LOCATION:   Anatomic Pathology and its component branches, Surgical Pathology and Cytopathology are located in the Department of Pathology, Building 3711.

DUTY HOURS:  Surgical Pathology and Cytopathology operate five days a week during regular duty hours.  Regular duty hours, with full staff, are 0730-1630, Monday through Friday.

KEY PERSONNEL AND TELEPHONE NUMBERS:

   Medical Director ....................... 486-7506
   NCOIC .................................. 486-8056
 

ORGANIZATION AND INSTRUCTIONS:  Anatomic Pathology is divided into three branches: Surgical pathology, cytology and forensic pathology. The following requirements should be met when sending material to this division.

I.  Surgical Pathology

  A.  Immediate Diagnostic Service: We provide immediate diagnostic service for all MTFs when no pathologist is assigned or when the assigned pathologist is not available (leave/TDY).

    1. Specimens should be shipped in 10% buffered formalin in a sealed plastic container clearly labeled with patient's name and SSN, source of specimens including anatomic site.  The ratio of specimen/fixative solution is 1/10 volumes.  Do not put other than surgical specimens in the same package.  The box should have the note, "ATTENTION: Anatomic Pathology, Department of Pathology and Area Laboratory Services, Landstuhl Regional Medical Center".

    2.  Specimens must be clearly labeled with name, SSN, age and sex of patient, ordering health care provider, clinic, type of tissue, and date obtained.  All orders will be entered through the CHCS by the requesting site and will include source of specimen including anatomic site, date obtained, and pertinent clinical information. If you desire Rush Handling, please mark that clearly on the specimen container or attach a brief note.  If you desire an evaluation for a particular diagnosis or a special study (example:  AFB, fungus, Helicobacter) please specify.

    3.  Please ship surgical specimens as often as possible.  Our in-house turnaround time is two days for routine cases.  Complicated cases requiring prolonged fixation, deeper cuts, special stains, or decalcification will require longer, but no case should take more than five days.  When a pertinent finding is important for patient management in a timely fashion, or a "rush" case is requested, we will phone and transmit a facsimile ("fax") of our diagnosis to you.

    4.  Unacceptable specimens/orders received from:

      a.  LRMC clinics which are not ordered or are labeled incorrectly will not be accepted by the histology staff until the discrepancy is resolved.  If specimens dropped off after duty hours contain a discrepancy, the submitting clinic/ward will be notified of the discrepancy and the specimen will be added to our problem log book.  The requesting site will have 24 hours from the time the discrepancy was noted to pick up the specimen or resolve the error.  All attempts by the histology staff to resolve the problem/contact the requesting clinic will be noted in the problem book.  If the problem is not resolved within the 24 hour period it will be turned over to the Chief of Anatomic Pathology for further action.

      b.  Outlying clinics with inadequate labeling and/or orders will be added to our problem log book and held for 48 hours by the histology section.  All possible attempts to locate the specimen origin, and/or health care provider will be made by our staff and noted in the problem log book.  If after 48 hours all attempts at identifying the ordering site or resolving the discrepancy have failed, the specimen will be processed and diagnosed to ensure patient care does not suffer.  The Chief of Anatomic Pathology will be notified and further action will follow.

  B.  Consultation Cases

    1.  When you desire a consultation, please send a complete set of H&E slides and all blocks.  This gives us the opportunity to make deeper cuts if necessary or to make special stains including immunohistochemistry if needed.

    2.  Include a copy of your complete SF515.

    3.  On those cases where it is appropriate, for example dental and bone cases, include x-ray.

    4.  Immunohistochemistry (immunoperoxidase) staining is now available at Department of Pathology and Area Laboratory Services through a contract with Homburg University at our cost.  When immunohistochemistry is requested, please send a set of H&E slides, paraffin blocks, and a copy of the SF515.  We will decide what antibody/battery will be ordered after evaluation of H&E slides.  This will cut down the cost (the actual cost of one antibody is DM 75).  Although Homburg University provides opinion on results of histochemistry, the final interpretation and diagnosis will be issued by our examining and reporting pathologist.   As a general rule, consultation will take two working days in-house for uncomplicated cases, five working days if a special stain is needed, and eight working days if immunohistochemistry is needed.  When the diagnosis is finalized and the finding is important for patient management in a timely fashion or when you need Rush Handling, we will phone and fax our diagnosis to you.

    5.  We will judge which cases should be sent to AFIP if further evaluation requiring experts from a subspecialty is needed, and you will be notified in our report.

    6.  If you desire a "rush" consultation from AFIP, or specifically desire an opinion from AFIP, you will save time by sending the slide and block directly to this institution.

  C.  Peer Review (Quality Control)

    1.  For each batch, please send a complete set of H&E slides and paraffin blocks and SF515 for each case.  We will return the slides and blocks along with our report to you.  A compiled report from each batch will be sent to you as documentation for your QA minutes.

    2.  Normally, immediate diagnostic service and consultations take priority over peer review.  In all circumstances the turnaround time is no more than seven working days with our present staffing.
 

II.  Cytology

Primary Diagnostic Service:  We provide diagnostic service for all MTFs.

  A.  Pap Smears

    1.  CONTRIBUTOR'S RESPONSIBILITIES

      a.  SPRAY FIXATION:  Immediately after placing the sample on the slide, spray the wet sample with an approved "spray fixative".  The fixed smear must have the patient's correct name and last four of the SSN written on the frosted end of the glass slide.

  B.  ORDER LISTS

    1.   Print "Order Lists" for each shipment of slides.

    2.  Match the information on the slides with that on the order list.  If the names or SS#'s do not match resolve the problem before sending.

    3.  If you have a slide and the name is not on the order list, hold the slide until it has been ordered or contact the HCP to order the pap smear, print up a new order list and send the shipment.

    4.  Do not hand-write names on the order list.  Print up new lists with their names on them.

    5. Select only those cases to print on the order list that you have slides for and are going to send out in the shipment.  Do not print up a general order list with names on it that are a part of shipments to go out in the future.

    6.  Make sure that you keep a copy of the order list for each shipment of slides.  Make sure that the order list is legible (Names and SS#'s).

  C.  PACKAGING

    1.  Do not send glass slides in urine containers, cups, jars, etc..

    2.  Place the slides in a container designed for slide shipment (i.e., slotted or grooved positions where the slide can be placed).  These containers come in different sizes holding anywhere from 1 to 100 slides at a time.

    3.  After placing the slides in the shipping container, fill extra space with gauze, tape the container lid closed and pack into a box with packing material (i.e., peanuts).  Make every effort to insure that the slides can reach us without being broken.

    4.  Address the box in the following way:

        "ATTENTION: Cytology Branch
        Department of Pathology and Area Laboratory Services
        Landstuhl Regional Medical Center, 09180"

NOTE:  Do not ship Pap smears in the same box or container with formalin fixed specimens.  If the formalin spills onto the Pap smeared slides or if the Pap smears are exposed to the formalin fumes, the Pap smeared slides will be ruined.

  D.  Our Responsibilities:

    1.  REJECTION POLICY

      a.  We are obligated to reject specimens (slides) that are unlabeled or mislabeled with incorrect patient information (i.e., if the slide information does not match the information on the order list).

      b.  Broken slides are rejected.

    2.  HCP NOTIFICATION

      a.  When slides are rejected they are mailed back to the contributor with an explanation.  These cases are recorded in our "rejection" log book and kept for future reference.

      b.  If we receive a case that has not been ordered in the computer we attempt to contact the HCP by phone or CHCS to place the order.  On rare occasions we do courtesy orders if the HCP can't be contacted.  Note: This scenario could be avoided if you ensure that the name prints up on the order list before you send the case.

      c.  We contact the HCP if the diagnosis is a "High Grade Dysplasia or worse" or if it is an "Unsatisfactory".  We also document this in a log book.

      d.  We notify the HCP if their patient had a "High Grade Dysplasia or worse" and there has been no follow-up biopsy or pap smear received within 90 days of the of reporting the diagnosis.

  B.  Non-Gynecological specimens

NOTE:  Since there are many different types of specimens (i.e., urines, pulmonary, CSF, etc...) it would be best to call us for clear guidance on proper collection and preservation techniques.  You can call to Cytology @ DSN 486-8056/8058 or CIV 06371-86-8056/8058.
 

III.  Forensic Pathology

LTC X, MC, has been appointed the Regional Medical Examiner (Tri-Service) for Europe, under the Armed Forces Medical Examiners System.  [S]he is available for consultation on any forensic or potentially forensic case.  DSN # is 486-8292.

LTC X also provides consultation on non-forensic autopsy cases.  This can be by phone or by way of submitting cases to the Regional Medical Center for review.  In those circumstances, we will forward the case to the AFIP as required by regulation.