Histopathology
		Specimens Requiring Special Handling Early Miscarriage Tissue / Products of Conception Frozen Sections

Histopathology specimens requiring special handling

- Skin biopsies for immunofluorescent examinations: These specimens are processed and reported by the Immunopathology Laboratory, the Royal Hospitals, Belfast. They require special transport medium, which can be obtained, along with the appropriate request form, from the Dermatology Outpatients Clinic. The skin biopsy should be sent directly to the Immunopathology Laboratory, with 10 ml of clotted blood, to arrive within 48 hours of biopsy. It is advisable to contact the Laboratory (90240503 ext 2534) beforehand.

- Muscle and peripheral nerve biopsies: Muscle biopsies require a special technique for excision and are best carried out at the Royal Hospitals, Belfast. Muscle and peripheral nerve biopsies are processed and reported by the Regional Neuropathology Laboratory, the Royal Hospitals, Belfast. Arrangements should be made directly with this Laboratory (90240503 ext 2019) before taking the biopsy.

Tumour Markers:
Increasingly, we are requested to carry out testing of archived tumour tissue for prognostic and therapeutic makers such as Her-2 in breast carcinomas and DNA mismatch repair genes in colorectal cancer. This requires specialist immunocytochemical analysis. At present we send breast tumour tissue at the time of diagnosis to the Histopathology Laboratory, Antrim Area Hospital for Her-2 analysis and we send colorectal tumour tissue, on request from the Medical Geneticist, to the Histopathology Laboratory, the Royal Group of Hospitals, Belfast.


Placentae (CESDI):

As part of the ‘Confidential Enquiry into Stillbirths and Death in Infancy', all placentae from late fetal deaths (greater than 20 weeks gestation), stillbirths and neonatal deaths are examined.

In addition, pathological examination of the placenta should be carried out when there have been complications of pregnancy. Criteria for examination are listed below –

Baby criteria

- Premature delivery, less than 34 weeks gestation
- Post term delivery, greater than 42 weeks gestation
- Intrauterine growth restriction
- Prolonged rupture of membranes
- Poor CTG in labour, poor Apgar scores
- Congenital abnormalities.
- Baby admitted to a High Dependancy Unit

Maternal criteria

- Diabetes mellitus
- Pregnancy induced hypertension
- Poor obstetric history
- Maternal fever
- Complicated multiple pregnancies
- Abnormal appearing placenta on clinical examination.

Microbiological swabs should be taken from the fetal and maternal aspects of the placentae and submitted with a completed Microbiology Form to the Microbiology Laboratory.

The placenta should then be placed, flat, in a large container, completely immersed in formalin and a CEDSI Label attached to the container. If the infant is liveborn or if the fetus or infant is stillborn and there is to be no post-mortem examination carried out, this should be indicated on the CESDI label and the placenta should be sent to the CAH Histopathology Laboratory with a completed ‘Northern Ireland Regional Paediatric Pathology, Request form for histopathological examination of the placenta’. Please note that all placentas from gestations of greater than 12 weeks are examined by the Regional Paediatric Pathologists at the Royal Hospitals Group Trust Histopathology Department. We will pass the placenta on to them as quickly as possible.

If the fetus or infant has died and is to have a post-mortem examination carried out, it is best to keep the placenta in its fixative and container with the baby and to send them to the Mortuary together, with a completed ‘ Consent form for a Hospital post-mortem examination of a baby’. Again, they will be transported to the Mortuary at the Royal Hospitals Group Trust as soon as possible.

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EARLY MISCARRIAGE TISSUE/PRODUCTS OF CONCEPTION

Most products of conception from early miscarriages (by definition less than 12 weeks size) consist only of placental tissue and decidua. Only a small number contain a formed fetus or fetal parts.
All POCs should be sent for pathological examination to confirm pregnancy and to examine for molar disease.
Recent Department of Health guidelines suggest that it is good practice to seek the mothers consent for examination of the tissue and to ascertain her wishes with regard to disposal of the tissue, even if there is no recognisable fetus.

Consent for histopathological examination and disposal of tissues should be taken by medical staff, probably at the same time as consent for the procedure of evacuation of the uterus is obtained.

Please remember that consent is also required for ectopic and molar pregnancies.

The correct consent form should be used. ( There should be four ticked boxes on the back of the form, if it has been completed correctly)

The original consent form signed by the mother and doctor (not a photocopy) should be sent with the Products of Conception specimen and a completed Histopathology Request Form to the Department of Cellular Pathology, CAH.

If the patient wishes the hospital to arrange disposal of the tissues, the following is standard procedure.

The patient may wish to have tissue, either recognisable fetus or products of conception, returned to her after examination to arrange disposal herself. Please ensure that her wishes are clearly indicated on the consent form. Processing and examination takes approximately 48 hours. The unprocessed tissue will be sent to the appropriate Mortuary (Craigavon or Daisy Hill) and the Mortuary technician will then contact the family to arrange for them to collect the tissue.

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FROZEN SECTIONS

If possible, book frozen sections in advance, to ensure that a pathologist is available, on site, to report the biopsy.

Requests for frozen sections should be arranged directly with a pathologist
(tel. 2689 or 2692) to ensure that the pathologist understands what information is required from the frozen section and what are the clinical management/treatment implications of the frozen section report.

The specimen should be placed in a clean, dry container which is labelled with the patient’s name, date of birth and nature of specimen. Do not place the specimen in formalin.

The specimen should be sent directly to the Department of Cellular Pathology, not to the main Specimen Reception area of the laboratory.

Please complete a Histopathology Request form and write a contact telephone number for the surgical team on the form.