[Histonet] Re: Floaters

[RSRICHMOND <@t> aol.com]

Geezer time again. Floaters, like, uh, compost, happen.

A pathologist or P.A. grossing too fast is apt to carry over fragments into 
the next case. If I were allowed to change the grossing ritual, I'd suggest 
using multiple sets of instruments (scalpels, tweezers, rulers etc) with the 
instruments dropped in a pot of water between specimens, and briefly washed as 
they accumulate.

Floaters rarely cause diagnostic confusion or errors, though I've seen cases 
where they did cause some trouble. The worst floater accident I ever saw 
occurred when a paper packet containing sediment from an ascitic fluid came open 
and spilled a papillary ovarian carcinoma into - I counted - 26 different 
patients' specimens, none of which however would have been likely to cause a 
diagnostic error. (The patient from whom the ascitic fluid came was not strongly 
suspected of having cancer.) Large papillary urothelial (worst of all renal 
pelvis) tumors are perhaps most likely to fragment, and should be grossed with very 
great care. 

A pathologist should NEVER mention a floater in a report. You take one of 
those glass-marking pens the ThinPrep folks give you, circle the offending object 
on the slide, and write "floater" beside the circle. I don't usually call 
them to the attention of the responsible histotechnologist, though perhaps I 
should.

Bob Richmond
Samurai Pathologist
Knoxville TN