FW: [Histonet] Revealing lymph nodes

[Luck, Greg D.]

-----Original Message-----
From: Luck, Greg D. 
Sent: Wednesday, March 01, 2006 1:42 PM
To: 'Marshall Terry Dr, Consultant Histopathologist'
Subject: RE: [Histonet] Revealing lymph nodes

Oh it's always something,
We use PenFix from R.A. with marginal improvement in helping distinguish
lymph nodes from surrounding tissues (obviously "fat" in particular).  If
you're willing to tolerate a bit more obnoxious dissection experience add a
little Trichloroacetic Acid to your Davidson's or try some Tri-Fix which we
have custom made for us by American Mastertech.  It's nearly as effective as
"Disect-Aid" but less unpleasant to work with.  I know how impressed many of
our surgeons are when we're able to consistently identify and demonstrate
lymph nodes from those problematic (from a node shuckin' perspective) low
anterior and abdominal perineal resections.  Good luck, Greg Greg Luck, BS,
HT(ASCP) Anatomic Pathology Supervisor Deaconess Medical Center 800 W. 5th
Ave Spokane, WA 99204 Phone 509.473.7077 Fax 509.473.7133
luckg <@t> empirehealth.org www.deaconessmedicalcenter.org


-----Original Message-----
From: Marshall Terry Dr, Consultant Histopathologist
[mailto:Terry.Marshall <@t> rothgen.nhs.uk]
Sent: Wednesday, March 01, 2006 5:10 AM
To: rsrichmond <@t> aol.com; histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] Revealing lymph nodes

Sigh.
This is an opportune discussion, because I have tried Davidson's in the past
and could see no difference whatsoever between before and after.
In the last few days we have made up a new batch, modified slightly to take
into consideration JK's view that there should be a greater proportion of
alcohol.
Same result, no difference whatsoever. No clearing, no lymph nodes going
white - nothing.

Is this the Emperor's new cloths?

PS I only tried it in the first place because of the regard I have for
anything uttered by Bob Richmond.

Dr Terry L Marshall, B.A.(Law), M.B.,Ch.B.,F.R.C.Path  Consultant
Pathologist  Rotherham General Hospital  South Yorkshire  England
        terry.marshall <@t> rothgen.nhs.uk

-----Original Message-----
From: rsrichmond <@t> aol.com [mailto:rsrichmond <@t> aol.com]
Sent: 28 February 2006 18:58
To: histonet <@t> lists.utsouthwestern.edu
Subject: [Histonet] Revealing lymph nodes


I think that a clearing fixative (such as the examples already given; there
are also commercial products) is essential for finding the small lymph nodes
that are often positive for colon cancer in colon resection specimens.
Remember that just one tiny positive lymph node upstages the tumor, and
makes chemotherapy mandatory - so there's a real patient care decision
involved here.
 
In my travels as a locum tenens pathologist I noted that about half of
pathologists were using clearing fixatives, and about half were not. As far
as I know there have been no official pronouncements on the subject.
 
Clearing fixatives are less necessary in axillary dissection material for
breast cancer - the specimensare smaller and the lymph nodes - and
metastases - are usually much bigger. The mesenteries from a colon cancer
resection are voluminous and hard to search through.
 
Bob Richmond
Gastonia NC
 
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