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Histopathology

The Histopathology Laboratory is responsible for the processing and slide preparation of surgical and autopsy tissues for diagnosis by a Pathologist.

Lab Hours

8:00 am - 5:00 pm, Monday through Friday
 
The department manager or senior technologists are available during this time and can be reached at (585) 922-4322. At all other times, please contact the pathologists on call through the page operator.

Director Anatomic Pathology, Dawn K. Riedy MD, (585) 922-4121
Histology Supervisor: Hal James, BS, HTL (ASCP), (585) 922-4322 or (585) 922-4943

Preservation of Tissue Samples

As a general rule (see exceptions below) specimens should be submitted in Formalin Fixative . The following specimens should NOT be placed in formalin:
Cone Bx of the Cervix submit on Saline Sponge*
Lymph Node for selected hematologic malignancy. Submit on Saline Sponge*
Specimens for Frozen Section* Saline Sponge*

* IMMEDIATELY place the specimen between two saline dampened gauze sponges and place in a dry specimen container. Do not float the specimen in saline. The specimen must be brought to the Pathology Department Immediately.

The following specimens require 24 hour notice to the Pathology Laboratory:

Buccal Mucosa and Skin Bx for Immunofluorescence Processing
Kidney Bx.
Muscle Bx.
Cardiac Biopsy (transplant) to be sent out
SUBMITTING OF TISSUE SAMPLES
Tissue specimens submitted from different anatomic sites or procured by different techniques MUST be submitted in separate containers.
Example: Liver - wedge biopsy
Liver - core needle biopsy

Labeling
  1. DO NOT prelabel container prior to collecting specimen.
  2. Always label the SIDES of the container NEVER the top.
  3. Check the labeled specimen to ensure that all required information is on the specimen container: patient name, physician name, and specimen type.
  4. Check that the information on the specimen container matches that on the Surgical Pathology requisition form.
  5. All specimens removed at the time of surgery are to be forwarded to the designated collection area for transportation to the pathology department.

Pathology Requisition Form
Must be filled out completely, to include the following:

Inpatient: OutpatientAll hand written information must be printed.
  • Patient name and Social Security Number
  • DOB - age
  • Sex of patient
  • Medical Record Number Address
  • Hospital number Billing information (All Insurance numbers)
  • Physician name
  • Specimen Type & location
  • History (clinical information)
  • Physician Signature

Transport Of Surgical Specimens

Surgical Specimens To Pathology
  1. Pathology personnel will pick up specimens from the OR at the following times each work day, Monday - Friday: 11:45 am, 1:30 pm, 2:00 pm, 3:00 pm and 4:15 pm.
  2. Place specimen container in a bio-hazard bag and seal shut. The requisition will be placed in the pocket flap of the Bio-hazard bag. NEVER place the requisition in the specimen part of the bag.
  3. When transporting several specimens use a cart or a tote to prevent the possibility of dropping specimens.
Outpatient Surgical Specimens

Rochester General's Laboratory Services will provide transportation for Outpatient tissue specimens as follows:

Hours:

  • MONDAY - FRIDAY 8:00 am - 5:30 pm
  • SATURDAY 8:00 am - Noon

Rochester General Laboratories provide free daily pick up and delivery service. Couriers pick up specimens on a pre-arranged schedule.

  • 3. Special pick-ups can be arranged by calling Client Services at (585) 922-4451 during the hours stated above. Special pick-ups should be requested for all RUSH specimens, specimens requiring frozen sections or specimens submitted fresh (saline). “ RUSH” should be clearly written on the biohazard bag and the requisition. The courier should be informed that the specimen is a rush specimen for pathology.
  • 4. Specimens will be placed in a Bio-hazard bag, the pathology requisition will be placed in the pocket flap of the Bio-hazard bag. NEVER place the requisition in the specimen part of the bag.
Surgical Specimens From LMH

Rochester General Laboratory Services will provide transportation for surgical tissue specimens as follows:

  1. Specimens will be picked up at the collection station at LMH at approximately 1:00 pm and 7:00 pm each day during the week for delivery to the pathology department at Rochester General Hospital.
  2. Specimens will be carried in a ice chest type container to keep the specimens cool.
  3. Specimens will be left in the Pathology area of the department during the hours of 8:00 am - 5:00 pm.
  4. Between the hours of 5:00 pm - 8:00 am specimens will be left in the Pathology area refrigerator.

Surgical Specimens From Newark Wayne Community Hospital
Rochester General Laboratory Services will provide transportation for surgical tissue specimens as follows:

  1. Specimens will be picked up at the collection station at NWCH at approximately 11:00 am, 2:00 pm and 7:00 pm each day during the week for delivery to the Pathology department at Rochester General Hospital.
  2. 2Specimens will be carried in an ice chest type container to keep the specimens cool.
  3. 3. Specimens will be left in the Pathology area of the department during the hours of 8:00 am - 5:00 pm.
  4. Between the hours of 5:00 pm - 8:00 am specimens will be left in the Pathology area refrigerator.

Amputated Limb ( 8:00 am - 5:00 pm):

The amputated limb will be:

  • wrapped and an identifying label placed on the wrap.
  • place the limb in a bag and a second label will be placed on the outside of the bag.
  • Surgical transport will deliver the limb and surgical request sheet to the Pathology Department.

Amputated Limb (RGH) ( 5:00 pm - 8:00 am weekends and holidays)

The amputated limb will be:

  • wrapped and an identifying label placed on the wrap.
  • place the limb in a bag and a second label will be placed on the outside of the bag
  • Evenings and weekends the leg should be placed in the Pathology specimen refrigerator in the Surgical Pathology Trim Room and the requisition should be placed on the refrigerator door; not in the refrigerator.

Amputated Limb From Lakeside Memorial Hospital
The laboratory at Lakeside Memorial Hospital will contact the Funeral Director at (585) 247-6360 to arrange for the pick up and transport of amputated limbs from Lakeside Memorial Hospital to Rochester General Hospital.

Amputated Limb From Newark Wayne Community Hospital
The laboratory at Newark Wayne Community Hospital will contact the Funeral Director at (585) 247 -6360 to arrange for the pick up and transport of amputated limbs from Newark Wayne Community Hospital to Rochester General Hospital.

Genetic Studies (Dr’s offices, LMH, Newark)
Tissue for Genetic Studies (usually products of conception) should be submitted fresh (NO FORMALIN) and sent to the Pathology Department as a rush specimen for immediate evaluation and tissue preparation. The pathology requisition should clearly request chromosome analysis. If a need for genetic studies arises at night or on the weekends, the pathologist on call should be immediately contacted through Rochester General Hospital page operator.

Rgh- In House Procedure For Obtaining Products Of Conception/Fetal Tissue For Chromosome Analysis.

The specimen must be divided into separate containers if both chromosome analysis and histologic examination by pathology is desired.

Specimen handling for chromosome analysis:
 

  1. Tissue for chromosome analysis should be collected using sterile technique and placed in sterile saline. Fetal tissues such as lung, kidney, liver, periumbilical skin, or tendon are suitable (extremities are not). Placental tissue is also acceptable if fetal tissue is not present.
  2. The amount of tissues collected should equal the size of an adult’s fifth fingernail.
  3. The specimen should be sent immediately to the RGH hematology lab on the ground floor of the hospital with a Strong Memorial Hospital chromosome analysis requisition completed by the attending physician. Hematology is staffed 24 hours a day, 7 days a week (hematology extension (585) 922-4424).

Specimen handling for histologic examination by pathology:
 

  1. Any excess tissue not used for chromosome analysis should be placed in formalin. A surgical pathology specimen requisition should be completed by the attending physician.
  2. The specimen in formalin may be delivered to surgical pathology via the usual specimen delivery system.

Specimens Requiring Special Handling:

Renal Biopsies

Renal biopsy solutions are obytained from Pathology. Pathology hours are Monday to Friday from 8:00 am - 4:00 pm. with a 24 hour advanced notice except in emergency situations.

The Nephrologists will send technical staff to assess the adequacy of the specimen. The Pathologists’ Assistant will gather clinical history, patient information and transport biopsy to the Pathology Department. Representative sections are sent for Electron Microscopy Immunofluorescent studies and light microscopy.

Biopsies are sent to Ohio State University for processing. Immunofluorescent and light microscopy results are usually available within two (2) days and electron microscopy within seven (7) to ten (10) days.

Muscle Biopsies (for light microscopy and enzyme histochemistry)

Muscle biopsies may be scheduled Monday to Friday 8:00 am - 3:00 pm with a 24 hour advance notice except in emergency situations. After hours/weekends/holidays are emergency situations, notify the Pathologist on call.

At least 1.5 cm x 0.5 cm of muscle should be taken from an area of no previous trauma, injections, or recent electromyographic examinations. In general, the muscle selected must be moderately involved to avoid advanced degenerative changes of severely diseased muscle. Proximal muscles are the best choice in proximal muscle syndromes (polymyositis) and the gastrocnemius would be best for distal muscle syndromes (peripheral neuropathies). It may also be helpful to include a 1 x 0.2 cm ellipse of skin when inflammatory disease is being considered.

The biopsy MUST be placed on dampened (not floating) saline gauze and placed in an appropriate labeled container. All muscle biopsies must be delivered to the Pathology Department IMMEDIATELY upon removal along with a COMPLETE clinical history, physicians' names (not just surgeon's), and complete patient information.

Biopsies are sent to Strong Memorial Hospital with results usually taking 10 to 15 days. Verbal reports in emergency situations may be available sooner.

Skin And Mucosal Biopsies For Immunofluorescentstudies

Fresh unfixed skin and/or mucosal biopsies may be sent Monday to Friday 8:00 am - 4:30 pm with a 24 hour advance notice except in an emergency situation. After hours/weekends/holidays are emergency situations, notify the Pathologist on-call as soon as possible.

Biopsies are performed using standard biopsy techniques.

Prior to the skin and/or mucosal biopsy, an Immunopathology Kit may be obtained from the Pathology Department. Each kit contains the following:

For immunofluorescent studies, biopsy specimen should be at least 3-4 mm in diameter and placed immediately into a red "LESION" tube or  "NORMAL tube marked" for immunofluorescence..

For histopathologic studies, lesional biopsy specimens should be placed in tubes containing buffered FORMALIN or may be placed in the regular specimen jars containing 10% buffered formalin obtained from the Pathology Department.

Specimens for serum serologic test should be collected without anticoagulants. Red top Vacutainer or equivalent tubes can be used for this purpose or placed into the tube marked "SERUM". Approximately 5 to 10 ml of blood should be collected. Serum samples do not have to be cooled or frozen.
or
The fresh unfixed biopsy of skin and/or mucosal tissue MUST be placed on dampened (not floating) saline gauze and placed in an appropriate labeled container. All fresh unfixed skin and/or mucosal biopsies must be delivered to the Pathology Department IMMEDIATELY upon removal along with a completed Pathology request.

Preferred Biopsy Sites

Connective Tissue Diseases


Discoid LE: a lesional skin biopsy preferably from an untreated, sun-exposed area that is 30 to 60 days old. Older lesions are more frequently positive.

SLE, SCLE, MCTD: normal skin; preferably a sun-exposed area (e.g. wrist).

Scleroderma, PM/DM: lesional biopsy of skin or muscle

Vesiculo Bullous Diseases

Pemiphgus, Pemphigoid, EBA, herpes gestationis and desquamative gingivitis, linear IgA bullous dermatosis and other associated bullous disorders, the first biopsy should be taken from the edge of the lesion, preferably a fresh one.

Dermatitis herpetiformis: a biopsy of a normal skin close to a lesion is suggested.

For mucosal biopsies, a second specimen from a clinically normal site is also recommended.

Porphyria cutanea tarda: lesional biopsy.

Vasculitis

Leukocytoclasitc vasculitis, Henoch Schonlein purpura, essential mixed cryoglobulinemia or polyarteritis nodosa, the earliest lesions (<24 hours="" if="" possible)="" should="" be="">

Fresh biopsies should be hand delivered as soon after removal as possible. When using the Immunopathology Kits, all tubes should be placed into the styrofoam container and topped with the absorbent pad after labeling each tube with the patients name, date, and type of biopsy. Securing the container with a rubber band will help to hold the tubes in place during transport. The container should them be placed into a biohazard bag along with the completed Pathology Requisition. Biopsies placed immediately into the appropriate tube may be sent to the Pathology Department as soon as possible by your regular delivery service.

Gene Rearrangement (Lymphomas)

Fresh unfixed tumor tissue may be sent Monday to Friday 8:00 am - 4:30 pm. After hours/weekends/holidays, call the on-call
Pathologist for arrangements. The tissue is submitted on dampened saline gauze and hand delivered to the Pathology Department. A completed Pathology Requisition should be forwarded with the specimen. Results usually take two (2) weeks.

Cell Markers (Lymphomas)


Fresh unfixed tumor tissue may be sent Monday - Friday 8:00 am - 1:30 pm. The tissue should be submitted in RPMI cell media (may be obtained from Flow Cytometry Lab) or on a sterile dampened saline gauze. Tissue should be kept at 2-8 C. The specimen must be hand delivered to the Pathology Department. A completed Pathology Requisition should be forwarded with the specimen which contains the date and time sample was obtained and the diagnosis (very important). Results may take one (1) week.

Quantitative Iron In Livers

Specimens may be sent Monday to Friday 8:00 am - 4:30. pm. After hours/weekends/holidays, liver biopsies may be placed in the specimen refrigerator located in Pathology. The biopsy should be clearly marked for "Iron quantitation" and have a completed Pathology requisition attached. The whole liver biopsy specimen is sent for this study. Liver biopsy specimens are placed into a fresh jar of 10% Buffered Neutral Formalin immediately after removal.

Immunopathology

Immunoperoxidase


Patient Preparation: Standard biopsy and/or surgical procedures are used.

A wide variety of Immunoperoxidase procedures are performed on paraffin embedded tissue samples on a daily basis. Consultation with the primary pathology is required.

Estrogen, Progesterone and HER/2/NEU Studies

Patient preparation: Standard biopsy and/or surgical procedures are used.

Studies on paraffin embedded tissue sections are available. Consultation with the primary Pathologist is required.