histopathology unit - Hospital Kuala Lumpur

HISTOPATHOLOGY UNIT
Head of Unit
Phone
Email
Dr. Arni Binti Talib
+603 2615 5555 extension 5619
[email protected]
1. INTRODUCTION
Histopathology Unit is divided into 3 subsections:
i. Routine laboratory
ii. Specialised laboratory
(Special stain, immunohistochemistry and molecular histopathology laboratory)
iii. Neuromuscular laboratory
2. WHERE TO FIND US
Routine Histopathology and Specialised Laboratories are located within the main laboratory
complex of Pathology Department. The Neuromuscular Laboratory is situated in Institute of
Neurology at Level 1. Diagnostic consultation with histopathologists is at Pusat Diagnostic
Anatomik Patologi, which is situated at Dermatology Institute next to Dermatology
Auditorium.
3. TO CONTACT US:
1. Head of Unit and Consultant Pathologist (Dr. Arni Talib)
2. Histopathology office
3. Report enquiry
4. Pathologist
5. Microscopy Room (Medical Officer and Scientific Officer)
6. Routine, Special Stain and Molecular Histopathology Laboratory
7. Neuropathology Laboratory
8. Senior Medical Lab Technologist
: 5619
: 5595
: 5603
: 5619, 5707, 5704
: 6851
: 5605
: 6651
: 6572
4. SERVICES PROVIDED
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General histopathological examination of tissue (routine HPE)
Frozen section
Histochemistry (Special Stain) – refer to Appendix 1 for list of special stain
Immunohistochemistry (IHC) – refer to Appendix 2 for list of antibodies for IHC.
Immunofluorescent microscopy (IMF) – refer to Appendix 3 for list of antibodies for
IMF.
Enzyme histochemistry – refer to Appendix 4 for list of enzymes for enzyme
histochemistry.
Clinical autopsy
Molecular histopathology (Her-2 In-situ hybridization) for breast cancer
5. SUBSPECIALTY SERVICE
1. Paediatric pathology
2. Neuropathology
3. Renal pathology
4. Neuromuscular pathology
5. Urological pathology
6. Gynecological pathology
7. Bone and soft tissue pathology
8. Dermatopathology (in collaboration with UPM Dermatopathologist).
List of Consultant Pathologists with subspecialties and their contact details can be found in
Appendix 5.
6. OUT-OF-HOURS SERVICE
A histopathologist is rostered for 24 hours call to cater for frozen section and clinical
autopsy services as well as surgical pathology consultation. He / she can be contacted
through the hospital operator.
7. HOW TO MAKE A REQUEST FOR ROUTINE HISTOPATHOLOGY
EXAMINATION OR OTHER HISTOPATHOLOGY SERVICE.
7.1 General (routine) histopathology.
Use PER-PAT 301 carbonized request form filled in with relevant clinical information for all
histopathological examination requests. If the report is needed urgently, please mark the
request form URGENT clearly at the top right hand corner.
Histopathology Laboratory requires a set of request form (3 carbonized copies) for each
request. A request with multiple specimens only requires one set (3 carbonized copies) of
request form.
7.2 Frozen section.
All requests for frozen section examination must be preceded by appointment and
discussion with the Surgical Pathologist on-call at least 1 day before the operation. This is
followed by filling up of the request form for the frozen section and submitting it to the
Histopathology Laboratory for notification.
Request form for frozen section (HKL/JP/HI/AK-05-02) is available at the Histopathology
Office (Appendix 6 - A).
Please inform the laboratory at extension 5605 or Medical Officer/Pathologist at ext. 6851 if
the frozen section examination is cancelled.
All cases scheduled for frozen section examination are best placed first in the operating
list.
7.3 Clinical autopsy
Clinical autopsy or postmortem examination is conducted to ascertain the cause of death in
non-medicolegal cases. This service is only provided for patients who died in Kuala Lumpur
Hospital.
The following procedure should be followed:
 The requesting doctor shall first obtain written consent from the next of kin.
 Use Borang Keizinan Bedah Siasat Mayat Klinikal (Autopsi Klinikal HKL/JP/HI-BP02). This consent form is available at the mortuary counter of Forensic Department,
Kuala Lumpur Hospital.
 In cases where the next of kin is not available, the Hospital Director and one medical
specialist will have to give their consent.
 In case of a foreigner where the next of kin is not available, consent from their
respective embassy officials is required.
 The clinician who requests for post-mortem shall communicate directly with the
Histopathology Medical Officer or Pathologist on call.
 Postmortem examination is usually performed during office hour but requests can be
made after office hour.
 During office hour, the Medical Officer/ Pathologist on call for clinical postmortem
can be contacted at extension 6851 or 5603.
 After office hour, the Histopathology Medical Officer and Pathologist on call can be
contacted through telephone. Duty roster of Histopathology Medical Officer
/Pathologist on call and their contact numbers are available at the mortuary counter
of Forensic Department (ext. 6695) and hospital operator.
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A clinical summary together with the case notes and consent form shall be sent to
the Medical Officer or Pathologist on duty.
The requesting specialist from the clinical department is required to be present
during the autopsy.
7.4 Specialised histopathology services / Referrals
Histopathology Unit provides specialized histopathology services in areas as listed above.
Referrals or cases for expert or second opinion are welcome.
i.
For consultation :
 The client (pathologist or clinician) can communicate directly with the
Pathologist specialized in the respective field.
ii.
Referral for expert or second opinion :
 For HKL patients that need expert or second opinion, the requesting doctor
(clinician) is required to fill up the request form as routine cases and submit it
to Histopathology Laboratory together with the specimen (paraffin embedded
tissue, stained and/or unstained slides). Paraffin embedded tissue is
preferred if the cases need further ancillary studies or staining.
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For outside cases, the material together with referral letter should be sent to
Histopathology Laboratory. The request should be directed or addressed to
the specific Pathologist depending on the specialty. The fax number where
the report needs to be sent to should be provided by the requesting doctor.
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The general referral cases or cases other than the above listed subspecialties
will be reported by the pathologist on call on that particular day.
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If the case has been reported elsewhere, a copy of the report should be
provided.
8. SPECIMEN COLLECTION AND CONTAINERS
All specimens for routine histological examination are to be fixed in 10% neutral buffered
formalin (NBF) in a suitable clean leak-proof container.
The containers should have wide opening and if possible with screw cap to prevent
leakage.
The volume of formalin used must be at least 10 times the volume of specimen to be fixed.
Do not put large specimen in small containers as this would prevent proper fixation of the
tissue and also distort the specimen.
All specimen containers should have the same identification details as that written on the
request forms.
Multiple small specimens such as gastrointestinal biopsies should ideally be mounted on a
piece of filter paper and immediately put in formalin.
Specimens from different anatomical sites should be sent in separate containers, properly
labelled and must be clearly itemized in the request form.
For cases that require confirmation of the adequacy of surgical excision, the margins of the
specimen must be marked or tagged accordingly by sutures or by diagrammatic
representation of the excised specimen.
Specimen for frozen sections should be sent in a clean container without fixative.
Specimen for enzyme histochemistry (acetyl cholinesterase) studies is to be sent fresh
immediately without fixative in closed containers and moistened with normal saline to
prevent drying.
8.1 Muscle biopsy
All requests for muscle biopsy must have prior arrangement with the pathologist concerned
or Medical Lab Technologist (MLT) at extension 5605 at least one day before the
procedure.
(Usually the biceps or quadriceps muscle would suffice in most cases)
Important information to be included in the request form are :
 Creatine kinase level
 LDH
 Contact no. of treating clinician relevant hospital fax number
For open biopsy:
 Remove at least one good cylinder of muscle measuring 1.0x0.5x0.5 mm, the
smaller diameter being the cross-section of the muscle.
 For optimal processing muscle specimen must be wrapped with aluminium foil and
sent fresh in an air tight, dry and clean container.
 The specimen should be transported in a container containing ice or gel ice. (Never
use dry ice).
 Do not tie the muscle to stretch it and do not put tissue on gauze.
 Do not put saline or formalin.
The laboratory will accept fresh muscle biopsy specimen up to 6 hours upon removal but
please remember that optimal result requires the specimen to be as fresh as possible.
8.2 Renal biopsy
Prior arrangement with the Pathologist concerned is preferred for very urgent requests.
Generally two specimens are recommended for each case for proper histopathological
evaluation, i.e formalin fixed tissue for ordinary light microscopy examination and fresh
tissue for immunofluorescent staining.
Renal biopsy tissue for immunofluorescence:
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Take at least 3mm core of fresh tissue.
The specimen should be sent fresh in a clean air tight container.
If the specimen cannot reach the laboratory immediately, the fresh tissue should be
put in phosphate buffer, properly packed and transported in ice or gel ice.
Do not put fresh tissue specimen on gauze.
9. DESPATCH AND TRANSPORTATION OF HISTOPATHOLOGY SPECIMEN
Specimens for routine histopathological examination should be sent directly to
Histopathology Laboratory (not at the common specimen reception counter).
Fresh tissue specimen for frozen section, immunofluorescent staining and enzyme
histochemistry should be sent immediately to Histopathology Laboratory.
Fresh tissue should be properly packed and transported in ice or dry ice if the specimen
cannot reach the laboratory immediately (especially specimen from other hospitals).
For frozen section, the specimen should be sent immediately upon removal to the
laboratory by a doctor who will wait for the report.
Muscle biopsy specimen should be sent to Neuropathology Laboratory which is situated at
level 1, Institute of Neurology (Tunku Abdul Rahman Institute), HKL.
10. HISTOPATHOLOGY REPORTS
Reports of biopsies for histopathological examination which are labelled ‘urgent’ will be
available within 1 week after receipt of the specimens by the laboratory (unless the case
needs further staining, second opinion etc).
NOTE: Please leave the requesting doctor’s name and contact number on the request form
for early flagging of results.
Results of frozen section will be immediately communicated to the surgeon via
telephone or the doctor who brought the specimen to the laboratory.
10.1 Report enquiry
Report enquiries can be made via extension 5603. Accession number of the specimen
(HPE number) can be obtained using Labviewer in the respective ward or clinic. The
accession number is the last five digits of the request code which starts with 33XXXXX.
Please identify your request according to specimen sent to the laboratory.
The requesting doctors are welcome to discuss the cases directly with the reporting
Pathologist or Medical Officer concerned at extension 6851.
10.2 Collection of report
 All histopathology reports shall be collected by respective clinics / wards /
department from histopathology office.
 Request for a second copy shall be made in writing or using form PERMOHONAN
MENDAPATKAN SALINAN LAPORAN HPE UNIT HISTOPATOLOGI (HKL/JP/HIBP-04) (Appendix 6 - B).
11. AFTER OFFICE HOURS SPECIMEN
All specimens for routine histological examination taken after office hours should be fixed in
the usual manner (in formalin) in the respective OT or ward and keep at room temperature.
The specimen should then be despatched to the Histopathology Laboratory during
operating working hours and Saturday from 900 am to 1200 noon.
12. INTERDEPARTMENTAL CLINICOPATHOLOGY CONFERENCE
Histopathology Unit conducts clinicopathology conference (CPC) with the major clinical
departments in Kuala Lumpur Hospital on a monthly basis. The schedule for the whole year
is issued before every new year begins.
The clinical department concerned is required to submit the list of patients to be discussed
to the Histopathology Office at least one week before the schedule date.
Enquiries about clinicopathology conference should be communicated directly to the
Medical Officer in charge or Pathologist concerned at extension 6851 or 5603.
13. TAKING OUT PARFFIN BLOCKS/SLIDES FROM HISTOPATHOLOGY UNIT.
Patients’ paraffin blocks and slides are archived in Histopathology Unit.
For certain valid reasons the unit allows the clinician to take diagnostic material (paraffin
block / slide) from the Unit. The following procedures must be followed.
i.
ii.
iii.
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The request to borrow the diagnostic material must be made by a specialist.
The requesting specialist needs to fill up a form PERMOHONAN PEMINJAMAN /
PENGAMBILAN BAHAN DIAGNOSTIK UNIT HISTOPATOLOGI (HKL/JP/HI-BP-01)
(Appendix 6 - C) which is available at Histopathology office.
The completely filled form should be submitted to Histopathology Office and the
material can be taken within 3 working days upon submitting the form to the office.
The paraffin block and stained slides must be returned to Histopathology Office
within 1 month.
14. TAKING OUT TISSUE FROM HISTOPATHOLOGY UNIT.
All specimens (tissue) sent to and officially received by Histopathology Laboratory will be
kept in the unit up for 3 months after the official report is released.
The Histopathology Unit allows the patient to take their tissue, organ or limb back upon
request. Please follow this procedure.
i.
ii.
iii.
The patient or next kin must make a formal request by filing up a form
PERMOHONAN PENGAMBILAN SPECIMEN / TISU UNIT HISTOPATOLOGI
(HKL/JP/HI-BP-02) (Appendix 6 - D). This form is available in Histopathology Office.
The completed form should be submitted to Histopathology Office.
The tissue is released only after the specimen is being examined by the Pathologist
and adequate sampling has been taken for reporting.
15. REQUEST TO OBTAIN MICROSCOPIC IMAGE FROM HISTOPATHOLOGY UNIT.
Microscopic images are not archived as routine but images can be provided upon request.
A request shall be made or endorsed by specialist.
i.
For presentation :
 The requesting doctor should communicate directly with the Pathologist
concerned.
 A request shall be made by filing up a form i.e PERMOHONAN
MENDAPATKAN
GAMBAR
HISTOPATOLOGI
(HKL/JP/HI-BP-03)
(Appendix 6 - E) which is available at the Histopathology Office. The
completed form should be submitted to the Histopathology Office.
ii.
For publication :
 The requesting doctor shall communicate directly with the Pathologist
concerned followed by filling up the request form.
 The abstract of the publication should be provided and the Pathologist
concerned who reported the case should be included as co-author.
The microscopic histopathology images will be available within 2 weeks upon submission of the
form. Only soft copy of the images is provided and the requester should provide a CD before
collecting the images from the unit.
16. RESEARCH
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The histopathology unit welcome research projects or studies to be done in
collaboration with our unit.
All collaborative studies or research projects must have approval from the Head of
Pathology Department.
A copy of research proposal must be provided.
One pathologist from the unit shall be appointed as collaborator or co-researcher.
The researcher will be assisted by the appointed Pathologist to retrieve the materials
required if the research project requires archival material from this unit.
All archival slides can be borrowed for review in the unit only.
If paraffin blocks are required for further testing, sections should be done at the
allocated station in this laboratory.
No archival material should be taken out from Histopathology Unit.
Appendix 1
LIST OF ANTIBODIES FOR HISTOCHEMICAL STAIN
1. Alcian Blue
2. Bielschowsky's silver
3. Congo Red
4. Cresyl Fast Violet
5. Fouchet (Bile)
6. Giemsa
7. Gomori Trichrome
8. Gram
9. Grimelius
10. Grocott-Gomori Methena Silver (GMS)
11. Leder Giemsa
12. Luxol Fast Blue
13. Masson Fontana
14. Masson Tichrome
15. Martius Scarlet Blue
16. Melanin Bleach
17. Mucicarmine
18. Oil Red O (Fat)
19. Orcein
20. PAAG
21. Periodic acid Schiff (PAS)
22. PAS – OG
23. PAS / Alcian Blue
24. PAS + D
25. PAS + D/ Alcian Blue
26. Perl Prussian Stain
27. Phloxine-tartaxine
28. PTAH
29. Reticulin (Gordon/Sweet)
30. Rubeanic acid
31. Schmorl's reaction
32. Toluidine blue
33. Van Gieson
34. Von Kossa
35. Verhoeff Elastic Van Gieson (EVG)
36. Wade Fite
37. Warthin Starry
38. Ziehl-Neelson
Appendix 2
LIST OF ANTIBODIES FOR IMMUNOHISTOCHEMICAL STAIN
1. ALK protein
2. Amyloid A
3. Alfa-feto protein A
4. Alfa-1 anti trypsin
5. ACTH (AdenocorticontrophinHormon)
6. B-CATENIN
7. BCL 2
8. BCL 6
9. CA 125
10. CD 1 - ALPHA
11. CD 2 (T-Cell)
12. CD 3(T cell)
13. CD 4
14. CD 5(T cell)
15. CD 7
16. CD 8
17. CD 10
18. CD 15(Hodgkin's)
19. CD 20(B cell)
20. CD 21
21. CD 23
22. CD 30(Ki-1) Antigen
23. CD 31(Endothelial cell)
24. CD 34
25. CD 43 (Hematologi)
26. CD 56 (NKT-cell)
27. CD 61 (Hematologi)
28. CD 68(Macrophage)
29. CD 79 Alpha(B cell)
30. CD99 (Mic2 Gens)
31. CD 117
32. CD 138 (Hematologi)
33. CD235a - Glycophorin A (Hematologi)
34. CDK4
35. CDX2
36. Calcitonin
37. Caldesmon
38. Calretinin
39. CEA(Carcino Embryonic Antigen)
40. Chromogranin
41. CK 5/6
42. CK 7
43. CK 20
44. CK AE1/AE3
45. CK MNF 116
46. CMV (Cytomegalovirus)
47. C4d
48. C1q
49. C3
50. Cyclin D1
51. Desmin
52. E-Cadherin
53. EBV(Epstein Barr Virus)
54. EMA (Epithelial Membrane Antigen)
55. ER(Estrogen receptor)
56. Epithelial antigen
57. F8 (Factor V111 R Ag)
58. Fli-1
59. FSH(Follicle Stimulating Hormone)
60. GFAP(Glial fibrillary acidic protein)
61. GH(Growth Hormone)
62. GLUT 1
63. H-Caldesmon
64. HER-2
65. Hepatocyte Antigen
66. HMW CK
67. HbSAg (Hep. B Surface Antigen)
68. HPL
69. HCG(H. Chorionic Gonadotropin)
70. HPV (Human papilloma virus)
71. HMB45
72. Inhibin
73. IgA
74. IgG
75. IgM
76. KI 67
77. Kappa
78. Lambda
79. LCA(Leuco. Com. Antigen)
80. LH(Luteinizing Hormone)
81. Lysozyme
82. Mammaglobin
83. Melan A
84. MUM 1
85. MPO (Hematologi)
86. Myogenin
87. Myoglobin
88. MYO D1
89. MUC-2
90. NSE(Neurone Specific Enolase)
91. NB84
92. NF (Neurofilament)
93. PSA (Prostate Specific Antigen)
94. P16
95. P53
96. P63
97. PAX 5
98. PLAP
99. PR (Progesteron Receptor)
100. Prolactin
101. P53
102. RCC
103. SMA
104. SNF5 (INI-1)
105. SV40
106. Synaptophysin
107. S100
108. Tdt
109. TSH
110. TTF1
111. Thyroglobulin
112. Toxoplasma gondii
113. Vimentin
114. Wilm's tumour 1
Appendix 3
LIST OF ANTIBODIES FOR IMMUNOFLUORESCENT STAIN
1. IgG
2. IgA
3. IgM
4. C3
5. C1q
6. Fibrinogen
7. Kappa
8. Lambda
9. Albumin
Appendix 4
LIST FOR ENZYMES FOR ENZYME HISTOCHEMICAL STAIN
A/ RECTAL BIOPSY FOR HIRCHSPRUNG’S DISEASE
Acetylcholinesterase
B/ MUSCLE BIOPSY FOR NEUROMUSCULAR DISORDER
1. Acid phosphatase
2. Alkaline phosphatase
3. AT Pase (pH 4.3 TO 10.9)
4. Cytochrome Oxidase
5. Cytochrome Oxidase /Succinate dehydrogenase
6. NADH-TR
7. Succinate dehydrogenase
APPENDIX 5
CONSULTANT HISTOPATHOLOGISTS, SUBSPECIALTIES AND
CONTACT DETAILS
Pathologist Name
Dr. Arni Talib
Head Of Unit
Datin Dr. Fauziah Kassim
Dr. Nik Hasimah Nik Yahya
Dr. Suryati Mohd Yusoff
Dr. Zanariah Alias
Dr. Razmin Ghazali
Dr. Noraini Mohd. Dusa
Dr. Rosna Yunus
Dr. Hemlata Kumari
Gnanasegaram
Dr. Zuliatul Faizah Baharom
Field Of Subspecialty
Paediatric Pathology
Neuropathology
Renal Pathology
Neuromuscular Pathology
General Histopathology &
Cytology
Gynaecological Pathology
Bone And Soft Tissue
Pathology
Urological Pathology
Training in Transplant
Pathology
Training in Dermatopathology
Email Address
Tel Ext. No.
[email protected]
5619
[email protected]
[email protected]
[email protected]
5623
5619
5707
[email protected]
5707
[email protected]
5707
[email protected]
5704
[email protected]
5704
[email protected]
5704
[email protected]
5704
Note: Please be informed that all Histopathologists now have moved to PUSAT
DIAGNOSTIC PATOLOGI ANATOMIK which is situated at level 1, Institute of
Dermatology Block next to Dermatology Auditorium.
APPENDIX 6 - A
BORANG PERMINTAAN FROZEN SECTION
APPENDIX 6 - B
PERMOHONAN MENDAPATKAN SALINAN LAPORAN HPE UNIT
HISTOPATOLOGI
APPENDIX 6 - C
PERMOHONAN PEMINJAMAN / PENGAMBILAN BAHAN DIAGNOSTIK
UNIT HISTOPATOLOGI
APPENDIX 6 – D (1)
PERMOHONAN PENGAMBILAN SPECIMEN / TISU UNIT
HISTOPATOLOGI
APPENDIX 6 – D (2)
PERMOHONAN PENGAMBILAN SPECIMEN / TISU UNIT
HISTOPATOLOGI
APPENDIX 6 – E
PERMOHONAN MENDAPATKAN GAMBAR HISTOPATOLOGI