Fix in formalin. (Bouin's is used in some labs, but is losing popularity because it degrades nucleic acids and prevents molecular assays.)
- Note number and size of tissue fragments, as well as any distinguishing gross characteristics (stalk, cauterized margin, etc.).
- Wrap in tissue paper and submit entirely.
- If appropriate for your lab, preorder special stains (for H. pylori if appropriate clinical context, etc.).
The case is received in three formalin filled containers, each labeled with the patient’s name and medical record number.
Specimen #1 is designated “proximal esophagus” and consists of two pink-tan soft tissue fragments measuring 0.5 x 0.3 x 0.2 cm and 0.6 x 0.3 x 0.2 cm, respectively. The specimen is entirely submitted in one cassette labeled 1A.
Specimen #2 is designated “GE junction” and consists of three pink-tan soft tissue fragments ranging in size from 0.4 x 0.3 x 0.2 cm to 0.6 x 0.4 x 0.2 cm. The specimen is entirely submitted in one cassette labeled 2A.
Review and SignoutEdit
For every endoscopic biopsy, review the endoscopic report; print it out or save it as a PDF so that the attending can see it when signing out. The endoscopic pictures are the gross pathology for these specimens and thus can help in interpretation of the biopsy findings. The endoscopic report also usually contains additional history. Add a comment to the report: "The endoscopic report has been reviewed."
Just as important is to make sure you check for any prior relevant biopsies. Sometimes you’ll need to pull the slides to compare the current tissue with the prior. This is most common for esophageal biopsies for surveillance of Barrett’s, whenever there is a new diagnosis of dysplasia or when you find high-grade dysplasia.
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