Specimens from the gastrointestinal tract are common. Endoscopic biopsies are often performed to evaluate patients with symptoms (bleeding, diarrhea, malabsorption, symptoms of infection), as well as to evaluate mass lesions (polyps and tumors). Resections are commonly performed for tumors but are also performed for inflammatory bowel disease, diverticulosis, and ischemic bowel. Esophagus . Relevant clinical history In addition to age and gender, relevant clinical history is…

. . Of all organ systems, the skin has the greatest number of pathological lesions, perhaps in part because the skin is subject to a wide variety of environmental exposures, no special procedures are necessary to visualize its surface (therefore pathologic lesions are readily apparent), and skin is the largest organ! Relevant clinical history In addition to age and gender, relevant clinical history is often necessary…

Cytologic specimens are obtained from patients by minimally invasive methods: Brushings and scrapes (e.g., bronchial brushing, gastrointestinal [GI] brushing, Papanicolaou [Pap] test) Washings (e.g., bronchial washing, bronchoalveolar lavage, peritoneal washing) Fine needle aspiration (FNA) of mass lesions Body cavity effusions (e.g., cerebrospinal fluid [CSF], pleural effusion) Sputum Urine Cytologic preparations can also be made from surgically excised specimens (touch or scrape preparations). Cytologic specimens have the…

For structural issues in cardiac pathology, the gross findings are often more critical than microscopic features to render a specific etiologic diagnosis for some cardiac tissues (e.g., valves and hearts). However, for changes in the myocardium, histologic analysis of endomyocardial biopsies may reveal an underlying process (e.g., inflammation, extracellular deposition) or etiology (e.g., infection). Many helpful resources are available for gross specimen evaluation and diagnosis. ,…

Breast procedures generate many specimens for the evaluation of palpable masses, radiologic lesions, or nipple discharge, as well as for the treatment of malignancy. Clinically significant nonmalignant diseases of the breast are rare – the most common being nonlactational chronic abscesses. Surgery for malignant disease may include portions of the breast (e.g., lumpectomies or quadrantectomies) or the entire breast (mastectomy). Less commonly, breasts are removed for…

Bones are common surgical specimens that may be submitted after reconstructive or joint replacement surgery, as part of a larger soft tissue resection, to diagnose metabolic bone disease, or after resection of tumors primary to bone. Relevant Clinical History In addition to age and gender, clinical history is often necessary or helpful for interpretation ( Table 11.1 ). TABLE 11.1 RELEVANT CLINICAL HISTORY HISTORY RELEVANT TO…

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The most common reasons for amputations are peripheral vascular disease (with or without diabetes mellitus—account for over half of amputations), trauma, and occasionally tumors. After pathologic evaluation, an amputation specimen may be requested by the patient for burial. It is preferable for such specimens to be released to a funeral home. , Relevant clinical history In addition to age and gender, relevant clinical history is often…

Adrenal glands may be resected en bloc as part of a radical nephrectomy, to remove a clinically evident tumor (usually a functional cortical adenoma or a pheochromocytoma), or to investigate an incidental mass seen on CT scan (usually adenomas, rarely carcinomas). Cortical carcinomas, primary or secondary hyperplasia, and other benign lesions (e.g., myelolipomas, ganglioneuromas) are less common. Biopsies are usually fine-needle aspirations to confirm the diagnosis…

Microscopes have always been the essential tool for pathologists and will likely remain so. Although this relationship is now being questioned due to increasing reliance on digital imaging, it is important to remember that a tissue section is a three-dimensional object with optical properties that cannot be fully captured by a photograph—no matter how detailed. The microscope will continue to play an important role in that…

A pathology department potentially can be a dangerous place to work. Hazards related to the profession include physical injury (scalpel cuts, needle sticks), infectious disease, radioactivity, and noxious chemical fumes. However, the most common health-damaging risks are associated with long hours sitting, a poor ergonomically designed work environment, and eye strain from microscope or screen use for long hours. Although some risks are inevitable when working…

The pathologist’s H&E (hematoxylin and eosin) is like the clinician’s H&P (history and physical)—basic examinations performed on every specimen or patient forming the cornerstone of diagnosis. A wide variety of additional special studies are available to evaluate pathologic processes, from simple histochemical stains to global gene expression patterns. Pathologists are now clinical cell biologists with the “special power” of being able to link morphology to biology.…

The surgical pathology report is a complex document with medical, legal, and regulatory significance for patients, patient populations, research, and institutions. Pathology reports have five major uses: Diagnostic and prognostic information for individual patients. Information to guide treatment of individual patients. Criteria for eligibility for clinical trials. Since the results of these trials are used to determine the efficacy of treatments, the accuracy of information in…

The histotechnologist and the histology laboratory are essential for the accurate diagnosis of pathologic specimens. However, the process by which tissue in cassettes is converted into glass slides remains an enigma for many pathologists ( Fig. 3.1 ). A basic knowledge about histologic techniques is necessary to facilitate communication between pathologists and histotechnologists. Poor communication can lead to suboptimal evaluation and possibly errors in diagnosis. Open…

Surgical pathologists should deal with each specimen as if they were the clinician – or, better yet, the patient – awaiting the surgical pathology report. Questions such as whether to photograph a gross specimen, how many sections to submit of a particular lesion, how carefully to search for lymph nodes in a radical procedure, whether to order recuts or special stains, whether to write or dictate…

As our knowledge deepens about the molecular underpinnings of disease, the need for precise and optimal pathologic evaluation increases. The pathologist has an essential role in patient care as guardian of the integrity and quality of specimens, diagnostician, patient advocate, and clinical teacher. The surgical pathologist examines cells, tissues, and foreign objects removed from patients to identify disease processes, document surgical procedures, and release tissue for…