| Question |
Answer |
| procedure to perform rapid microscopic analysis |
Frozen Section |
| What are frozen section most commonly used in |
Oncological Surgery |
| Whole intervention by pathologist, frozen section,gross evaluation of specimen, examination of cytology preparations, aliquotiong of specimen for special studies |
intraoperative consultation |
| instrument for cryosection |
cryostat |
| in a frozen section, Where is the specimen placed |
metal chuck |
| examination of tissue while surgery is taking place |
principle use of frozen section |
| Why is a metastasized tumor sent for cryosection |
help surgeon decide wheter there is any point in continuing surgery |
| chance to cure the patient |
agressive surgery |
| surgery not curative |
metastasized tumor |
| when is an interoperative consultation requested? |
if tumor has been resected but its unclear whether surgical margin is free of tumor |
| sentinel node containing tumor tissue |
Lymph node dissection |
| Rapid examination of lesion to identify possible cause of patient's symptoms |
explorative surgery |
| Unfixed tissue (use PPE), sharp blades (new case new blade),look for blade left in holder by previous user |
Biohazards |
| how should you hold the brush |
like a pen, in left hand, and let the pinky rest on the stage |
| how should you turn the wheel |
continous motion |
| how should you move the brush |
as block begins to move toward knife, move downward in pace with the block |
| how should you pull the tissue |
pull tissue toward you |
| what happens when you press the tissue on the cryostat stage |
the stissue adheres to the stage |
| as block descends toward brush, brush keeps pace with block by gently resting on the bottom 2mm of block |
riding the block |
| block meets blade and sections begins its curl, brush leaves block while catching the curl edge |
catching the curl |
| brush jumps of block with curl |
brush jumps over blade |
| Where can the tissue be picked up from |
cryostat stage or block |
| how is the tissue picked up |
by holding slide above the section, angle slide down to touch a portion of the tissue |
| how does the section adhere to the slide |
static attraction draws section to adhere to and melt on the warm slide |
| how do you retrieve sections from the block |
tissue is cut through and stopped when the handle of medium on far side of tissue is reached, crank is moved backward and block is reversed away from knife, section uncurls downward with brush over face of block and section is picked up off block face ins |
| how do you retrieve from stage |
slide levers down to touch section, section floats onto slide |
| immediately place tissue into fixative |
rapid fixation |
| delay in fixing the tissue |
drying artifact |
| it starts to under go significant drying artifact,loss of nuclear detal and leakage of fluids from the cytoplasm |
tissue touches slide |
| thickness of sections |
6 microns |
| they look pale at 2x and 4x views, fine details are easy to miss |
Thin sections |
| Pathologist preference, dont rush any step,keep all stains and solutions fresh. |
staining the section |
| what can you do to speed the process in staining |
gentle agitation |
| why does the tissue fall of your slide |
dry tissue, thin strips, ammonia bluing too concentrated, 100%Etoh instead of 95%,section placed over embedding medium which is already on the slide |
| What happens when ammonia blueing is too concentrated |
tissue falls off |
| What should be the last thing to hit the blade |
Fat |
| what happens when fat hits the blade before the manageable tissue does |
the fat smears and ruins the rest of the section |
| what do you do if your having difficulty getting a good section because fat appears on your plane |
rotate the chuck to avoid the fat |
| rotate the chuck to avoid the fat |
Gouge |
| Place where we are lest likely to see artifacts and have cleanest histology, see critical portion of slides, inked margins |
Middle |
| shaving away surface of block to a depth at which complete desired tissue face is available for frozen section |
trimming the block |
| section doesnt include critical feature |
trimmed too little |
| unnecessary wastage of tissue and potential loss of some portion of samples |
trimmed too much |
| in between too cold and too warm |
temperature of block |
| quickly curl, unmagnageable, shatter creating, venetian blind artifact |
block too cold |
| bunch, crumple pile |
block too warm |
| translucent lens paper like quality |
section too thin |
| looks opaque and seems less flexible |
section too thick |
| result of block being to cold, can be dealt with by warming the block |
shattering |
| tissues with high water content have greater tendency to |
shatter |
| Edematous or blody tissues have tendency to |
shatter |
| nicks on blades |
stripes on section |
| cutting tissue with calcification, suture or staples |
Nicks on blade |
| stripes, tearing, mysterious difficulty cutting tissue |
tissue adhearing to underside of blade |
| movement in cryostat,call for servicing |
wavy lines |
| will not freeze |
fat |
| removing fat after you have started to trim block and plaster |
Fat gouge trick |
| rapid way to address problems caused by defects in block, |
plastering |
| Time, limited special stains and studies, lack of consultations, freezing artifacts |
limitations |
| apprearance of soap bubbles,that compress the strands of fibrous tissue |
Ice crystals |
| cellular tissue compress by expanding ice bubbles |
compression Artifacts |
| nuclei show tendency to form ice crystals.the thinner tissue is cut,more ice crystals appear as holes. |
Nuclear ice crystal |
| Brush holding the curl pulls section horizontally over the stage |
pull over the blanket |
| how should epithelial, mucosal tissues, like skin, GI,bladder, uterus and cervix be oriented |
with plane of epithelium perpendicular to blade |
Ch.18 LTI-MA 509
