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13.1 What are the key subheadings for conventional histopathology reports?
ANSWER
There are several key subheadings in conventional histopathology reports; they include:
• Patient demographics (name, date of birth, biopsy date, hospital number)
• Clinical suspected diagnosis and associated patient history
• Clinicians signature and authorisation
• Macro or gross description
• Microscopic description
• Diagnosis ex tumour type/ cancer grade
• Tumour size or depth of invasion (metric measurement) often with prognostic significance
• Tumour margins: There are three outcomes when whole tumours are removed clinically A) Positive margins, meaning tumour cells remain at the edge of the tissue removed B) Negative margins, meaning clear or free tumour margins ie there are no cancer cells found at the outer edges and deep margins of the removed tissue. C) Close margins, this indicates that the cancer cells are very close to the margins of the tissue taken.
• Information pertaining to other investigations undertaken and providing the contengt of a supplementary report ie T cell gene re-arrangement assessments to confirm clonality and confirm cancer.
• Diagnostic code or SNOMED CODE
• Histopathologist’s signature and details of affiliations/qualifications. Information on departmental contact information.
13.2 What is the purpose of datasets in histopathology reporting?
ANSWER
The standards and datasets for reporting cancers help histopathologists to formulate consistent reports. This approach is used to facilitate communication with clinicians to achieve optimal patient management and to improve audit within the pathology service, allow comparison between cancer services, and optimize data collection by cancer registries. The formulation of datasets has driven the move towards ‘proforma style’ reports, in which pathological parameters associated with the specimen are listed. These types of report replace the more traditional descriptive reports from which it can be difficult to extract information.
There is no doubt that there has been an increasing complexity imposed on diagnostic outcomes and how patient management is subsequently handled. This is principally due to a much closer correlation that now exists between our understanding of the clinic-pathological correlations and the use of ever increasing plethora of supporting techniques whether IHC/ molecular based or perhaps both. These techniques have enabled us to be more selective and precise about how we classify tumours for example. Further still they also provide information that enables us to link prognostic outcomes and patient treatment modalities. In brief it is simply no longer sufficient to simply diagnose tissue based disease, but rather there is a demand to qualify these statements with evidence on prognostic indicators such as tumour grade, lymph node and vascular spread for example. The ever increasing demands on ensuring consistency and reproducibility of assessment of these factors has encouraged the development of ‘standardized cancer datasets’. The goal of these datasets is not just to define what is core and none core factors which are relevant to patient management with any given cancer type, but also to include audit criteria as a means to underpinning quality standards. This approach within the United Kingdom is sponsored by The Royal College of Pathologists (RCPath).
13.3 What are the key clinical findings of inflammation?
ANSWER
The clinical signs of inflammation (the cardinal signs) are redness, heat, swelling, pain and loss of function. Redness is caused by increased blood flow to the inflamed tissue. In skin, the increased blood flow warms the skin surface. In addition, inflammatory mediators cause an increase in body temperature (pyrexia). The development of swelling occurs as a result of the accumulation of tissue fluid (oedema). The inflammatory response produces symptoms of pain because there is distortion and stretching of the tissues, and inflammatory mediators sensitize pain receptors in the affected tissue. Loss of function is caused by the increasing pain and swelling.
13.4 What are the main benign and malignant types of tumour seen in histopathology?
ANSWER
Broadly speaking there are several key benign and malignant tumours defined by histological reports (tabulated below)
| Benign | Malignant | |
| Epithelial | Squamous cell papilloma | Squamous cell carcinoma |
| Transitional | Transitional cell papilloma | Transitional cell carcinoma |
| Glandular | Adenoma | Adenocarcinoma |
| Mesenchymal | Fibrous tissue Fibroma | Fibrosarcoma |
| Adipose tissue Lipoma | Liposarcoma | |
| Blood vessels Haemangioma | Angiosarcoma | |
| Cartilage | Chondroma | Chondrosarcoma |
| Bone | Osteoma | Osteosarcoma |