Auto text: “Insert Lymphoma Workup”
- If tissue is received in RPMI, please page 4659 (Hemepath on call) and send DIRECTLY to the Hematology Laboratory (for Flow cytometry). This process is time sensitive and should not be delayed. There is no need to “gross” the tissue.
- For tissue received from the operating room labeled “lymphoma workup”, please use the procedure outlined below.
- For lymph nodes or spleens received fresh from the operating room, the grossing resident or PA should review the patient’s clinical history in EPIC and contact the on-call attending Hematopathologist prior to placing the specimen in formalin.
- If the specimen has been specifically identified as a possible lymphoma or another hematologic disease, a frozen section should NOT be performed without the specific approval of an attending pathologist from Surgical Pathology or Hematopathology.
- Technician should determine if the surgeon is waiting for an answer. For specimens labeled “intraoperative evaluation of adequacy and lymphoma workup” – tech should assume that the surgeon IS waiting.
- The Hematopathologist on call should be contacted immediately (4659). Technician should include in the message if the surgeon is waiting for an answer.
- If the Hematopathologist does not respond, call 2-1314 and request for the Hematopathologist on call to be notified about the urgent lymphoma workup.
- Look up the patient’s relevant history in EPIC.
- Before opening the container:
- Obtain the “lymphoma bucket,” which should contain a sterile suture removal kit, slides, and an empty conical tube. Obtain tubes of RPMI and RPMI+PenStrep from the refrigerator.
- Prepare and label containers for formalin, flow (RPMI), and cytogenetics (RPMI+PenStrep).
- Flow: RPMI
- Cytogenetics: RPMI+PenStrep
- On a clean working surface, open the suture removal kit.
- Turn the specimen container upside down, so that the lymph node rests on the inside of the lid. Loosen the lid and lift the specimen cup off to expose the lymph node.
- After opening the container:
- Measure (L x W x H) and take note of the lymph node’s appearance. If the specimen’s gross appearance is impressive or unusual (and the OR is not waiting on results) consider photographing the whole specimen and one representative cut surface.
- Slice the lymph node with a sterile scalpel blade, using sterile forceps (from the suture kit) to stabilize the specimen on the lid. Keep the specimen as sterile as possible.
- If the node is small, simply bisect the node.
- If the node is large, consider using a short blade to make thin serial sections.
- Gently dab the specimen with sterile gauze (from the suture kit) to remove excess blood.
- In order to make touch-preps, label at least 2 glass slides.
- Touch the cut surface of the lymph node to different areas of each slide. Allow slides to air-dry.
- Consider saving at least 1-2 touch preps as unstained (can potentially be used for FISH studies later).
- Stain 1-2 touch preps with Diff-Quick according to instructions at staining bench.
- Once touch preps are made, place the container back over the specimen to prevent drying out or contamination.
- Evaluate stained touch preps with the attending.
- Once touch-preps are evaluated, additional studies may be necessary. For a limited amount of tissue, follow the prioritization made by the Heme Path attending:
- Cancer cytogenetics: Take a portion (at least 0.5-1 cubic cm) and place into RPMI+PenStrep. This must be kept STERILE. Once this has been done, sterility is no longer imperative.
- Flow cytometry: Take a portion (at least 0.5-1 cubic cm) and place in RPMI. This does not need to be sterile.
- Lymphoma bank: For certain lymphoma cases with ample tissue, a small portion can be given to one of the PAs whom will snap freeze and bank it.
- Microbiology: If there is suspicion of an infectious process, check to see if the surgical team already directly sent specimens to microbiology from the OR. If not, place a STERILE small portion (0.5-1 cubic cm) in a sterile tube, and take to microbiology. You will need to fill out a paper order for culture (like you do on Autopsy).
- Normally, sections will be taken for fixation in formalin. Sections should be thin to allow for adequate fixation and be made gently to avoid crush artifact.
- Allow tissue to fix adequately before submitting for processing: At least 4 hours prior to pick-up by histology (preferably in a clean container with adequate amount of fresh formalin).