How to handle specimen

for histopathological
and cytological
examination?
Pathology Department
Faculty of Medicine Udayana University

Histopathological
examination

Purposes of histopathological
exam.
Tissue identification
Diagnosis
Determining safety margin of surgery
Patient monitoring and follow-up
Refer patient for further therapy

Handling and sending

specimen.
Specimen
Fixation is necessary, unless:
Hospital

lab is near
Frozen section

Form Id, clinical information,

purpose of exam

Fixative solution
Formalin 10 % / formaldehyde 4 %
Formalin Saline
Formalin 70-80%
Zenker sol
Bouin sol
Neutral Buffer (> ideal)
Alcohol

Purposes of fixation
To avoid autolysis
To maintain tissue integrity and
arrangement
Soft and fluidy tissue harder
(easier to process)
To distinguish varying structure with
certain substance

Fixation quality of
preparation
Delayed fixation

Post mortem decomposition

The tissue is drying

The amount of fixative solution <

Fixative solution do not infiltrate tissue
adequately
Incorrect fixative solution
Inappropriate time
Inappropriate concentration

Avoid.
Autolysis
Physical or chemical damage
Drying process cover with gaas +
physiologic solution

How to send the specimen ?

Fill the form correctly and completely
Add fixative solution 15-20 x tissue
volume
Large tissue :
make section every cm, but still easy
to reconstruct send it all
Choose representative sample

Labeled with patient Id

Cytological examination

Purposes
To diagnose certain pathological
process, the most important is :
early diagnosis
To determine inflammatory process
and, if possible, it causes
Other : to monitor hormonal effect in
female genitalia, to determine sex
chromatin

Important things in handling

cytology specimen
The specimen must be representative
Correct fixation
Clinical information
Send the specimen as soon as
possible to the lab

Various kind of
specimens

Vaginal smear, cervical smear

Sputum
Urine
Serous fluid (pleura, ascites, pericard,
CSF, joint)
Rectal swab
FNA, imprint and scraping of tumor
Etc.

Pap Smear
Purposes
To diagnose cervical pra cancer early
detection
Follow-up cervical cancer

Accuracy : 88-98 %

Pap Smear

Before taking specimen

Menstruation/vaginal bleeding
Vaginam pill 1 week
Post partum, post hysterectomy, post
radiotherapy 6-8 weeks
Excessive fluor albus or scale

Pap Smear

Sampling and handling specimen

Fill the form
Preparing equipment (object glass, cytobrush,
speculum, bottle+ fixative solution)
Patient in lithotomic position enter the speculum
smear the cervical canal with cytobrush
Smear the specimen on object glass
Immerse immediately in alcohol 95% at least for
30 minute
Send

Pap Smear

Interpretation
Papanicolaou classification
Class I
Class II
Class III
Class IV
Class V

: abnormal cell (-)

: abnormal cell (+) no malignancy
: suggestive for malignancy
: strongly sug. for malignancy
: conclusive for malignancy

The Bethesda System

Sputum cytology
Purposes

To determine malignancy in lung

To determine the type of malignancy
To determine inflammatory process

Sputum
Without

fixation
With fixation

Without fixation

Send collected sputum

Smear fix in
alc 95% min 30`

Send

* Examination is done 3 times consecutively, @ 3 days

With fixation

Expectorant for 3 days

Saccomano technique

Collect sputum 24 hour

in
alcohol 70%
1
send

2
Smear
alc.95% min 30`
send

Urine cytology
Purposes
To determine inflammatory process
To determine urinary stone
To determine tumor

Urine..

How to collect and send the specimen

Collect the morning urine (minimum 50 cc)
Male: from direct voided urine or catheter
Female: catheter

Fix in alcohol 50% a.a.

Send as soon as possible

Fluid from body

cavities

Pleural effusion, ascites, CSF,

pericardial effusion, joint
Purposes
To determine inflammatory process
To determine primary or secondary tumor

Specimen
100-200 cc + fixative sol alc 50% a. a.
send

Rectal swab
To determine malignancy
Method:

swab smear fix in alc.95% min 30`

send

FNA, imprint and scraping

Purposes

To determine malignancy
To determine inflammatory process and
other pathologic process

Special technique SS