Histopathology

The Department of Pathology has been an important component of SGRH from its inception because of the crucial role it plays in patient care. It provides anatomical pathology services with two separate divisions – Histopathology and Cytopathology. All through, the pathology services have been headed by eminent and highly experienced persons. Each division is manned by well-qualifi ed staff with long experience and expertise. The expertise of consultants attracts a number of referrals for diffi cult and controversial cases from outside. Several of them are nationally and internationally recognized for their contribution to diagnosis, research and education in different fi elds. Technical support by adequate technology staff is of high quality. The department is accredited by the NABL (National Accreditation Board for Testing and Calibration of Laboratories). The department serves three essential functions: patient care service, education and biomedical research.

Overview and strengths

• Faculty staff are well-trained, experienced and have areas of expertise involving non-neoplastic conditions and all forms of cancer and other tumours related to different organs/systems of body. The expertise of consultants attracts a number of referrals for diffi cult and controversial cases from outside.
• Dedicated and well-trained technical staff.
• Latest and advanced equipment and automated technologies are used in the procedures for prompt and accurate diagnosis.
• The focus is on delivering an early report without compromising quality
• Prompt and quality service and accurate, dependable, diagnosis.
• Facilities are present to issue urgent reports, when clinicians so require.
• All processed material on which diagnoses are given, all written reports (hard and soft copies) are stored for reference and review, when needed.

Spectrum of services and activities

The division of histopathology provides diagnostic services on surgical biopsies and resected specimens, which are important for the treatment and further management of patients. It utilizes ancillary techniques like immunohistochemistry incorporating a wide panel of antibodies, immunofl uorescence, special stains and ultrastructural studies for precision diagnosis, which is critical for planning any line of management. It is also involved in the diagnosis of autoimmune disorders using immunofl uorescence and related modalities

Diagnostics

More than 20,000 surgical resection and biopsy samples are reported annually. Special tests done are –

• Frozen sections: Intraoperative report on tissues is given within 10–15 minutes, to help the surgeon take critical decisions regarding patient management.
• Microwave processing for urgent biopsies: If a critical treatment decision is to be made on a small biopsy diagnosis, a report can be given within 24 hours.
• Immunohistochemistry: Extensive panel of more than 110 antibodies are available for precision diagnosis of oncological cases as well as for some non-neoplastic diseases.
• Immunofl uorescence: Direct immunofl urescence: Standard panel of FITC tagged antibodies – IgG, IgA, IgM, C3, C1q, fi brin, kappa and lambda light chain are used in kidney biopsies and skin biopsies for diagnosis and categorization of immune-mediated renal and skin disorders. Indirect immunofl uorscence is used for detecting auto-antibodies such as ANA, ASMA, AMA, anti-dsDNA, ANCA and PLA2R in certain autoimmune disorders. Anti-liver-kidney microsomal antibody (ALKMA) test is done by LIA.

How to collect the sample and necessary precautions

For histopathology and immunohistochemistry

1. Immediate transfer into the appropriate fi xative to prevent drying of the specimen especially small biopsies. HISTOPATHOLOGY 99
2. Most commonly used fi xative – 10% neutral buffered formalin. Collect the formalin from the Department of Pathology.
3. For testicular biopsies, bouins fl uid is preferred.
4. Minimum amount of fi xative should be about ten times the size of biopsy.
5. Resection specimens must be sent completely immersed in formalin and soon after resection.
6. Preferably the specimen should be not cut open for its better orientation.
7. The request form must contain the clinical details and type of surgery done like excision or incision biopsy, core needle biopsy, resected specimen or radical surgery. It must also include past history and any previous biopsies done on the patient. The biopsy number, if done in our own hospital, to compare the present disease with that in the past. Results of other laboratory and radiological investigations should be mentioned for correlation in the pathology department. A clinical diagnosis must be indicated for better evaluation of the tissue. The request form must also include what is specially required such as the margins, any specifi c area for tumour infi ltration including specifi c blood vessels or whatever is in mind of the surgeon depending on the case. Margins of the specimen must be labelled with sutures which should also be specifi ed in the request form. Contact telephone number of the referring consultant/assisting resident should be there on the request form for discussing the case, if necessary.
8. A barcode sticker with patient’s details must be present on the request form and container of specimen to match them and avoid any mix-up.
9. Biohazard samples must be sent with appropriate warning sticker such as those with hepatitis B, C, HIV or tuberculosis.
10. If more than one sample is sent for a patient, sites for all of them should be mentioned on the request form and the container.
11. For quicker results, microwave processing can be done. To ensure report on same day, biopsy must be sent before 12 noon to the histopathology department. Only small biopsies can undergo microwave processing at present.

Protocol for reporting results in histopathology

• Reporting for non-neoplastic lesions and benign tumours is done under following headings – gross examination, microscopic examination, special stain interpretation (if done), immunohistochemical markers interpretation (if done), fi nal diagnosis. For malignant cases – CAP guidelines are used. TNM staging is done.
• Frozen sections – a frozen section is done for diagnosis (benign/malignant), margin status, to assess adequacy of a sample, to identify the tissue, such 100 THE SGRH RESIDENT MANUAL as parathyroid, nerves and ganglion cells, etc. The specimen should be fresh and not to be sent in any fi xative. The request form for frozen section must have relevant clinical details and mention of the type of surgery done like excision or incision biopsy, core needle biopsy, resected specimen or radical surgery. OT/contact number for informing the report must be mentioned on the form. Indication of frozen must be mentioned to the pathologist. Specimens sent for margin status must be oriented with sutures. Barcode sticker with patient details must be present on the request form and container of specimen. Biohazard samples must be sent with appropriate warning sticker. Reporting protocol – immediately telephonically inform the clinician in the operating room. Written report has to be collected by the clinicians/attendant from the reception.
• Immunohistochemistry – done on formalin fi xed tissue sent for routine histopathological examination. Payment for IHC is to be done separately by the patient besides the routine histopathology charges. Clinicians should intimate the patients about the same beforehand.
• Immunofl uorescence – renal and skin biopsies are to be sent in normal saline. For auto-antibodies like ANA, ASMA, AMA, anti-dsDNA, ANCA and PLA2R serum samples are sent. Dilution at which the test is done should be mentioned in the report.
• LIA – done on serum (blood sample may be sent).

Postgraduate education and academics

department has a very active in-service residency training programme for the Diplomate of the National Board (DNB) in Pathology. Most faculty staff have long experience in undergraduate and postgraduate teaching. Several intradepartmental conferences as well as conferences with different clinical departments are conducted by the department faculty as regular programmes of continued professional development (continued medical education, CME). The department also arranges for conducting a clinico-pathological conference of interesting cases once every month. The department participates as faculty in almost all CMEs conducted by other departments of the hospital.

Research

All the postgraduates and staff are involved in research projects and have published these in indexed journals. Several of the faculty members have excellent track records in research and act as advisors and committee members/ chairman for research in institutional and national bodies.

Achievements

The department is well known for its dependable and quality services and prompt, accurate diagnosis. Expert opinion and advice is available on any specialized organ/disease. Some of the important academic and educational programmes involving multiple disciplines have been initiated and are conducted by the department. One of these, the clinico-pathological conference (CPC) is well known in the region and is extremely popular. The department is popular and well-known for the quality of resident training programme it offers. Several research papers are published by the department staff and those on liver diseases are internationally acclaimed. Some senior members of the departmental faculty spearhead research and academic activities in SGRH.

Address: 1st Floor, SSRB Building Telephone nos: +91-11-42242130, +91-11-42252137 All working days 9–5 p.m. Monday to Saturday E-mail: pathology@sgrh.com