[Histonet] Cautery-Like Artefact

Roger Heyna rheyna <@t> lumc.edu
Tue Aug 20 13:45:59 CDT 2013


Thank you everyone for your feedback. I will report back if we are able
to identify the problem variable. Since we've already addressed
processing cycles, we'll start by checking that the cassettes aren't
allowed to dry out before processing and then enlist some help at our
dermatology clinic to investigate their specimen collection methods.
 
Roger

>>> Rene J Buesa <rjbuesa <@t> yahoo.com> 8/20/2013 9:27 AM >>>
Roger:
Any artifact that is hematoxylin (+) and resembles a cautery i.e.
without cellular details at all is either caused by an actual cautery
procedure, by incomplete fixation or by drying out.
Your dermatologists attest they are not using cautery, so that can be
eliminated.
You wrote they are fixed overnight so it is very likely that fixation
is close to appropriate, so fixation can be eliminated also.
Additionally had this artifact appear in all your Bx. fixation would be
the culprit.
You wrote that the artifact appears both in "conventional" and in MW
tissue processing so processing with MW oven can be eliminated.
Then the only cause not "eliminated" is drying out and it has to occur
before fixation.
The issue is now determining when the Bx. dries out and if you receive
all your Bx. in fixative, the drying out has to occur at the
dermatologist's office. Sometime between the moment the Bx. is taken and
is placed in the fixative the margins of the Bx. driy out.
Answers to some questions will allow you to "narrow down" the problem:
1- is this artifact more frequent during the periods when the air in
your area is drier, i.e., are there variations in the frequency during
different months?
2- is this artifact more frequent in Bx. from some dermatologists than
from others?
3- does the artifact present variations in the "intensity" of the
drying, meaning that it can be concluded that the drying times can be
identified?
I think that you should tally this artifact frequency and intensity
against months of the year and referring dermatologists. You may even
end with enough information to write something about this artifact after
all.
René J.    

From: Roger Heyna <rheyna <@t> lumc.edu>
To: histonet <@t> lists.utsouthwestern.edu 
Sent: Monday, August 19, 2013 4:55 PM
Subject: [Histonet] Cautery-Like Artefact


We are experiencing a staining artefact on our H&E's, most commonly
seen on skin specimens, but also observed on other specimen types as
well. 

Within the dermis and subcutaneous regions of the skin specimens, there
are portions of what should be collagen that appear homogenized and
stained with hematoxylin, instead of the 
usual eosin staining. It's often on the edge of the section and varies
in size between different specimens. The pathologist is normally able to
read around it, but there have been cases that were made more difficult
to diagnosis by this artefact.

Our pathologists believe this artefact resembles cautery artefact, but
the dermatologists insist they are not using cautery during collection.


We have a large derm service, and most of our derm specimens fix
overnight. We have both microwave and conventional processing, and the
"artefact" specimens have been processed on both. All of these specimens
have grossing ink on them.

Any thoughts on what could be causing this? If it's not cautery, does
it seem like a fixation issue? Has anyone seen grossing ink affect
processing?

Thanks ahead of time for your help.
Roger
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