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Path - The Acquisition + Handling of Tissue from Neoplasms for Pathology…
Path - The Acquisition + Handling of Tissue from Neoplasms for Pathology Evaluation (i)
How to obtain material for Dx
FNA Bx
small amount of cells
no stromal (connective) tissues, e.g. collagen, fibroblasts
architecture can't be assessed :(
Trucut Core Needle Bx
width/bore of needle is wider
more tissue (cells AND stroma)
better for pathologist, special stains can be used (immunohistochemistry)
Incisional Bx
Complete removal lump
liquid fluid Bx
ascites
blood
pleural effusion
then preserve in formalin, process (place in cassette, then wax - makes cutting v thin sections easier), cut section, place on slide, H+E staining, examined, reported
Prognostic features of Neoplasms
stage
most important predictor
extent of SPREAD
assessed clinically, radiologically + pathologically
alters management (e.g. node +ve breast cancer receives chemo, node -ve doesn't)
often under/over-called
international staging = TNM
t = tumour size
n = no. of nodes
m = mets
older systems outdated (e.g. Duke's staging of colon cancer)
often done using to SENTINEL node
esp in breast carcinoma + malignant melanoma
= node to which tumour 1st spread
if -ve: no further nodal dissection (less SEs)
if +ve: further nodal dissection
identified by injecting a blue dye/isotope (tracer material) into tumour site, will drain to sentinel node 1st
! risk of false -ve: if node is fully replaced by tumour dye can't get in
grade
histological assessment of degree of DIFFERENTIATION (resembles to mature tissue)
3 grades
low grade: well-differentiated
intermediate grade: moderately differentiated
high grade: poorly-differentiated
assessment based on...
1) cytological features - look for nuclear abnormality (hyperchromasia, high nuclear:cytoplasmic ratio, pleomorphism, high mitotic activity)
2) architectural features
gland formation in adenocarcinomas
degree of epithelial maturation
3) functional features
amount of keratin in squamous cell carcinoma
amount of mucin in adenocarcinoma
size
varies according to neoplasm type
2mm melanoma = bad (50% mortality)
2mm basal cell carcinoma never fatal
! if unexcited though can erode through skull + cause meningitis
site
skin has a better prognosis than abdominal/ovarian due to earlier detection
host immune response
lymphocytic infiltration = good prognosis (body can generate immunological response against tumour)
e.g. semioma (germ cell cancer) - host can attack it with lymphocytes - 98% cure rate :)
adequacy of Tx
complete removal NB
margin of excision (must be >/= 2cm in melanoma)
General health status of patient
are they fit enough to withstand the tx?