Other Pathology topics
Autopsy Persmission

All tissue removed from a patient in the course of an operation must be submitted for pathological examination. The following specimens are excluded (unless the surgeon suspects an abnormality): hardware of any kind; foreign bodies, particularly if of medicolegal importance; teeth, provided the number and anatomic location are recorded in the medical record; therapeutic radioactive sources; normal infant foreskin; varicose veins.

Specimen Delivery
Specimens for routine pathological examination should be taken to the Surgical Pathology Laboratory, Blake 3, reception window, between 8am and 5pm, Monday through Saturday. Specimens not in fixative should be kept in the operating room refrigerator until the laboratory reopens. When the laboratory is closed, the Pathology Resident on call should be notified (Beeper #23305) of any specimen that requires immediate attention.

Intraoperative consultation - gross or microscopic (frozen section):

Indications
a) Diagnosis required to complete operation or plan immediate (24 hour) postoperative care
b) Fresh tissue required for special studies (lymphoma markers, estrogen receptors, electron microscopy, miscellaneous other special studies)

Procedure
Between 8am and 5pm Monday-Friday, specimens should be delivered by OR personnel to the Frozen Section Laboratory (Blake 3), accompanied by a Pathology requisition and appropriately packaged and labeled as indicated below. After 5pm, and on weekends and holidays, page the Pathology Resident on call as far in advance as possible. After 8pm, the Pathologist is unlikely to be in the hospital. (On-Call Pathology Resident: beeper #23305).

Requisition
In addition to the information listed under REQUISITION, requests for frozen section should include:

a) OR number and/or extension to call with results
b) Indication whether patient is awake or asleep
c) Specific questions to be answered by intraoperative consultation (e.g., adequacy of tissue, presence or absence of metastatic tumor in nodes, status of margins, receptor or marker studies, etc.)

Prior Specimens
If reviewing prior pathology specimen may assist the pathologist in interpretation of a frozen section, notify the department prior to the operation. Call the Frozen Section Laboratory (x6-7903) and discuss the case with the pathologist or resident on duty.

Specimen Packaging
All specimens should be placed in a container which is clearly labeled with the patient’s name, unit number and specimen type. Specimen containers must be sealed to prevent leakage of blood or fixative. These containers must then be placed in a specimen bag with the pathology requisition attached to the exterior of the bag with an elastic band. The exterior of the jar and encasing plastic bag must be free of blood or fluids. Extremely large specimens (i.e., amputations) should be wrapped in a cloth sheet and then placed in a double plastic bag, which is clearly labeled. Please do not tape requisitions to the specimen.

If several biopsies or specimens are obtained from the same patient, care should be taken that each is placed in a separate jar and individually labelled. Each specimen should be identified on the requisition form. When possible, multiple specimens from the same patient should be kept together to prevent different specimens from the same procedure being assigned separate pathology numbers.

Pathology Requisition
Every specimen submitted to the Pathology Department must have a legitimate and completely filled out Pathology Requisition. The information on the requisition must include the patient’s name, unit number, requesting physician’s first and last names, the date of operation and a complete list of all tissue(s) submitted.

If there are multiple parts to a case, each specimen must be separately identified on the requisition and on the specimen containers. All specimens obtained at a single procedure should be sent to Pathology together if possible. Large multi-part cases which may be sent to Pathology in different deliveries must each have a properly completed requisition. If other specimens have been sent, this fact should be noted on the requisition.

Relevant clinical information should be written on the requisition, including the results of relevant diagnostic tests, preoperative diagnosis, operative findings, and prior diagnoses and treatment. The physician should also include information for orienting complicated specimens. Localizing clips and sutures and/or a diagram on the requisition form are helpful as an aid in orienting the specimen. Any special procedures desired (i.e., frozen section, estrogen receptors, lymphoma markers, electron microscopy, special stains, photographs) should be indicated on the requisition.

Outside Slides for Review
Whenever a patient is seen at MGH, relevant surgical pathology slides from other hospitals should be reviewed by the Pathology Department. In all cases in which definitive treatment is to be undertaken at MGH based on an outside pathology diagnosis, outside slides should be reviewed by the MGH Pathology Department. Outside slides should be submitted to the Pathology Laboratory, Warren 219, together with: 1) a properly completed Pathology requisition and 2) a copy of the Pathology Report from the outside hospital. This is necessary to ensure that the correct slides have been received and to provide a gross description and section code.

Specimen Refusal
The Pathology Department reserves the right to refuse specimens that are received unlabeled, without a requisition, with an incomplete requisition (lacking any of the above items) and/or inappropriately packaged (leaking or bloody).

Radioactive Materials
The Pathology requisition should indicate the nature and location of any radioactive pellets or rods in the specimen. Notation should also be made of the time of administration and the type of therapeutically active radioisotopes recently profused through the tissue (this does not include diagnostic tracer doses).

Expedited Processing
All diagnostic biopsy specimens are considered to be high priority. Slides on small specimens are generally available by 4pm on the day following the biopsy (specimens from Friday operations are available Monday afternoon) and are examined by a Staff Pathologist beginning at 8am the following day (Tues-Sat.). Reports on small, uncomplicated cases will generally be available from the Pathology computer by the end of the second post-operative working day, and should reach inpatient charts no earlier than the 4th post-operative working day. Need for special studies and additional sections will delay many difficult diagnostic cases.

In cases of an emergency situation, in which a diagnosis is required in <48 hours after operation, and which cannot be made on a frozen section, selected slides can be made available for early review by a Staff Pathologist. Expedited processing can be offered only on small specimens, and only with prior approval of the Staff Pathologist responsible for signing out the case. Call x6-2967 during working hours, or page the Pathology Chief Resident (Beeper #31768) after hours.