Cytology and Pathology of the Vulva
The pathologist is an integral part of the patient’s team, and a pathology report is a consultation, not an automated test like a blood count. As such, clinicians can maximize the utility of the report for themselves by keeping a few things in mind. First
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Cytology and Pathology of the Vulva Debra S. Heller
3.1
What the Pathologist Wants the Clinician to Know About Vulvar Pathology
The pathologist is an integral part of the patient’s team, and a pathology report is a consultation, not an automated test like a blood count. As such, clinicians can maximize the utility of the report for themselves by keeping a few things in mind. First, a thorough relevant clinical history should always be provided, including the appearance of a lesion, symptoms, and any prior treatment, which may be significant in that it changes the histology of the lesion, or allows the pathologist to compare the tissue to prior biopsies or excisions on the patient. There is often not a single answer in pathology, as in clinical medicine, and the information the clinician provides is used in developing a differential diagnosis. The clinician might find it helpful to understand some of the workings of a pathology laboratory. Briefly, after confirmation of identification of the specimen, the specimen is measured, weighed when appropriate, and described grossly, and the tissue is submitted for processing. The gross description becomes part of the final pathology report. Also in the gross description is whether the specimen was
D. S. Heller (*) Department of Pathology, Immunology, and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA e-mail: [email protected]
entirely submitted to make the slides, as in a biopsy, or if representative sections were submitted, as in a larger excision. These larger specimens are kept for a period of time after the case is signed out and can be gone back to if additional sampling is warranted. The tissue that will be made into slides is placed into a plastic tissue cassette, which goes through a processor that takes it through several steps of dehydration. This is usually on a computerized timer, and tissue is processed in batches. Hence a specimen labeled “rush” may derail the schedule for other patients by altering the timing of the processing run, and this request should be used with discretion. After processing, the tissue is embedded in paraffin on the outside of the tissue cassette, and slices are cut off this tissue block with a microtome, producing very thin (4–5 micron) sections that can be placed on slides and stained. Many sequential sections can be made from the same block. The remainder of the block is maintained on file for many years, according to local regulations. As such, duplicate slides can be produced. Recuts are the next section that comes off the block and are often used for creating slides to send out for second opinions or for special staining. Levels go deeper into the tissue block, and as such can be used to evaluate more of a tiny area, such as when assessing for superficial invasion. During the gross examination of a specimen, ink may be applied when marginal status is important, so that the ink shows on the slides. This allows for determination of whether or not a lesion is completely excised. If there is no
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