Monday's hint for the day!

The information/results that your pathologist gives you is only as good as the sample and information you provide. Don't just cut a "representative" sample, be sure to send the sample in it's entirety if possible (obviously some limitations exist such as those 10 pound splenic tumors!). Mark your margins with India Ink or suture material to help orient the pathologist, as tumors shrink and distort in formalin on their way to the lab. If you do have a larger size tumor, you can "bread loaf" cut it, leaving the base in tact so that the formalin will fix the tissue, but it stays in it's original configuration. Give a good, complete clinical history.

Most importantly, develop a close relationship with your pathologist! If the diagnosis doesn't fit the clinical picture, call and find out why. The basic information need with each histologic cancer diagnosis should be 1.) what is it 2.) did I get it all (margins) 3.) how wide the microscopic margins are 3.) indication of biologic behavior (poorly differentiated, etc.). Don't forget to ask regarding immunohistochemistry stains if the diagnosis is not clear with routine H and E staining.

Most clinicians identify a pathologist that is more experienced in certain areas (e.g. a pathologist that is more experienced in dermatology or one more experienced in cancer) when submitting a sample. Never be afraid to call your pathologist and ask for a re-read if all the information listed above is not provided for you. Some labs charge more for a more detailed report, but you really need a more detailed report to decide if post-operative cancer treatment is necessary.