Saturday, October 22, 2005

SURGICAL IMPLANTS, METALLIC FOREIGN BODIES, HARDWARE

Unless otherwise ordered, the tissue or material for gross examination (identification) will be stored temporarily (i.e. 3 months) and then discarded. Exercise caution in the following instances:

Despite the instructions "ID ONLY" by the surgeon the pathologist must use his own judgment. If a lesion of possible clinical significance is encountered, it must be submitted and processed for microscopic diagnosis.

If a piece of tissue, "hardware", or the like has potential medico-legal significance (e.g. intraocular foreign body), the specimen must be marked "store permanent". Hardware of this type are stored indefinitely in either fixative, alcohol, or dry in a plastic bag. ALL NON-METALLIC AND METALLIC FOREIGN BODIES SHOULD BE "STORED". Bullet fragments are routinely requested by the police months to years after their removal from the eye. All metal fragments must be tested with a magnet. The report must indicate whether the fragment is magnetic. While the storage is not “permanent” it should be in keeping with institutional standards compliant with state regulations.

A procedure sometimes used by the surgical pathologist is the "block only" category. Such specimens are embedded in paraffin, plastic, etc. and stored as such without microsectioning. This might be used for example when one had a large tumor of possible future teaching value or again, tissue of potential medico-legal significance. When blocked in paraffin or plastic the tissue can be stored virtually "forever".

If you choose a gross only work up for a piece of tissue, your description should include the phrase "under the dissecting microscope" and should contain enough information to indicate you accurately described the tissue. For example, "tan tissue with parallel longitudinally oriented fibers that merge with tendinous tissue" describes muscle. If you cannot describe the tissue in this way, it is probably not normal and microscopic sectioning is warranted. Cases with a history of both CPEO (chronic progressive external ophthalmoplegia) and ptosis repair should be brought to the attending pathologist's attention immediately, as the tissue will need to be processed for electron microscopy as well as routine light microscopy.

Gross descriptions should be accurate and give enough detail so that the reader could diagram the specimen with measurements from your report. Be sure to detail specific margins that were inked with different colors if appropriate. Document if the specimen was placed in an embedding bag. Clearly indicate when specimens from 2 cassettes, each inked a different color, are combined for embedding in one paraffin block (we do this occasionally in cases such as Mullerectomy specimens for efficiency).

SCLERAL BUCKLE: Scleral buckling devices are removed from cases of repaired retinal detachment when they extrude and/or become infected. A complete and accurate description of the size and shape of each piece as well as a description of any bands or grooves should be reported. A microscopic examination is not performed and the specimen is not processed but stored temporarily. See the example below.

CLINICAL INFORMATION: retinal detachment repair 2002, exposure
FINAL DIAGNOSIS: Synthetic device "right eye” (removal)- consistent with scleral buckling device
MICROSCOPIC EXAM: Not performed.
GROSS DESCRIPTION: Specimen #1, labeled “scleral buckle from right eye” consists of a translucent soft flexible synthetic bandshaped device measuring 16 mm in length x 2.5 mm in width and x .5 mm in thickness. There is a groove in the center of the band that measures 1 x .5 mm.






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