Tuesday, December 27, 2005

OUTSIDE SLIDE CONSULTATIONS

Outside Slide Review
In general, outside slides are sent from other institutions for review or a second opinion. They require a precise description of the number of slides received and the label on each slide. DESCRIBE EVERTYHING ON THE LABELS OF THE SLIDES, INCLUDING HOSPITAL NAMES, ADDRESS, PHONE NUMBER, SPECIAL STAINS, ETC.. Everything! This is because only a portion of the total slides may have been sent. Mention whether there is or is not an accompanying report and whether it corresponds to the slides. For example:

GROSS DESCRIPTION: Received for review are 4 slides and the corresponding pathology report. All slides are labeled " Department of Pathology, Named Hospital, City, California, 90002 L01-341". Individual slides are labeled "A", "B", "C", and "D”, respectively.

MICROSCOPIC: Slides from the specimen designated “periocular tissue” in the accompanying report show dense connective tissue with moderate chronic inflammatory infiltrate consisting of lymphocytes, plasma cells, and occasional eosinophils with no involvement of vessels.

Slides from the specimen designated “lacrimal gland" in the accompanying report show dense connective tissue and lacrimal gland with moderate chronic inflammatory infiltrate consisting of lymphocytes, plasma cells, and occasional eosinophils without involvement of vessels.

FINAL DIAGNOSIS: Soft tissue, "periocular tissue" (OSR-biopsy)- chronic inflammation
FINAL DIAGNOSIS: Lacrimal gland, "lacrimal gland " (OSR-biopsy)- chronic inflammation

In some cases the slide labeling may be complicated by the large number of slides and the type of biopsy and special stains. In this case it is possible to consolidate the slides as shown:

GROSS DESCRIPTION: Received for review are 24 slides and the corresponding pathology report. All 24 slides are labeled "Jane Doe, Department of Pathology, Named Hospital, City, Arizona, S11111". 14 of the 24 slides are additionally labeled "H&E" and individually labeled "A", "B", "C", and "D”, respectively. 10 of the 24 slides are additionally labeled "X-lab" and are individually labeled "MART-1", "S-100", "HMB-45", "Ki67", "panker”, "PC "MART-1", "PC S-100", "PC HMB-45", "Contro Ki67", and "Control AE-1-3”, respectively.

MICROSCOPIC DESCRIPTION: The slides show a tumor composed of nests and sheets of epithelioid cells that infiltrate into fat, muscle and fibrous tissue. There is extensive necrosis and individual cells show marked pleomorphism, a plasmacytoid shape, intranuclear cytoplasmic invaginations, nuclear atypia, prominent nucleoli and numerous abnormal mitotic figures. The slides that are indicated as taken from the margins of resection in the accompanying report are negative for tumor. The immunohistochemical stains show the tumor cells are reactive for anti-MART-1 and -S100. In the MART-1 reactive cells 32% react to anti- HMB-45, and 8% react to anti-Ki67. However the tumor cells are non-reactive to pan-keratin.


R and S cases are similar but EY cases (rarely used) have a letter format. But the general principle to indicate everything on the submitted slides holds true on these cases as well.





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