If the clinical differential diagnosis of a tissue biopsy includes malignant lymphoma or lymphoid hyperplasia, special ancillary studies including flow cytometry, immunoperoxidase studies on frozen tissue, cytogenetics, FISH studies on touch preparations, molecular studies (PCR and/or Southern Blot) and/or electron microscopy are useful and may be necessary for diagnosis. These studies require that the biopsy specimen be transported unfixed to the Blake 3 Pathology Frozen Section Laboratory IMMEDIATELY AFTER EXCISION. Under no circumstances should a lymph node, spleen, or any other tissue removed for lymphoma work-up be placed in formalin fixative in the OR. These samples should be handled as follows:
1. Lymph node excision for lymphoma work-up: The largest accessible lymph node should be totally removed with the capsule intact, placed on a saline-soaked sponge, and covered with another wet sponge
2. Core needle biopsy samples (taken in radiology): All biopsy cores should be placed in sterile saline.
3. Splenectomy specimens: Intact splenectomy specimens should be wrapped in surgical towels.
4. Other biopsy or resection specimens with strong clinical suspicion of lymphoma: These specimens should be handled similarly to lymph node biopsies for lymphoma work-up, as described above.
ALL OF THE ABOVE SAMPLES SHOULD BE SENT TO THE BLAKE 3 PATHOLOGY FROZEN SECTION LABORATORY IMMEDIATELY UPON OBTAINING THEM. The accompanying Pathology requisition should be marked with instructions for “LYMPHOMA WORK-UP.” Unfixed biopsy tissue should never be sent to the Warren 2 Pathology Laboratory. Prolonged exposure to room temperature results in rapid cell death and the tissue may be unsuitable for both routine histology and ancillary studies. If the biopsy is done outside of normal working hours, the Pathology Resident on call should be paged to handle the specimen.
In all cases, the entire specimen should be sent unfixed. The pathologist will divide the tissue for routine histology and any appropriate special studies (exception: If bacterial or fungal cultures are indicated, these should be obtained in the OR before the specimen is sent to the Frozen Section Lab). When the specimen is received in the Frozen Section Lab, a frozen section will usually be done if there is sufficient tissue. This is used to guide the pathologist in determining which ancillary studies are appropriate; providing clinical information on the Pathology requisition form is helpful in ensuring appropriate, cost-effective work-up. Although a definite diagnosis is rarely made on frozen section in such cases, a tentative diagnosis and/or an opinion regarding the adequacy of the tissue may be given if requested by the surgeon. Please call the Hematopathology Signout Booth (x4-1451), Dr. Nancy Harris (x6-5155), Dr. Judith Ferry (x6-3978), Dr. Robert Hasserjian (x4-1445) or Dr. Lawrence Zukerberg (x6-5151) with any questions concerning processing of lymph node biopsies.