Histopathology Unit BI - Kuala Lumpur Hospital › content › 2020 › Patologi › Unit...Diagnostik Patologi Anatomik (PDPA), which is situated at Dermatology Institute next to

HISTOPATHOLOGY UNIT

Head of Unit Dr. Nik Hasimah Nik Yahya

Phone +603 2615 5555 extension 5595

Email [email protected]

1. INTRODUCTION

Histopathology Unit is divided into 4 subsections:

i. Routine laboratory

ii. Specialised laboratory (Special stain, immunohistochemistry and molecular histopathology

laboratory)

iii. Neuromuscular laboratory

iv. Molecular laboratory

2. WHERE TO FIND US

Routine Histopathology and Specialised Laboratories are located within the main laboratory

complex of Pathology Department. The Neuromuscular and Molecular Laboratory is situated in

Institute of Neurology at Level 1. Diagnostic consultation with histopathologists is at Pusat

Diagnostik Patologi Anatomik (PDPA), which is situated at Dermatology Institute next to

Dermatology Auditorium.

3. TO CONTACT US:

1. Head of Unit and Consultant Pathologist (Dr. Nik Hasimah Nik Yahya) : 5595

2. Histopathology office : 5595

3. Report enquiry : 5603

4. Pathologist : 5619, 5707, 5704, 7586

5. Microscopy Room (Medical Officer and Scientific Officer) : 6851

6. Routine, Special Stain and Molecular Histopathology Laboratory : 5605

7. Neuropathology Laboratory : 6651

8. Senior Medical Lab Technologist : 6572

4. SERVICES PROVIDED

1. General histopathological examination of tissue (routine HPE)

2. Frozen section

3. Histochemistry (Special Stain) – refer to Appendix 1 for list of special stain

4. Immunohistochemistry (IHC) – refer to Appendix 2 for list of antibodies for IHC.

5. Immunofluorescent microscopy (IMF) – refer to Appendix 3 for list of antibodies for IMF.

6. Enzyme histochemistry – refer to Appendix 4 for list of enzymes for enzyme

histochemistry.

7. Clinical autopsy

8. Molecular histopathology – refer to Appendix 5 for list of molecular tests.

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

9. Molecular pathology

List of Consultant Pathologists with subspecialties and their contact details can be found in

Appendix 6.

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.

W TO MAKE A REQUEST FOR

7. HOW TO MAKE A REQUEST FOR ROUTINE HISTOPATHOLOGY

EXAMINATION OR OTHER HIST OPATHOLOGY 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 7 - A).

Please inform Medical Officer at ext. 6851 or 5603 if the frozen section examination is

cancelled.

All cases scheduled for frozen section examination are best placed first in the operating list.

So it can be done during normal working hours.

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:

1. 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-BP-02).

This consent form is available at the mortuary counter of Forensic Department, Kuala

Lumpur Hospital.

2. In cases where the next of kin is not available, the Hospital Director and one medical

specialist will have to give their consent.

3. In case of a foreigner where the next of kin is not available, consent from their respective

embassy officials is required.

4. The clinician who requests for post-mortem shall communicate directly with the

Histopathology Medical Officer or Pathologist on call.

5. Postmortem examination is usually performed during office hour but requests can be made

after office hour if necessary.

6. During office hour, the Medical Officer/ Pathologist on call for clinical postmortem can be

contacted at extension 6851 or 5603.

7. 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.

8. A clinical summary together with the case notes and consent form shall be sent to the

Medical Officer or Pathologist on duty.

9. 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.

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 report will be emailed to the

respective department.

The general referral cases or cases other than the above listed subspecialties will

be reported by the pathologist on call on that particular day.

If the case has been reported elsewhere, report should be viewed from system LIS.

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 x Family history of

similar problems.

For open biopsy:

Remove at least one good cylinder of muscle measuring 1.0x0.5x0.5 cm, the

smaller diameter being the cross-section of the muscle.

For optimal processing muscle specimen must be wrapped with aluminum 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.

The laboratory will accept fresh muscle biopsy specimen up to 4 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.

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:

Take at least 5 mm 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 in formalin to counter no. 5,

common receiving area (CRA) of Pathology Department.

Fresh tissue specimen for frozen section, immunofluorescent staining and enzyme histochemistry

such as muscle biopsy 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 Histophatology

laboratory (Pintu 6). by a doctor who will wait for the report.

Muscle biopsy specimen should be sent to Histopathology Laboratory (Pintu 6).

10. HISTOPATHOLOGY REPORTS

Reports of small biopsies for histopathological examination which are labelled ‘urgent’ will be

available within 1 week after the specimens were received by the laboratory. Exception are cases

sent in more than 4 containers, and/or require further ancillary studies.

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 within 1 hour.

10.1 Access to HPE reports

For clinics / wards / departments within HKL, HPE reports can be accesses via

Doctor2U laboratory informative system. For others (non-HKL), reports will be emailed to

the respective departments.

Request for a second copy for reports prior to the year 2020 shall be made in writing or

using form PERMOHONAN MENDAPATKAN SALINAN LAPORAN HPE UNIT

HISTOPATOLOGI (HKL/JP/HI-BP-04) (Appendix 7 - 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 common receiving area in Pathology department

main counter 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. The request to borrow the diagnostic material must be made by a specialist.

ii. The requesting specialist needs to fill up a form PERMOHONAN PEMINJAMAN / PENGAMBILAN BAHAN DIAGNOSTIK UNIT HISTOPATOLOGI (HKL/JP/HI-BP-01) (Appendix 7 - C) which is available at Histopathology office.

iii. 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.

iv. 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 1 month 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. The patient or next kin must make a formal request by filling up a form PERMOHONAN

PENGAMBILAN SPECIMEN / TISU UNIT HISTOPATOLOGI (HKL/JP/HI-BP-02)

(Appendix 7 - D).

ii. This form is available in Histopathology Office.

iii. The completed form should be submitted to Histopathology Office.

iv. The tissue is released only after the specimen has been reported and validated by the

Pathologist.

EQUEST 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 filling up a form i.e PERMOHONAN

MENDAPATKAN GAMBAR HISTOPATOLOGI (HKL/JP/HI-BP-03)

(Appendix 7 – 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.

16. RESEARCH

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. Congo Red

3. Cresyl Fast Violet

4. Fouchet (Bile)

5. Giemsa

6. Gomori Trichrome

7. Gram

8. Grocott-Gomori Methena Silver (GMS)

9. Leder Giemsa

10. Luxol Fast Blue

11. Masson Fontana

12. Masson Tichrome

13. Martius Scarlet Blue

14. Melanin Bleach

15. Mucicarmine

16. Oil Red O (Fat)

17. Orcein

18. PAAG

19. Periodic acid Schiff (PAS)

20. PAS / Alcian Blue

21. PAS + D

22. PAS + D/ Alcian Blue

23. Perl Prussian Stain

24. PTAH

25. Reticulin (Gordon/Sweet)

26. Rubeanic acid

27. Schmorl's reaction

28. Toluidine blue

29. Van Gieson

30. Von Kossa

31. Verhoeff Elastic Van Gieson (EVG)

32. Wade Fite

33. Warthin Starry

34. Ziehl-Neelson

Appendix 2

LIST OF ANTIBODIES FOR IMMUNOHISTOCHEMICAL STAIN

1. ABCB11 (BSEP)

2. ABCB4 (MDR3)

3. ACTH

4. AFP

5. ALK cl: DSF3

6. ALK PROTEIN

7. Alpha 1 ANTITRYPSIN

8. AMACR

9. AMYLOID A

10. AR1D1A

11. ATRX

12. B-CATENIN

13. BCL2

14. BCL6

15. Ber-EP4

16. BRAHYCURY

17. BRG1

18. C1q

19. C3c – IP

20. C4D

21. CA 125

22. CALCITONIN

23. CALDESMON

24. CALRETININ

25. CARBONIC ANHYDRASE IX (CA IX)

26. CD 1 – ALPHA

27. CD 10

28. CD 117

29. CD 138

30. CD 15

31. CD 163

32. CD 2

33. CD 20

34. CD 21

35. CD 23

36. CD 3

37. CD 30

38. CD 31

39. CD 34

40. CD 4

41. CD 43

42. CD 5

43. CD 56

44. CD 61

45. CD 68

46. CD 7

47. CD 79 𝛼

48. CD 8

49. CDX2

50. CEA

51. CHROMOGRANIN A

52. CK 19

53. CK 20

54. CK 5/6

52.CK 7

53.CK AE1/AE3

55.CMV

56.C-MYC

57.CYCLIN D1

58.D2-40

59.DESMIN

60.DOG 1

61.EBER PROBE

62. E-CADHERIN

63. EMA

64. ER

65. ERG

66. F8

67. Fli 1

68. FSH

69. GATA3

70. GFAP

71. GH

72. GLUT 1

73. Glycophorin A

74. GLYPICAN-3

75. HBs Ag

76. HCG

77. HEPATOCYTE

78. HER-2

79. HHV-8

80. Histone H3

81. HLA-ABC Ag

82. HMB45

83. HMW CK

84. HPL

85. IDH-1

86. IDH-2

87. INHIBIN

88. INI-1

89. KAPPA

90. KI 67

91. LAMBDA

92. LCA

93. LH

94. LYSOZYME

95. MAMMAGLOBIN

96. MDM2

97. MELAN A

98. MIC 2

99. MLH 1

100. MPO

101. MSH 2

102. MSH 6

103. MUC 2

104. MUC4

105. MUC6

106. MUM 1

107. Myo D1

108. MYOGENIN

109. MYOGLOBIN

110. NAPSIN A

111. NB84

112. Neu N

113. NF

114. NKX2.2

115. NSE

116. P16

117. P40

118. P53

119. P63

120. PAN CK

121. PAX 5

122. PAX 8

123. PLAP

124. PMS2

125. POLE

126. PR

127. PROLACTIN

128. PSA

129. S100

130. SALL4

131. SAT B2

132. SDHB

133. SMA

134. SMAD4

135. SOX 10

128. STAT 6

129. SV40

130. SYNAPTOPHYSIN

131. Tdt

132. TFE 3

133. Thyroglobulin

134. TIA-1

135. TLE 1

136. Toxoplasma Gondii

137. TSH

138. TTF1

139. VIMENTIN

140. WILM'S TUMOUR 1

141. YAP1

Appendix 3

LIST OF ANTIBODIES FOR IMMUNOFLUORESCENT STAIN

1. IgG

2. IgA

3. IgM

4. C3

5. C1q

6. Fibrinogen

7. Kappa

8. Lambda

Appendix 4

LIST FOR ENZYMES FOR ENZYME HISTOCHEMICAL STAIN

A/ RECTAL BIOPSY FOR HIRCHSPRUNG 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

LIST OF MOLECULAR TESTS

1. HER-2 DDISH

2. EBER ISH

3. NMYC FISH

4. ETV6 FISH

5. EWSR1 FISH

- A

APPENDIX 6

CONSULTANT HISTOPATHOLOGISTS, SUBSPECIALTIES AND

CONTACT DETAILS

Pathologist Name Field Of Subspecialty Email Address Tel Ext.

No.

Dr. Arni Talib

Head Of Department Paediatric Pathology [email protected] 5594

Dr. Nik Hasimah Nik Yahya

Head Of Unit Renal Pathology [email protected] 5595

Datin Dr. Fauziah Kassim Neuropathology [email protected] 5623

Dr. Suryati Mohd Yusoff Neuromuscular Pathology [email protected] 7586

Dr. Zanariah Alias General Histopathology &

Cytology [email protected] 5619

Dr. Razmin Ghazali Gynaecological Pathology [email protected] 5243

Dr. Noraini Mohd. Dusa Bone And Soft Tissue

Pathology [email protected] 5704

Dr. Rosna Yunus Urological Pathology [email protected] 5619

Dr. Norhayati Omar Molecular Pathology [email protected] 7586

Dr. Hemlata Kumari

Gnanasegaram Renal Pathology [email protected] 5244

Dr. Zuliatul Faizah Baharom Training in Dermatopathology [email protected] 7586

Dr. Sellymiah Adzman Perinatal Pathology [email protected] 5707

Dr. Subasri Armon General Histopathology &

Cytology [email protected] 5244

Dr. Siah Hui Hui General Histopathology &

Cytology [email protected] 5707

Dr. Serena Diane Santhana

Dass Molecular Pathology [email protected] 5244

Dr. Nur Dini Jalaludin General Histopathology &

Cytology [email protected] 5707

Dr. Asmawiza Awang General Histopathology &

Cytology [email protected] 5243

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.

- B

APPENDIX 7

BORANG PERMINTAAN FROZEN SECTION

- C

APPENDIX 7

PERMOHONAN MENDAPATKAN SALINAN LAPORAN HPE UNIT

HISTOPATOLOGI

- D

PERMOHONAN PEMINJAMAN / PENGAMBILAN BAHAN DIAGNOSTIK

UNIT HISTOPATOLOGI

APPENDIX 7 D (1)

PERMOHONAN PENGAMBILAN SPECIMEN / TISU UNIT

HISTOPATOLOGI

APPENDIX 7 D (2)

PERMOHONAN PENGAMBILAN SPECIMEN / TISU UNIT

HISTOPATOLOGI

APPENDIX 7 E

PERMOHONAN MENDAPATKAN GAMBAR HISTOPATOLOGI