[Histonet] Fatty breast tissue

[Bob Richmond]

Carolyn Demarinis at Saratoga Springs NY asks: >>What are the best choices
for processing fatty breast tissue when the pathologist grosses the tissue
the same day it is excised?<<

Breast tissue should always be grossed promptly, and placed in cassettes on
the day it's excised - that's particularly important with open biopsy
material such as wire localization specimens.

Those cassettes should then sit in formalin overnight, and get processed
the next day. You simply cannot process fatty breast tissue with
insufficient fixation - you don't get good sections, and you compromise the
ER/PR and HER2 immunostains. Even needle biopsy specimens that are obtained
late in the day need overnight fixation. Overnight fixation is particularly
important if the pathologist is given to cramming cassettes with fatty
tissue, as so many of us do.

Pathologists sometimes need to remind surgeons that, while you understand
the patient's anxiety, that the patient needs a right diagnosis, not a
quick diagnosis. Surgeons need to tell breast surgery patients before
surgery that while the lab is fast, that inevitably some diagnoses will be
delayed.

I've been grossing breast tissue for 50 years, and I've made most of the
grossing mistakes it's possible to make.

Bob Richmond
Samurai Pathologist
Maryville TN