Biopsy Information and Courses from MediaLab, Inc.

The prototype history for this organism is either a still birth or a neonate with death ensuing within 2 or 3 days post-partem due to high fever, sepsis, and respiratory distress. The mother usually experienced a flu-like illness late in the third trimester of pregnancy, characterized by low-grade fever, myalgias, malaise and backache. In this case, biopsy material of brain tissue obtained at autopsy was submitted to the pathology laboratory for tissue diagnosis and fluid from the pia-arachnoid was sent to the microbiology laboratory for culture.

The H & E section of the brain biopsy (left frame)revealed edema of the parencymya with the accumulation of inflammatory cells in the perivascular spaces. The close in view of the exudate (right) frame reveals that the inflammatory exudate is comprised primarily of polymorphonuclear luekocytes. The histologic diagnosis therefore is suppurative meningitis, with culture results necessary to establish the etiologic agent.

The biopsy specimen is usually fixed in Zenkers’ acetic solution (5% glacial acetic acid; 95% Zenkers) for 6-18 hours or B-5 fixative for one to two hours. Excessive time in either fixative makes the tissue brittle, then briefly decalcified. The tissue is processed together with other tissues, and is embedded in paraffin and cut at 4 µm and stained with hematoxylin and eosin (H&E) and Perls’ Prussian blue iron stain, and other special stains as indicated.

A bone marrow biopsy involves removing a small portion of the bone marrow without destroying the architecture of the marrow. This type of biopsy is necessary when the marrow cannot be aspirated (dry tap) due to a disease process, and also provides additional information complementary to that derived from the aspirate: biopsy specimens are more accurate for assessing cellularity, and infiltrative processes, such as metastatic carcinoma, fibrosis, amyloid, and lymphoma. A biopsy specimen is processed as follows: touch preparation tissue section

This low power view is from a biopsy of a patient with normal iron stores. Note the presence of iron shown by the arrow.

Markely increased stainable iron is present in this biopsy. Iron stores may be increased in sideroblastic anemia, chronic infections, hemochromatosis, hemosiderosis due to numerous blood transfusions, chronic hepatitis, cirrhosis, and uremia.

The microscopic examination of marrow smears can be divided into three main steps.Evaluating cellularity from the biopsy/particle smearEvaluating marrow iron from the biopsy/particle smearMorphology examination from the Romanwsky stained smears

This biopsy section was taken from a patient who has very few cellular elements in the marrow. Notice that over 90% of the marrow is composed of fat. If all of the cellular elements are decreased, the patient's condition is said to be pancytopenic or aplastic. There are numerous causes for aplasia, including drugs such as chloramphenicol, chemotherapy and inheritance (Fanconi's Anemia).

This is another view of the same slide showing increased cellularity and decreased fat.

The setting is the cafeteria in a hospital or the lounge in an independent laboratory. Two employees from different departments are old friends are having lunch together. A billing clerk and a medical technologist are friends and are having lunch together. The billing clerk mentions that she saw a bill go through the system for one of her coworkers for a biopsy. She asks the medical technologist if she has the necessary security level access to see pathology test results because she is concerned about the welfare of the coworker. The medical technologist does have the necessary security clearance to see the results. She should:Correct Answer: Refuse to look up the results for the clerk and remind the clerk that it is a violation of compliance policies to do so, or to ask another to do so. Remind her of the requirement for each employee to report any violations of policy. Discussion: The Medical technologist has a responsibility to report violations of compliance policies and the friend has put her in a difficult position. For that reason, it is not enough to just refuse the clerk's request. If the medical technologist does not take the responsibility to inform the employee of the policy then there is a possibility that the employee would ask some other employee to do it for her.