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Amyloid

Acknowledgments Special thanks to friends, colleagues and patients at the National Amyloidosis Centre for their support and encouragement. Introduction History Amyloidosis is a disorder of protein folding, in which normally soluble proteins misfold and aggregate in a characteristic highly ordered fashion, and are deposited in the extracellular space as insoluble fibrils (or filaments). These interstitial fibrillar protein deposits (generically known as amyloid) may form anything from…

Pigments and minerals

Introduction In biology, pigments are defined as substances occurring in living matter which absorb visible light (electromagnetic energy within a narrow band which lies approximately between 400 and 800 nm). The various pigments may greatly differ in origin, chemical constitution and biological significance. They can be either organic or inorganic compounds which remain insoluble in most solvents. Minerals are naturally occurring homogeneous, inorganic substances having a…

Carbohydrates

Introduction This is a large group of compounds with the general formula C n (H 2 O) n . The role of carbohydrates in cellular metabolism has been known for many years but carbohydrates have more recently been implicated in a wide range of cellular functions including protein folding, cell adhesion, enzyme activity and immune recognition ( ). Histochemical techniques for the detection and characterization of…

Connective and other mesenchymal tissues with their stains

Introduction During embryonic development, the ectoderm and endoderm are divided by a germ cell layer, the mesoderm or mesenchyme. The term mesenchyme comes from the Greek ‘mesos’ meaning middle and ‘enchyma’ meaning infusion. Connective tissues and muscle develop from the mesenchyme. The parent cell of the entire series, the embryonic mesenchyme cell, is rarely found in adults. Connective tissue This is one of the four tissue…

Automation in the histology department

Introduction Transforming a tissue specimen from fixed material to stained sections is a multiple step process which began as separate manual tasks. Indeed, histology in the last century has been the slowest of the laboratory medicine departments to innovate and keep pace with the speed required for a modern dynamic hospital. Whereas the availability of high-throughput analyzers has made same-day results the expected norm in the…

The hematoxylins and eosin

Introduction Hematoxylin and eosin (H&E) is the most widely used histological stain. It is simple to use, easy to automate and demonstrates different tissue structures clearly. Hematoxylin stains the cell nuclei blue-black, showing clear intranuclear detail, whilst eosin stains cell cytoplasm and most connective tissue fibers in varying shades and intensities of pink, orange and red. Automated staining machines and commercially prepared hematoxylin and eosin solutions…

Theory of histological staining

Introduction The physicochemical mechanisms of most histological stains are now understood. Detailed accounts and general overviews are to be found in the references and further reading at the end of this chapter. Histological staining methods from acid dyes to silver impregnation, involve broadly similar physicochemical principles. The present chapter aims to outline the major theories on common staining procedures and facilitate rational trouble-shooting if problems are…

Resin (plastic) embedding for microscopy and tissue analysis

Introduction Resins are used to provide exceptionally strong support in tissue preparation for microscopy. Currently available resins include epoxy and acrylic formulations which can be used in standard histological techniques, but also may be useful in specialized techniques such as immunohistochemistry. The applications, advantages and disadvantages of these agents are described and a comprehensive listing of commercially available resins and resin kits is also included. The…

Microtomy for paraffin and frozen sections

Introduction Microtomy is the means by which tissue is sectioned and attached to the surface of a glass slide for further microscopic examination. The basic principles are applicable to both paraffin and frozen sections although most microtomy is performed on paraffin wax-embedded tissue blocks. The instrument used to cut sections is the microtome. This has an advancing mechanism which moves the object, the paraffin block, for…

Tissue processing

Introduction Proper handling of tissue specimens is critical to ensure that an accurate diagnosis is obtained from patient tissue samples. Whilst technological advances have streamlined processing, the principle steps remain the same: fixation, dehydration, clearing and infiltration. Regardless of the methodology, tissue samples requiring processing need to be placed in fixative as soon as possible after excision from the patient. This first step is essential to…

The gross room/surgical cut-up including sample handling

Introduction The initial dissection and preparation of any specimen for histological/microscopic analysis involves more than simply the transcribed macroscopic description and sampling of the specimen. Whilst the dissection and laboratory area are often perceived as the two key elements of the department, it must be clearly understood that there are many steps which follow specimen receipt, interfacing with the dissection room, that directly affect case handling.…

Fixation of tissues

Acknowledgment We would like to thank all the previous contributors to this chapter for their scientific input and Dr Catherine Cannet for her review of the chapter for this edition and her updates. Introduction This chapter discusses the basics of fixation, alongside the advantages and disadvantages of specific fixatives. It also provides some of the formulas for these fixatives currently used in pathology, histology and anatomy.…

Light microscopy

Introduction This is an introduction to the theory of light microscopy. The subject is dealt with in more depth in the previous editions of this book and further information may be found in dedicated texts to the subject. The light microscope is an essential part of the histopathology laboratory as it is the device with which histological preparations are studied. The designs and specifications of modern…

Chemical safety in the laboratory

Introduction Improper handling of hazardous chemicals can produce significant health and/or physical harm. For many years countries issued their own national regulatory standards to assure employees were informed of the hazards in the workplace. The regulations and descriptions of hazards varied between countries. In 2003 the United Nations established the Globally Harmonized System (GHS) for the classification and labeling of chemicals. This GHS, adopted by the…

Pathology laboratory management

Acknowledgments We would like to thank Sheffield Teaching Hospitals NHSFT for their kind permission to adapt and use the risk severity and likelihood values from the Trust risk policy. We also wish to acknowledge Louise Dunk who contributed this chapter in the last edition. Introduction Management of the histopathology laboratory in today’s environment requires a balancing act of technical knowledge, business skills, fiscal responsibility, understanding of…

Measures, Weights, and Assessment of Growth and Development

Outline ADULTS Table B-1: Adult organ weights and measures Table B-2: Percentage weight change of organs with formalin fixation Table B-3: Adult heart weight by body length Table B-4: Brain weight by age, 0-90 years FETAL Table B-5: Fetal body and organ weights by postmenstrual gestational age Table B-6: Fetal measurements by postmenstrual gestational age Table B-7: Fetal bone lengths by postmenstrual gestational age Table B-8:…

Atlas of Gross Autopsy Pathology

* Florey HW. The history and scope of pathology. In: Florey L, ed. General pathology . Philadelphia: WB Saunders; 1970:1-21. External Findings Pericardial, Pleural, and Peritoneal Cavities Cardiovascular System Respiratory System Gastrointestinal System You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Quality Management

Even in this high-technology era, the autopsy continues to play a prominent role in medical quality assurance and quality improvement, particularly in health care facilities that support educational or academic programs. Autopsies consistently identify misdiagnoses at a significant rate and are valuable in assessing responses to medical and surgical therapies. This role in measuring and maintaining clinical excellence requires excellence in the performance of the autopsy…

Death Certification

Death certificates ( Fig. 14-1 ) serve two primary purposes: legal and statistical. Legally, death certificates contribute to the record of death and are commonly used in medicolegal, interment, insurance, and inheritance matters. Statistically, death certificates are widely used in epidemiologic and public health studies. However, as autopsy rates decline, the value of these data is dubious. Inaccuracies stem primarily from three situations: deaths without postmortem…