re:[Histonet] Isopropyl (again)

From:"Julia Dahl"

A technique that I have found useful in assisting in decreasing fixation 
time for breast tissue:

(1) Write the patient's last name and accession number on a paper towel (or 
(2) If the breast specimen is received oriented, write MEDIAL or LATERAL or 
whatever "landmark you do KNOW on one edge of the paper towel
(3) As soon as possible after the fresh specimen is received, ink the 
margins of the breast tissue and apply mordant (acetic acid or Bouins)
(4) section the fresh, inked tissue as thinly as possible (usually between 4 
and 8 mm)
(5) As each section is cut from the gross specimen, "stretch" the tissue out 
on the labeled DRY paper towel, allowing expansion of the tissue,  
maintaining the integrity of the orientation (i.e. gross serial sections 
placed next to one another
(6) FOLD the paper towel(s) over the fresh breast tissue and place the 
SECTIONED, oriented breast tissue in at least 5 times volume (but preferably 
10X volume) fixative.

This method allows a greater surface area of the breast tissue to be fixed 
simultaneously than the general method of leaving a lump of fatty breast 
tissue in fixative overnight.  Remember that formalin fixes at approximately 
1 mm per hour.  If you have a 6 mm sections of breast tissue handled in this 
manner - the tissue needs to be in fixative for 6 hours PRIOR to cassetting 
the representative sections.

Remind surgeons that their patients are best served when these "STAT" cases 
are done in the morning - and I agree with Dr. Peters that routine education 
of our clinical colleagues is helpful in promoting the "we're on the same 
team" for each patient environment.

Just my opinion,


>From: "Stephen Peters M.D." 
>Subject: re:[Histonet] Isopropyl (again)
>Date: Wed, 13 Apr 2005 07:06:41 -0700 (PDT)
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>I cannot help you with the isopropal question. But let me ask you are you 
>trying to speed
>up your turn around time on breasts or are you having trouble cutting under 
>  If you are trying to speed up turn around time you picked a bad tissue to 
>be in a
>rush with! Reading a miserably processed breast specimen is a frustrating 
>and risky
>buisness frought with potential legal repercussions. I think your 
>pathologists would
>  agree with this. I suggest a little patience. If the surgeons are busting 
>their chops it is time
>for a little histology lesson for the surgeons. I like to tell my surgeons 
>I will be be happy to give a rush diagnosis, but if they would like the 
>correct diagnosis that will take a bit longer!
>If poorly processed tissue is the problem then it is a matter of  all the 
>things you already know. The sections should  be cut no more than 3mm thick 
>across the entire section
>  ( not just the edge). Once cut sections should be give adequate fixation 
>in clean
>formalin before putting it in the processor. Over night if possible. 
>Processor solutions should
>be clean and changed at appropriate intervals. Baskets should not be 
>overstuffed if possible especially with, cassettes filled with large 
>samples. If you have multiple processors at your disposal you may want to 
>sequester these cases an adjust the program and solution
>changes until you are satisfied with the result.
>If your grossing staff leaves intact specimen sit overnight  in the 
>fixative it arrived in and
>then cuts it the next day, fixation will often not be adequate because 
>inadequate amout
>  of formalin, formalin which has been weakened by dilution or inability of 
>the formalin
>to penetrate and fix a thick piece of tissue.
>I am sure you already know this . Make sure your grossing staff do to.
>Stephen Peters M.D.
>Vice Chairman of Pathology
>Hackensack University Medical Center
>201 996 4836
>Pathology Innovations, LLC
>410 Old Mill Lane,
>Wyckoff, NJ 07481
>201 847 7600
>Histonet mailing list

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