Director: Neriman Gokden, M.D. 

The Surgical Pathology Laboratory at UAMS is open each working day from 7:00 a.m. to 5:00 p.m.

The staff is available to answer your specific questions at 686-6537. After regular hours and on the weekends an anatomic resident is available for specific questions at pager 658-8313.

Procedure for Submitting Surgical Specimens

Specimens should be transported observing UNIVERSAL PRECAUTIONS, OSHA (29 CFR 1910.1030), “treating all body fluid/materials as if infectious.” EACH SPECIMEN SHOULD BE ENCLOSED IN AN IMPERVIOUS CONTAINER WHICH HAS BEEN EXAMINED CAREFULLY FOR LEAKS BEFORE TRANSPORTING.

1. Tissue samples obtained at the operating room, clinics and the floor should be submitted in containers of 10% buffered neutral formalin pH 7, labeled with the name of the patient, DATE OF BIRTH, unit number, account number, and tissue identification.

2. Each specimen jar should be accompanied by a requisition form containing the same information inscribed on the container, a short clinical history, ORDERING PHYSICIAN’S NAME (physician must have hospital admitting privileges), and location code (nursing station or clinic).

3. All tissues should be forwarded as fast as possible to the receiving area, B007.

4. All specimens received prior to 3:30 p.m. are processed with the expectation of providing a typed report by 5:00 p.m. the next day. Exceptions are instances where special studies or complex dissection has to be performed. In some of these cases a provisional diagnosis can be obtained by calling 66537.

5. The validity of requests for specimens to receive accelerated processing, requiring a report the same day or by 9:30 a.m. the following day must be assessed jointly by the pathologist and the physician requesting such service.

6. Large specimens originating from the operating room should be sent to the Surgical Pathology Laboratory unfixed. Do not mutilate or attempt to dissect such a specimen. If you would like to know gross detail, contact the Pathology Department at Ext. 66537. A pathologist will be available to dissect the specimen and show it to you.

7. When a case of gout is suspected, the tissue should be sent to the Surgical Pathology Laboratory in absolute alcohol. Uric acid crystals dissolve in formalin.

8. Should you feel the gross specimen may not reach the Surgical Pathology Laboratory soon enough to prevent autolytic changes, e.g., after 4:30 p.m. or on weekends or holidays, it should be fixed in formalin or placed in the specimen refrigerator.

9. DO NOT LEAVE FRESH, UNFIXED TISSUES AT ROOM TEMPERATURE.

10. If an after hours consultation is needed, please call the Pathology Resident on pager 658-8313.

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Unacceptable Specimen Criteria

1. Unlabeled specimens cannot be accepted. The submitting physician or nursing station will be notified and will be expected to submit a fresh, correctly labeled specimen; if not possible, the submitting physician or nursing station may personally identify and label the existing specimen and sign a witnessed voucher.

2. Mislabeled or misidentified (patient specimen and S/P Accession Form have different names) specimens cannot be accepted. The submitting physician or nursing station will be notified and asked to submit a fresh, correctly labeled specimen; if not possible, the submitting physician or nursing station personnel may identify and relabel the existing specimen and sign a witnessed voucher.

3. Unidentified specimens (cases in which the specimen is labeled with the patient’s name, but contains no identification of specimen type or source). These specimens cannot be accepted until the physician or nursing station is notified. The specimen will then be dictated and documented as received unidentified.

4. Specimens submitted improperly (not in compliance with OSHA (29 CFR 1910.1030) cannot be accepted. The submitting physician or nursing station will be notified and will be expected to retrieve the specimen and submit it correctly.

5. Specimens not accompanied by a Surgical Pathology Accession Form cannot be accepted.

6. Incorrect Accession Form (tissue specimens received with an accession form from another patient service, e.g., Microbiology) cannot be accepted.

7. Soiled Accession Forms (tissue specimens received with an accession form soiled or wet with fixative, blood or any other fluid). The submitting physician or nursing station will be notified, requested to prepare a clean Accession Form and sign an Incident Form.

8. Other conditions for non-acceptance include: insufficient quantity of specimen containers received “empty”, improper storage (i.e. incorrect fixative, no fixative, not on ice, etc.). These specimens will not be accepted until the submitting physicians or nursing station is notified.

An internal Specimen Incident Form is completed for appropriate documentation and noted in gross description of the Specimen.

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Frozen Section Consultations

1. During regular hours the need for a frozen section consultation should be forwarded to the Surgical Pathology Department, extension 66537.

2. Fresh tissues should be placed on a green towel, moistened with isotonic saline and enclosed in an impervious plastic bag for transportation to the frozen section room, B007.

3. A courier will collect the specimen and requisition form. The Pathologist will interact by telephone with the surgeon or physician performing the surgery.

4. All frozen section consultations must be accompanied by a Pathology Requisition containing the following information: Patient name, account number, date of birth, unit number, tissue identification, attending physician’s name and a short clinical history. PLEASE INDICATE IF THE PATIENT IS AWAKE AND O.R. NUMBER.

5. DO NOT TRANSPORT TISSUES ON GAUZE OR SUBMIT TISSUES IN FORMALIN.

6. In the event of after hours consultation, please call the Pathology Resident on pager 658-8313.

LYMPH NODE TO RULE OUT LYMPHOMA

Handle the specimen as frozen section consultation. Specimen must be submitted fresh.

Procedure for Kidney Needle Biopsies

1. Obtain a needle biopsy, preferably 2 cm or more in length, or an open wedge biopsy.

2. Using renal biopsy service kit (obtain from UAMS Pathology, Room B007, Ext. 66537):

a. Place one portion of kidney biopsy in LM-EM fixative.

b. Place remaining portion of kidney in I.F. transport media.

c. Complete UAMS Accession Form:

  • Patient name
  • Account number
  • Date of birth
  • Ordering physician
  • Specimen I.D.
  • Date of procedure
  • Short clinical history and services required

3. Transport immediately to surgical pathology accessioning in Room B007 for processing.

4. Where tissue is adequate, light and electron microscopy and direct immunofluorescence are performed on all renal biopsies. Where technical difficulties prevent an adequate specimen of tissue from being obtained, the selection of techniques should be decided jointly by the pathologist and attending physician.

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Muscle Biopsy for Histochemistry

Section: Histology

Request Form: Surgical Pathology

Specimen Required: Minimum of 1 cm square of fresh muscle – do not tie down or divide into pieces

Routine Hours Offered: 8:00 a.m. – 4:30 p.m., Monday-Friday

Test Information:
Muscle Histochemistry includes a battery of nine stains plus a paraffin H & E. The muscle is divided within our laboratory – it should never be sent in more than one portion. Once received, two portions are quick frozen for the Histochemical stains, a sample is saved for Electron Microscopy and a portion is routinely processed through paraffin. Electron Microscopy is not done routinely; it is only performed when indicated by the pathologists.

Transportation of Specimen:
The specimens should be sent in a timely fashion in a specimen container. That container should be placed on ice. Never put the specimen directly on ice. This causes freezing artifacts, which render the specimen useless. The specimen may be wrapped in a gauze pad slightly moistened with saline. It should never be submerged in saline, as this also causes freezing artifacts. Each specimen and accompanying requisition should contain the following information: patient name, date of birth, account number, service, attending physician and tissue identification. In addition, the requisition should contain a brief clinical history, pre- and postoperative diagnosis.

Please notify the lab when sending a muscle biopsy at 686-6537.

PROCEDURE FOR IMMUNOFLUORESCENT STUDIES (INCLUDING STAINS FOR LIGHT AND HEAVY CHAIN DEPOSITION)

1. Tissue submitted for immunofluorescence should be forwarded to the Surgical Pathology Laboratory, room B007, immediately in fresh state, contained in an impervious container (clean specimen cup or plastic bag).

2. DO NOT FIX THE TISSUE IN FORMALIN OR FREEZE.

3. It is advisable to call the Surgical Pathology Department, extension 66537, ahead of time to advise the personnel of the procedure.

4. Each sample should be accompanied by a requisition form bearing the patient’s name, date of birth, account and unit numbers, requesting physician, a short clinical history and specimen identification.

5. Endomyocardial biopsies for myeloma patients only should be handled as other specimens which are submitted for Immunofluorescent studies. Please notify the immunohistochemistry lab as soon as possible.

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Bone Marrow Biopsy Fixation Procedure

See Clinical Pathology section.
Estrogen/Progesterone Receptor Analysis (ER/PR)

If an invasive breast carcinoma is detected at the time of gross or microscopic examination by the pathologist, he or she will automatically order ER/PR. The results will be available within 7 working days.

REPORTING RESULTS

1. All results, unless complicated and/or requiring special stains or consultations, will be completed and signed by the Pathologist 24 hours following the receipt of the tissue.

2. The pathology staff is available at any time for consultation.

3. Questions and matters concerning a report should be addressed to the receptionist’s room, telephone extension 686-5172, between 8:00 a.m. and 4:30 p.m. The receptionist’s office is closed on weekends.

4. Any questions regarding diagnostic matters should be directed to the pathologist who initially signed the report. If further consultation is needed, another pathologist can also be contacted providing, as a matter of courtesy, the pathologist responsible for the case is notified.

SPECIAL HANDLING

Exceptionally, and only when it is necessary to obtain vital information, the Department of Surgical Pathology is willing to process tissues or perform special techniques after 4:30 p.m. or on an emergency basis. The establishment and validity for such a request is assessed jointly by the pathologist-on-call and the physician requesting the procedure.

Electron Microscopy

Because of the high degree of expense and technical effort involved, all specimens must be approved for electron microscopy (EM) by a faculty member of the Department of Pathology. Generally, this will be the person with responsibility for the routine surgical pathologic examination of the specimen in question (686-5172). The faculty member will be responsible for examining the tissue in a fresh state, selecting suitable areas for ultrastructural examinations, fixing the material. The same faculty member is also responsible for examining the semi-thin sections and electron micrographs from the E.M. Lab and for reporting a diagnosis.

A. Responsibility of Requesting Clinician:
Clinicians desiring E.M. studies on a specimen should contact a pathology faculty member before the biopsy is taken. It is essential that the specimen for E.M. be delivered to Pathology immediately after removal from the patient. Delay in fixation of more than a few minutes may result in an unsatisfactory study.

B. Responsibility of Resident “on” Pathology:
Residents involved in the gross examination and dissection of surgical specimens are responsible for recognizing cases in which E.M. may be indicated. These cases are to be sampled, fixed, and stored; the faculty pathologist responsible for surgical pathology will decide if E.M. studies are warranted.

C. Specimen Examinations for Scientific/Academic Purposes
For most specimens handled by the E.M. Lab the ultrastructural findings will bear directly on the patient’s diagnosis and treatment. Some pathologists, clinicians, or basic scientists may wish to examine specimens to further scientific research or their education. These specimens will be clearly designated as such and no charge will be made to the patient for these studies.

D. Inquiries:
Questions regarding E.M. Lab procedures should be directed to Dr. Neriman Gokden at 501-686-6535.

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