Re: Bone Marrow
Thanks, Cliff Berger at www.decal-bone.com for reminding us that >>Decal is a
registered trademark of Decal Chemical Corp.<< When I replied to this query
before, I was on the road and without my reference books.
As many readers of this list know, I'm an elderly pathologist who does locum
tenens work, and thus sees many different working hospital and private
histopathology labs.
Cliff's observation that >>the trouble with most decalcified tissue is not
the type of decalcifier used but the specimen handling before and after
decalcification. Proper fixation is usually the most important factor in good
decalcified specimens<< is entirely correct. Let me add several practical
points to that.
If a piece of bone isn't thin enough to fixed overnight, it needs to be cut
down with a saw until it is thin enough. If a femoral head arrives over the
weekend, it needs to be slabbed on Monday, the slab fixed overnight, and
decalcification begun on Tuesday. If the pathologist objects to the delay, he
can come in over the weekend and slab the bone, and, if he comes in twice,
decalcify it also. (Dream on.)
Pathologists need saws, and what they want varies. Many pathology services
supporting orthopedic services no longer have a saw at all! I am unwilling to
use a Stryker oscillating saw (there's often one of these left over from an
otherwise forgotten autopsy kit) on a piece of loose bone with no clamp. The
old Satterlee amputation saw looks like something left over from the Civil
War, but it's a good saw for those of us who aren't comfortable with
hand-hazardous power tools. Still better is a double-bladed saw made for the
purpose. Since the Satterlee saw is over $70 (from whatever Lipshaw is called
this week) and the specially-manufactured double-bladed saw about $500, the
pathologist can't have one in these days of Good Management, so I routinely
go to a hardware store and buy a five dollar hacksaw.
Who is responsible for completing the decalcification, the pathologist or the
histotechnologist? This question needs to be settled for every specimen. A
couple of weeks ago I was working in a lab I'd never worked in before. Got an
important decalcification specimen - a curetted bone tumor - carefully fixed
and and put it into (the real thing, Cliff) Decal. The histotechnologist - a
pleasant elderly woman who had clearly never looked at a slide in her life,
and wasn't about to start at the behest of a wandering pathologist - put the
specimen away and never mentioned it to me again until I asked her about it
at the end of the week. It appeared that I was supposed to go get it off the
shelf and get it into a cassette. Bad slip-up, but the sort of thing one is
apt to fall into the first week on the job
Cliff adds: >>Second, decalcifiers that contain HCl (hydrochloric acid)
should never, and we mean never, be mixed directly with formalin. The
combination of HCl and formaldehyde causes an extremely carcinogenic vapor
known as bis-chloromethylether.<< Uh, Cliff, you left something out here - do
Decal and Decal-Stat contain hydrochloric acid? - I've heard the
bis-chloromethylether story and I've also heard it's an urban legend. John
Kiernan, do you know the answer to this? I don't.
Histopathology laboratories are losing the skills needed to prepare and cut
ordinary calcified tissue. To keep them up, it's important for pathologist
and histotechnologist to insist on good preparation of ordinary junk bone
specimens - femoral heads from fractures are an important specimen to focus
on, since they're common, reasonably easy to prepare, and actually of some
clinical importance, since unsuspected pathologic fractures (fractures
through deposits of metastatic cancer in the bone) are reasonably common and
are important to diagnose.
A worthwhile reference likely to be on a pathologist's book shelf is in one
of the AFIP fascicles: Tumors of the Bones and Joints, AFIP Atlas of Tumor
Pathology Third series fascicle 8, by Robert E. Fechner and Stacey E. Mills
(Charlottesville VA), AFIP/UAREP 1992.
Bob Richmond
Samurai Pathologist
Knoxville TN
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