Re: [Histonet] Re: breast processing


In my recent past, I worked with an excellent pathologist who would thinly 
(5-10 cm) "breadloaf" mastectomy and other large breast specimens, placing 
paper towels between each slice to wick in the formalin.  These specimens 
would fix at least overnight in large closed 'tupperware' vats before 
additional grossing early in the a.m. We would then fix the cassettes in 
alcoholic formalin for the rest of the day (6-7 hours) before routine 
processing. (No need to go back into 10% NBF - started off in 70% on the 
processor.  Specimens like this were processed for 1 hour each station 
(under vacuum), and I don't recall having any underprocessed/underfixed 
tissues.    Don't tell the kiddies, but in my more distant past, when I 
did come across a block that was underprocessed,  I'd take a good whiff to 
see what solution (alcohol, xylene, formalin)  I smelled in the block, and 
back it up to that point only.  If I smelled xylene, it needed more time 
in paraffin - plopping it back into a couple of fresh changes of paraffin 
for a couple of hours seemed to do the trick.    If it smelled like 
alcohol, it was backed up to fresh xylene for a couple of hours, then 
brought forward again.    Ahh, the good old days.  Thanks Flonase.

Jackie O' 

"Johnson, Teri" 
Sent by:
05/12/2004 11:03 AM

        Subject:        [Histonet] Re: breast processing

although I recall seeing this published in the Journal of
Histotechnology, I also don't agree with teh idea of squeezing the fat
out of fatty breast tissue.  Other labs have also just soaked them in
molten paraffin overnight, sometimes resulting in burned looking tissue.
If they are not adequately fixed and processed well in the first place,
any of this type of trauma can't be good for the specimen.  I do like
the idea of adding a xylene step in the processing schedule between the
alcohols, never thought of that.  Brilliant!
I do suggest that some labs that have particular difficulty with their
pathologists routinely not grossing in these specimens well, use this as
a Quality Improvement marker.  I would talk with the Lab Director and
Head Pathologist about doing this first because you will need their
support, but that might help supply the pressure (from somewhere besides
the techs) to improve their technique.
Bottom line is, we do what is best for the patient.

Teri Johnson
Managing Director Histology Facility
Stowers Institute for Medical Research
1000 E. 50th St.
Kansas City, Missouri  64110

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