Bone and Soft Tissue Extirpations: Whole-Specimen Freezing Delivers Superior Pathological Evaluation

  • Veronica Taylor Mayo Clinic
  • Dora Lam-Himlin Department of Laboratory Medicine and Pathology Mayo Clinic, Scottsdale, AZ
  • Monique Harize Phoenix Children's Hospital
  • Shipra Garg Phoenix Children's Hospital
  • David Carpentieri Phoenix Children's Hospital
  • Steve Taylor Phoenix Children's Hospital
Keywords: Whole-specimen freezing, slab-sectioning

Abstract

Background: Bone resections involved by either benign or malignant disease are complex specimens requiring special processing. Irrespective of experience, many pathologists, residents, and pathologists' assistants (PAs) are apprehensive of these resections due to their infrequency. For these extirpations, serial slab-sections are ideal for identifying margin status, size of tumor, documentation of diagnosis, tumor classification, imaging correlation and presence of discontinuous lesions. However, the variable density of bone and soft tissues creates a challenge for prosectors to reliably yield multiple intact thin slabs. Standardized protocols provide both reassurance and a systematic approach and herein we describe a method as implemented at the sister institutions of Mayo Clinic Hospital in Phoenix and Phoenix Children's Hospital.Methods: Utilizing the approach of whole-specimen freezing and slab-sectioning, we prospectively processed 41 cases of bone and soft tissue resections between 2011 and 2014 and histologic sections were retrospectively evaluated for freeze artifact, bone dust, thermal injury and immunoreactivity.  Slab-sectioning following whole-specimen freezing resulted in crisply visible anatomic relationships across multiple planes allowing for superior gross inspection, easy correlation with prior imaging, photographic documentation and ease in the selection of histologic sections.  Result: Microscopically, freeze artifact was present in 6 of 39 (15%) cases available for review, but was insignificant to interpretation and was not affected by freeze duration (up to 72 hours). No loss of immunoreactivity was present (0 of 5 cases) and neither bone dust nor thermal injury were significant findings in any of the cases.   Conclusion: The protocol is easy to follow, yields reproducible results and induces no significant freeze artifact, providing excellent histomorphology regardless of tumor type involving bone.  We recommend slab-sectioning following whole-specimen freezing and we offer our procedure in detail. 

Author Biographies

Veronica Taylor, Mayo Clinic
Laboratory Medicine and PathologyMHS, PA(ASCP), Associate Professor
Dora Lam-Himlin, Department of Laboratory Medicine and Pathology Mayo Clinic, Scottsdale, AZ
Department of Laboratory Medicine and Pathology,MD
Monique Harize, Phoenix Children's Hospital
Department of Pathology and Laboratory Medicine,MD
Shipra Garg, Phoenix Children's Hospital
Department of Pathology and Laboratory Medicine,MD
David Carpentieri, Phoenix Children's Hospital
Department of Pathology and Laboratory MedicineMD
Steve Taylor, Phoenix Children's Hospital
Department of Pathology and Laboratory MedicineMHS, PA(ASCP), HTL

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Published
2016-08-09
Issue
Vol 3 No 3 (2016)
Section
Original Article

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