GUIDELINES FOR SUBMISSION OF BIOPSY SAMPLES

Formalin Fixed samples   

Biopsy specimens should be submitted in a fixative e.g. 10% neutral buffered formalin solution (formal saline). Please ensure that the sample is fully immersed in formalin (appropriate ratio for size of tissue sample to volume of formalin is 1:10).   

If various lesions from different anatomical locations are submitted, collect the sample in separate containers.   

Label container(s) with patient name, sample source, and location.   

Double ziplock-bag the containers and place a paper towel or other absorbent material in the first bag, in case of leakage.

Submission of clinical images

Hard copies: Submission of clinical pictures is highly appreciated. Add hard copies with the submission form and sample.

Email attachments: Images can be emailed to alawere@yahoo.com; Please clearly state the animal’s name, owner’s name, and clinic name in your email.

Fresh Samples   

If considering sending fresh samples, contact the Pathology laboratory (E-Med) office before shipping.   

Fresh samples must be shipped via priority shipping (should be received within 4 hours following sampling..  

Only ship fresh samples Monday – Thursday, as we do not receive packages on weekends.   

Wrap the tissue sample in saline-soaked surgical gauze (excess fluid should be gently squeezed out). Place tissue with gauze in a tightly sealed container, such as a pill bottle or zip-lock bag, to prevent dessication.   

Place the wrapped sample with some gel cooling packs in a styrofoam box. Ensure that the sample and cooling packs are separated by some paper towels to avoid freezing of sample during shipping.

Indicate the origin of the tissue sample, especially if they come from multiple sites.   

Ensure the fresh tissue samples are kept separate from formalin-fixed tissues; eg: different bag.

Submission of Small specimens

Usually, small samples can be placed in individually labelled plastic biopsy cassettes and then the cassettes placed together in the same formalin container. Please contact the lab if you would like us to send you some cassettes. Minimizing the air pocket by filling the sample container to just below the lid, will help prevent fragmentation of small delicate samples, such as Tri-cut biopsies, during transit.

Alternatively, when they need to be individually identified, for instance punch biopsies taken from different parts of the body, then we prefer to receive specimens in separate containers. We generally find that skin biopsies that are sent on labelled pieces of card fall off the card during transit!

Large specimens

If you are sending a large sample, then fix it in a large container of formalin at the practice for 24 hours prior to submission. After 24 hours fixation, take out the specimen and then wrap in

formalin-soaked paper towels.

Place in a sealable plastic bag or container with a sealable lid. Double bag with cotton wool between the bags to absorb any formalin that might leak out.

All specimens

Specimens enlarge and harden when formalin is added, so always allow enough room for the specimen to expand and for the extraction of the specimen in the lab. Specimen containers should be plastic and should have screw-on lids.

On no account should glass bottles be submitted as these are a hazard to the postal workers and to our staff in the laboratory. Tupperware boxes, sharps boxes, milk bottles, etc., are not suitable containers and when we have received these in the past they have invariably leaked!!

All specimen containers or bags should be tightly sealed and wrapped with an absorbent material such as cotton wool. The amount of cotton wool used should be sufficient to absorb all of the formalin that might leak out if the specimen container becomes damaged.

The primary container/bag and the associated absorbent material should then be sealed tightly in another plastic bag. The form should then be separately attached to the outer bag.

The entire package should then be placed in a padded envelope for posting.

Please remember to fill out the submission form!

Identification of tumor margins

The meaningful interpretation of the surgical margins of a tumor mass by us as pathologists is unfortunately not quite as straightforward as you might imagine! To assure that the pathologist is examining the ‘true’ or most

important surgical margins of a specimen, particularly in an anatomically-complex site, it is helpful for the surgical margins to be marked. There are a number of different ways that this can be done.

1. Inking of margins

Although we ink the margins for every specimen that we receive where a tumour is suspected, it is sometimes helpful to identify margins prior to submission that you as a surgeon are particularly interested in.

Painting the specimen is the most reliable method of margin identification and using different colours to paint different surgical margins, can enable specific margins to be identified and individually assessed. While there are many different types and colours of commercially available surgical inks available, the cheapest and easiest method is to use one or more different colours of Indian ink.

To ink the margins, the tissue is first patted dry with paper towels to remove the surface blood.

The tissue is then painted as appropriate with undiluted Indian ink over the margin surfaces, for instance over the subcutaneous fat over the deep border of a skin tumour. The tissue should be painted with a large soft brush, rather than being immersed in the ink, as ink can otherwise percolate through small fissures rather than remaining on the tissue surface.

The painted tissue should then be immersed in 10% acetic acid (we use white vinegar from the supermarket in the lab, and re-use it multiple times) to stop the ink from being washed off in the formalin. The tissue can then be patted with a paper towel to remove the excess ink/acetic acid and then placed into formalin for submission to the lab. For the pathologists at the microscope, prior inking of the tissues can make a huge difference to how easy it is identify the ‘real’ surgical margins from false margins

2. Suture-tagging of margins

Place sutures at the appropriate margins that are of particular importance eg: a margin that grossly is close to normal tissue, or at an anatomically important site. This method works less well for broad tumour fronts or very large specimens, or where multiple surgical margins are being assessed.

Because the sutures have to be removed prior to processing, it is often impossible to identify the specific margins again on the wet tissue should further sections be requested.

3. Separate surgical margins

Marginal tissue is taken from the tissue bed that is left behind in the animal and this tissue is submitted separately as representing the tissue margins.

This is a good way of submitting margins particularly for large samples, reducing the chances of processing/trimming errors.

Packing instructions for Post Mortem (NOT BIOPSY) specimens

The packaging of diagnostic post mortem specimens must follow the specified rules in ensuring the safety of personnel involved in the transport of such specimens and those receiving the submission at the laboratory.

• The specimen must be placed in a leak proof bag or container and sealed.

• The bag should be wrapped in sufficient absorbent material to prevent the outer packaging from being contaminated with any liquid seepage from the specimen.

• The whole should then be placed in another sealed leak proof bag before final packing in a box or other suitable container.

• In view of the requirement for speedy despatch it is advised that the specimen be sent

personally or by courier.

RESEARCH ACTIVITIES

We are very keen to use our case material for clinical research purposes, such that our prognostically-relevant, clinically-driven studies may have a direct bearing on diagnosis, prognostication or treatment of veterinary patients.

We will have excellent links with the veterinary schools and other research institutes throughout the Ghana and are currently participating in a number of different research projects.

We would also be interested to supervise undergraduate and postgraduate research projects, for universities throughout Ghana. Dedicated time to be spent on research projects is factored into the diagnostic pathology rota.

We are committed to performing clinically-relevant research in our laboratory, often in partnership with our colleagues in practice and at research institutes.