Histopathology

 

Treatment of specimens

Specimens requiring special treatment

 

Reports

 

Contact numbers

Histopathology contact numbers are included in the Cellular Pathology contacts - click here.

Opening hours

Monday to Friday: 0830 to 1700h

Availability of clinical advice and interpretation

Consultant pathologists are available via the secretaries' office between the hours of 8.30am to 5pm, Monday to Friday. No on-call service is provided.

Request forms

It is the responsibility of the requesting doctor or source to complete the request form fully. All relevant details and history must be entered in the space provided.

Request forms are available for wards and departments from stationery using an ad hoc requisition form. GPs may request forms from the histology office on ext 4110.

Specimen containers

Pre-labelled, pre-filled (neutral buffered formalin) containers are available from the pathology store on (66)4407.  

Five litre containers of neutral buffered formalin are available from histopathology on ext 4591.

Specimen labelling

All specimens must be labelled with full patient identification and be accompanied by a request form giving full clinical details and signed by a doctor, in accordance with BSUH Pathology Specimen and Request Form Labelling Requirements (downloadable here).

Due to medico-legal considerations, all unlabelled or mislabelled specimens will require identification and verification prior to processing. The same applies to specimens arriving with no form, a mislabelled form or insufficient data.

Specimen delivery

Specimens are to be delivered to pathology reception. All histopathology specimens should be received in formalin unless for frozen section, when the case should be discussed with the laboratory before leaving theatres.

Treatment of specimens

Routine specimens

Adequately fixed tissue is vital in the interpretation of histopathology. For most specimens the tissue should be placed immediately into fixative (10% Formalin). The container must be of a suitable size: at least 3X the maximum dimension of the specimen. The specimen MUST be completely immersed in 10% Formalin (optimum is 10X the volume of the specimen) and sent to the laboratory as soon as possible. The exception to this is tissue requiring a frozen section (see specimens requiring special treatment).

What happens to a specimen?

Histological specimens are usually placed into a fixative solution of 10% buffered formalin immediately after excision. Specimens are fixed for a minimum of 12 hours before being examined by a pathologist. The pathologist records the macroscopic appearance and for large specimens selects the pieces to be processed. Small biopsies are processed completely. The tissue is then processed overnight. The next day wax blocks are prepared and slides cut and stained for the pathologist to report.

Turnaround time

The department will aim to achieve a TAT of 7 days for 90% of diagnostic biopsies and 10 days for large specimens

Diagnoses are usually made on sections stained by routine techniques but not infrequently cases require more sophisticated and extensive studies. Specimens requiring special techniques or decalcification will take longer.

Cases deemed to be clinically urgent should be discussed with a consultant prior to the specimen being sent to the laboratory.

Additional tests

All specimens are kept for approximately 2 months, blocks are kept for a minimum of 30 years should additional testing be required. Any additional tests must be arranged through direct contact with the reporting consultant.

Urgent biopsies

The average time for a routine specimen may be shortened if there are urgent clinical decisions to be made. The degree of urgency should be indicated on the request form. If the result is to be phoned, a bleep, or telephone number must be given on the request form. Any cases requiring a result within 24 hours should be discussed with a Consultant Pathologist, who will explain the possible options for processing of the specimen.

Diagnostic testing referral centres

The choice of referral for a second clinical opinion is the decision of the reporting consultant although many will be guided by regional agreement. The only primary diagnostic tests referred are cases requiring EGFR, ALK, PD-L1 and BRAF testing. These are referred to:

Molecular Pathology Diagnostic Service
Department of Cellular Pathology, Level 1
Queen Elizabeth Hospital Birmingham
Mindelsohn Way
Edgbaston
Birmingham B15 2WB
 

The turnaround time on these cases is 7 days.

Designated referral centres

Certain specimen types are routinely referred to designated external consultants for a second clinical opinion. These are:

Hydatiform Moles

 
Dr Baljit Kaur
Cellular Pathology Department
Du Cane Road
London W12 0HS

Specimens requiring special treatment

Frozen sections

24 hours notice is required if tissue is to be sent for frozen section. This is to ensure that equipment and staff are available. The specimen must be brought directly to the laboratory and must be unfixed. Please telephone the laboratory (ext. 4591) to inform them that the specimen is on its way.

It is the responsibility of the requesting source to organise the transport directly to the laboratory if the specimen is not on site.

The request form must state what the frozen section is for and must give a contact name telephone number to ring with the result. Frozen sections will not be performed on high risk specimens unless there is an adequate clinical reason. Please contact a consultant histopathologist to discuss.

Joint fluids for crystals

See Cytopathology - click here.

Testing for Hirschsprung Disease

Where possible the laboratory should be given 24hrs notice by contacting ext. 4625 or 4591. Please state if a result is needed urgently whilst the patient remains in the operating theatre.

In order for the maximum amount of tests to be performed, two specimens should ideally be sent to the laboratory.

  • One fresh specimen which has been adhered to the side of the specimen container. A wad of saline soaked gauze should be placed at the bottom of the container before inserting the specimen.
  • One specimen fixed in 10% Buffered Formalin.

The request form must state that testing for Hirschsprung Disease is required; a contact telephone number must also be given.

Specimens must be hand delivered to Pathology reception ASAP as fresh specimens deteriorate rapidly with time, which could adversely affect the test results.

The turnaround time for these specimens is approximately 10 days however a verbal result from the fresh specimen can be given the same or next day (depending on when the specimen is received into the department).

Special investigations

Some biopsies will require further investigation before a report can be issued. Examples include lymphomas or unusual tumours that require special stains or immunocytochemistry. The reports on these cases will take longer because the special stains take several days. In urgent cases the consultant pathologist may be able to give a provisional verbal report.

Electron Microscopy

Electron microscopy is routinely carried out on all native renal biopsies and renal transplant biopsies when required for diagnosis.

All renal biopsies are treated as urgent by the laboratory. If a same day result is required, specimens must be received into the laboratory by 12 noon at the latest.

When sending a renal biopsy please use a pre-filled 10% formal saline specimen pot which are located in the renal treatment room cupboard at RSCH. If supplies of these are running low please contact x4616 or x4591 to request more pots.

Reports

Reports are generated via the secretariat and are dispatched to the sender source. If further copies are required please indicate on the request form.

It should, however, be noted that departmental policy is that scientific and clerical staff cannot give results over the telephone, but will provide reprints for collection or post. When this is insufficient for clinical needs, consultant pathologists will give verbal results to medical staff. Urgent cases and verbal results can be given to an authorised source, at the discretion of a consultant histopathologist.