[Histonet] Lymph Node Frozen Sections

Stephen Peters M.D. petepath <@t> yahoo.com
Mon Oct 23 12:39:46 CDT 2006

Dear Travis,
  For lymphnode frozens first remove all fat from the outer surface. When given
   the usual fatty wad I place it on a paper towel an first using mild pressure with 
  my finget tips  I sqeeze away all the fat I can by pushing it away from the node.
   It should look like a recognizable oval  or bean shaped node by now. Next lie the node on a dry paper towel. Roll it a
   few mm. As the node rolls the fatty tissue adherent to the capsule sticks to the 
  paper and a  plane of dissection which opens as the node rolls away. With a 
  scalpel slice the capsular fat  away as this plane open. Continue rolling and 
  slicing until the capsule is clean. If you leave fat on the capsule when you go to cut 
  it will separate from the OCT. If fat totally surrounds the capsule the tissue 
  will entirely" curl away" from the OCT and make you miserable. When you bivalve
   the node there will often be fat in the medulla. I will scrape out as much of this as
   I can with a scalpel. If you have done a good job this the lymph node will cut as 
  easy as any other tissue. In general try to cut in a smooth continuous fashion 
  and always start with a sharp blade. If you do this there may be a few holes where
   fat remains but the nodal tissue will cut nicely. If you are still having difficulty
   with some fat in the block you can scrape it away from the block face and then apply a drop of OCT to the block face again an press it to the cold 
  stage to finish the "plastering" job. On my web site I call this 
  "The Gouge"
  Few other words on fat. If possiblett try to have the fat hit the blade last or
   by itself. Always give yourself a " handle of OCT" that will hit the blade before 
  the fat.The worse thing you can do is have fat hit the blade first without cutting 
  through some OCT first. Unless the tissue is super cold it will just smear everything in its path.
  To learn about continuous cutting, fat tricks  and general frozen section technique visit my frozen section tutorial at:
  Good luck,

Stephen Peters M.D. 
Vice Chairman of Pathology
Hackensack University Medical Center 
201 996 4836
Pathology Innovations, LLC 
410 Old Mill Lane, 
Wyckoff, NJ 07481 
201 847 7600 

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