38 year old woman with vague breast mass, reported suspicious on mammography. FNAC done. Out of the 3 slides only one was sent to us. The other cytologist reported the smear as benign. A second surgeon was consulted and Lumpectomy performed.

10 The lump was divided into two parts and sent to 2 more Pathologists. Both reported it as Benign Fibrocystic disease. Problem are as follows 1.: two surgeons, 4 pathologists have been involved. 2: Material has been divided into 4 parts and not a single Pathologist had analyzed it completely. 3: One of FNAC slide revealed atypical cells with features of malignancy. This finding had been ignored and no attempt made to search for in situ/infiltrating foci. 4. In-situ foci may have been lost during cutting of the lump into 2 parts or due to incomplete histological examination of the lump as the Pathologist was unaware of the cytological findings

11 Result of this confusion Patient was operated for Lump in the breast after 6 months in Bombay hospital and diagnosed as Infiltrating duct carcinoma.

12 Technical Problems arising in the laboratory 1. Lack of good quality Chemicals for processing 2. Lack of good quality instruments and Knife for cutting 5 micron sections. 3. Poor Staining 4. Lack of efficient quick processing techniques.

13 Poorly processed tissue cut with blunt knife with nicks. The diagnosis is not evident. (x100). Slide diagnosed as Diffuse NHL was given for opinion without providing any clinical history.

14 The block was reprocessed using Microwave and recut into 5 micron sections. The diagnosis was Tuberculous Osteomyelitis. (x100)

15 Processing times can be shortened by using better techniques Frozen section Cryostat for urgent specimen Costly suitable in large hospitals Microwave Quick processing cheap and produces paraffin embedded blocks for IHC. Tissue processors Suitable for large volumes of specimen. Microwave routine processing for large volumes of specimen 10 mins 32 mins hours 2-6 hours

16 FNAC from Breast mass with biopsy of the mass for quick diagnosis

17 FNAC of breast mass another case with biopsy of the mass for quick diagnosis

18 Testicular tumor sections with quick processing

19 Problems faced by Pathologist Pathology is a very vast subject involving all specialities of medicine. Research is progressing fast in immuno/molecular pathology. Extensive updating of information is required at all times. Keeping pace with this science is not easy. Lack of information regarding age/ sex/ site of biopsy 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.

20 Problems arising due to lack of clinicopathological correlation Both slides show small cell malignant tumor. Diagnosis requires: 1.clinical history, 2. age/sex of patient 3.Ct scan Ultrasound results. Without relevant information Diagnosis is not possible.

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

22 Beware of Imposters

23 Suggestions for achieving accurate diagnosis Complete evaluation of clinical picture with relevant investigations. Guided biopsies with sufficient material. Eg. 2cm for liver: 6 linear bits each at least 4mm for 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 entire material.

24 correct fixation procedures and transport to the laboratory. Submit material to Laboratories which practice quality control. Know your Pathologist. Always discuss the cases. Provide information to them. Allow them time to refer to Books and Literature when necessary. Take a second opinion by submitting the entire material to the second Pathologist

25 CLINICAL-PATHOLOGICAL CORRELATION IS A MUST FOR ACCURATE FINAL DIAGNOSIS Thank You