Histopathology

The department provides comprehensive diagnostic histopathology and anatomical pathology services to Epsom and St Helier hospitals as well as to satellite hospitals, HM Coroner, GPs, as well as community and outreach clinics in south west London and mid-Surrey areas.

We are committed to quality of care and subscribe to nationally agreed standards of reporting and service delivery, and participate in quality assurance programmes, where available. 

We can provide an extensive range of special techniques/services including immunohistochemistry, frozen sections, macrosectioning for complex lesions, lymph node recovery by lipid extraction, immunofluorescence, with facilities to process native and transplant renal biopsies with off-site electron microscopy and pathology FNA service.

Our main lab is located at Epsom hospital, but we also have a satellite lab at St Helier, where urgent specimens, Moh’s and frozen sections can be processed. Routine specimens will be processed at our main lab in Epsom.  

Requests

Please ensure that the specimen label and request form are completed in full. The minimum requirements for completion of the form are:

  1. Name, sex, DOB and patient identifying numbers
  2. Name of sender, ward, department or address of sender
  3. Number, nature and site of specimens. Multiple specimens should be separately identified
  4. Clinical details, including differential diagnosis (clinical information can strongly influence, if not determine, the histological diagnosis)
  5. Previous biopsy history, with laboratory numbers
  6. The requesting doctor must indicate if the patient is private and sign the request form.

Please supply a contact telephone or pager number to facilitate discussion of the case by the consultant pathologist or laboratory staff.

Consent

In completing a request card the sender is declaring that there is specific or implied consent for analysis from the patient. The department cannot analyse tissue without consent.

Acceptance and rejection criteria

Specimens received without the information detailed above will be rejected. The department will make contact with the requesting clinician in an attempt to complete any missing information. Thorough and relevant clinical information is also vital.

Location, opening hours and contact details

Our main laboratory is at Epsom Hospitals, with a satellite lab offering limited services at St Helier. 

Epsom Hospital
First floor, Headley Wing
Monday - Friday, 8.30am - 5pm

Tel (office): 01372 73 6619
Tel (laboratory): 01372 73 6618
Tel (results/enquiries): 01372 73 6093

St Helier Hospital
Ground floor, D block
Monday - Friday, 9am - 5.30pm

Tel: 020 8296 2495

No routine or on-call out-of-hours service is provided.

Histopathology specimens are occasionally referred to other sites for additional tests or second opinion. See Reference centres [pdf] 61KB

Complaints

For any queries and complaints, please contact the department on 01372 73 6619. 

All complaints are taken seriously.

Key staff

  • Dr Stephen Sampson, Specialty Lead Consultant Histopathologist and HTA Designated Individual
  • Dr Farag Smew, Consultant Histopathologist
  • Dr Rukma Doshi, Consultant Histopathologist 
  • Dr Kunju Harikrishnan, Consultant Histopathologist
  • Dr Tina Matthews, Consultant Histopathologist
  • Dr Anirudha Rajguru, Consultant Histopathologist
  • Dr Syamala Thomas, Consultant Histopathologist
  • Mr Chris Ferrari, Laboratory Service Manager
  • Michelle Santos, Scientific Lead Biomedical Scientist

Specimen information

Histopathology specimens

Please avoid batching specimens. Please send specimens to the department as soon as possible. Do not leave to the end of a long operating list or in the theatre/clinic over the weekend.

Surgical specimens

Please note that formaldehyde is known to be carcinogenic in high doses and suitable precautions must be taken when dealing with it.

Specimens should be placed in 10% buffered formal saline in a properly sealed container, with an adhesive label indicating the toxic nature of formalin. Sometimes, especially with larger specimens, this may not be possible and these should be sent to the laboratory as soon as possible for gross dissection, or dissected by the surgeon at the time of operation. However, every effort must be made to place specimens in suitably sized containers and there should be enough fixative to cause total immersion of the specimen by at least 10 times its own volume. The specimens should not be refrigerated.

Failure to use adequate amounts of buffered formal saline will result in potential loss of morphology, the potential loss of diagnostic information within the specimen and will also hinder ability to perform subsequent tests that may be required for diagnosis. 

In cases where gout is suspected specimens are best placed in alcohol and not aqueous solutions. Please telephone the laboratory for advice.

Specimens for immunofluorescence (hospital only)

Immunofluorescence is used mainly on cutaneous biopsies. Specimens should be sent immediately to the histopathology laboratory, to arrive within 30 minutes of excision in normal working hours. If this is not possible transport medium must be used (Michel’s) and the specimen kept refrigerated. This is available from the laboratory. Formalin must not be used as it will render the specimen uninterpretable.

The protocol for sending muscle biopsies can be obtained after direct discussion with the department (ext 701 6093 at Epsom Hospital and ext 721 2495 St Helier Hospital). 

Renal biopsies

Renal biopsies should be placed in 10% buffered formal saline and not sent fresh.

Testicular biopsies for investigation of subfertility/infertility

These should be placed in Bouin’s solution (available from the laboratory if not present in theatres).

Lymph nodes

Lymph nodes removed from suspected lymphoma should be sent as soon as possible to the laboratory to facilitate prompt transport to the Royal Marsden where these are processed.

If it is not possible to do this immediately or if lymph nodes are sent outside normal working hours, place in buffered formal saline and send to the laboratory. 

If lymphoma is not the primary clinical suspicion, lymph nodes should be placed in buffered formal saline.

If microbiological examination is required, the lymph node must be divided, and a portion placed in a sterile container and submitted to microbiology directly without fixative.

Gastrointestinal specimens  

All specimens should be transported to the laboratory in buffered formal saline. Segments of bowel that contain tumours that involve less than the full circumference should be opened through the uninvolved part.  

Muscle biopsies 

Muscle biopsies, after prior consultation with the laboratory, may be processed at King's College Hospital. Diagnostic material from paediatric neoplasms should be sent directly to the Pathology Department at St George's Hospital.

The protocol for sending muscle biopsies can be obtained after direct discussion with the department (ext 721 2495 St Helier Hospital and ext 701 6093 at Epsom Hospital).

Transportation

Specimens should be sent in dedicated pots or containers with the lids tightly closed. These should be placed in a leak-proof plastic bag, preferably one having separate compartments, one for the specimen and one for the accompanying request card.

Completion of histopathology requests

When completing the request form the sender is declaring that the patient has consented to this investigation.

Request forms should include three patient identifiers, details of sending clinician and location for report to be sent, clinician information and date the specimen was taken. The specimen pot should also have three patient identifiers as a minimum including the NHS number (to help prevent the duplication of medical computer records which is a potential clinical risk).

Specimens lacking correct information or where there is a discrepancy in this data will be returned to sender for inclusion of these details. Incorrect requests lacking sufficient clinical information will significantly delay the issue of the histopathology report.

Specimens should be sent to the laboratory as quickly as possible to prevent both deterioration and to assure rapid diagnosis. If there is a delay in the ability to send fresh material, this should be kept in the fridge until transportation is possible. 

Multiple specimens

If multiple specimens are removed, each is to be placed in a separate container and labelled with the usual demographic data and either a number or other distinguishing feature, eg site. If a numbering system is used then the sites to which the numbers relate must be shown on the request form.

Turnaround times

The turnaround time target for Histopathology specimens is as follows:

  • 90% of cases available within ten working days (from Royal College of Pathologists).

Turnaround time commitments are calculated from the date received not the date sent. These are normally: 

  • Five working days for specimens labelled 'urgent' by clinicians or pathologists (urgency can also be added later at the pathologist's discretion)
  • Ten working days for 'non-urgent samples' and 'major resections'
  • Calcified material such as bone may take longer than this and the decalcification time is not predictable.

If clinicians phone for a case which is still within the turnaround time period they will be informed that the result will be on Clinical Manager by the expected turnaround time limit.
 
Only cases that have exceeded the turnaround time will be brought to the attention of the pathologist.
 
If a clinician is bringing a patient back or requires a result in less than ten days, this has to be mentioned in the request form at the time of ordering the test. 

Urgent specimens

These should be discussed with laboratory staff (ext 701 6093 at Epsom Hospital and ext 721 2495 at St Helier Hospital) in the first instance and the request form marked ‘urgent’ appropriately.

If there are special requirements with regards to speed of a result, these should be clearly stated on the request form, eg result required by…. 

Specimens marked ‘urgent’ are usually ready to be diagnosed by a histopathologist on the afternoon of the first working day for biopsy cases. Larger excisions/resections will take longer due to fixation and processing schedules. Preliminary findings can be communicated by telephone, therefore please indicate the bleep or contact number of the relevant medical person.

Only a small number of cases can be handled in this way so please limit such requests to cases of genuine urgent clinical need. 

Frozen sections

Contact the laboratory at least 24 hours before the operation to book the frozen section and confirm that a pathologist is available at the planned time (ext. 701 6093 for Epsom ext. 721 2495 for St Helier).

Except in exceptional circumstances frozen sections can only be done between 9am and 5pm. There is no funded out of hours or on call service. If frozen sections are required on patients with AIDS or other infectious conditions please contact one of the consultant histopathologists. 

Details required: 

  • Date and time
  • Surgeon
  • Patient’s name
  • Nature of specimen and clinical context
  • Telephone/bleep number for report

Send the specimen in a dry container without fixative by hand as quickly as possible with the request form directly to the Histology laboratory. Do not take specimens to pathology reception.

The report for single block cases will be telephoned to the number given within 30 minutes of receipt of the specimen. Complex cases, such as those with multiple blocks to establish clearance, will take longer. 

Risk of infection

Surgical resections, biopsies and specimens known or suspected to be high risk of infection (HBV, HIV, TB and CJD) require additional handling precautions.

Specimens such as complete lymph nodes and larger tissue resections are seldom completely fixed when they reach the laboratory. Such specimens from 'high risk' patients should be left in fixative in a container until adequately fixed before processing. This may mean several days immersion and a judgment will be made in each case.

Frozen sections of unfixed material from high risk patients will not be prepared. In exceptional circumstances it may be possible to prepare frozen sections of unfixed material from such patients but only after prior arrangement with the histopathology laboratory and full discussion with consultant histopathologist. 

Storage

Surgical specimens are stored for approximately six weeks after a report is issued. If new clinical information becomes apparent that might require further investigation of the unprocessed tissue, if available, these should be raised during this period. Diagnostic slides are kept for a minimum of ten years and tissue blocks for a minimum of thirty years.

Any specimen or report may be discussed with the consultant histopathologist. 

Telephone enquiries, results over the telephone and the report

Reports are imported into clinical manager or sent via electronic links to outside users where these have been established. A hard copy is also sent to the sender/responsible clinician stated on the request card.

Reports on lymphoreticular pathology, where primarily reported by the Royal Marsden Hospital are dispatched by the Royal Marsden Hospital via e-mail to the histology department. Reports are transcribed on to Telepath and the original reports are printed and kept on file in the histology department.

Please do not request results by telephone, except in emergencies. Only validated results of histopathological/cytopathological diagnosis are to be communicated to the requesting clinician or an authorised deputy, by a histopathology consultant or secretary (with specific authorisation for each case) and only if the identity of the enquirer is beyond doubt.

Results will only be faxed to 'Safe Haven' fax machines and will only be sent following the completion and return to the department, of a 'Safe Haven' confirmation form. The departmental secretaries will fax these forms on request. This confirmation will be kept on file for future reference so will only need to be completed once for any single fax number. The use of fax machines is discouraged by the Trust.

The histopathologist will give a diagnosis where possible, or a differential diagnosis. It may be helpful for the case to be discussed to achieve a more precise diagnosis. Advice on the margins of excision and expected behaviour of tumours should be given. The histopathologists may be able to help on future management of the patient.

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