OCTOBER EDITION, VOLUME 2018, NO. 10
-Capital Medical Society Celebrates National Breast Cancer Awareness Month-
BREAST CANCER - A PATHOLOGIST’S PERSPECTIVE By Nicole Nabors Balmer, M.D. Pink and purple. These colors may bring to mind a sunset, flowers, or a young girl’s bedroom. For an anatomic pathologist, these are the colors of our lives, and the lives of our patients. Hematoxylin (deep purple) and eosin (bright pink) are the routine stains that are used to highlight structures and details we need to see in a patient’s biopsy tissue. Like radiologists, pathologists are medical doctors who focus primarily on the diagnostic aspect of medicine. Anatomic pathology, which includes surgical pathology and cytology, is primarily a visual field. The pathologist combines the variation of pinks and purples with the overall patterns seen (architecture) along with the features of individual cells (cytology) to come up with a differential diagnosis. However, there are many steps along the way between the moment the biopsy tissue is taken from the suspicious density or mass in a patient’s breast, to the moment when a patient is told by her physician, “It’s a benign lesion” or “Please have a seat.” This is when the battle with her cancer begins. Breast biopsies to rule out malignancy are particularly full of nuances. The first step on the path between the taking of the biopsy tissue to the moment of discussing the diagnosis with the patient starts with putting the biopsy
directly into a formalin container and recording the start time. Breast tissue is currently the only tissue that has a specific tissue fixation time. The range is a minimum of six hours and a maximum of 48 hours because of the potential problems with ancillary tests such as estrogen receptor (ER) and progesterone receptor (PR) in tissue outside of these ranges. The next step involves the “grossing” (visual examination) of the tissue when it is removed from formalin and placed into a tissue processor. It is then run through multiple rounds of tissue fixatives for several hours. In the next step it is placed into paraffin wax blocks and cut into four micron sections which are placed onto new glass slides. At this point the slides are then stained with hematoxylin and eosin (H&E) for the pathologist to read under the microscope. Tissue conservation is very important, as a very small portion of tumor may be present in only a few slices of the biopsy. Multiple sections through the tissue at different levels are stained and reviewed by the pathologist to ensure that the edge of a tumor or very small focus of tumor is not missed. If the specimen is from a lumpectomy or mastectomy, a different approach is taken at the “grossing stage.” If a known tumor is present, the pathologist must ensure that the margins of the tissue are “clear” and the tumor has been completely removed. At times the pathologist must CONTINUED ON PAGE 3
Capital Medical Society thanks the physicians and dentists in this community who provide care to breast cancer patients. CAPITAL MEDICAL SOCIETY 2018 MEETINGS CALENDAR October 16, 2018 November 13, 2018 CMS Membership & CME Meeting CMS Membership & CME Meeting Domestic Violence & Human Trafficking (2-Hour CME) Health Impact of Common Electronic Devices Suzanne Harrison, M.D., FSU College of Medicine and Alice Pomidor, M.D. Terry Coonan, J.D., Center for the Advancement 6:00 pm CMS Delegates: (l-r) Dr. Bill Kepper, Dr. Alfredo Paredes, Dr. John of Human Rights Maguire Center for Lifelong Learning 6:00 pm at Westminster Oaks Bailey, Dr. Hugh VanLandingham, Dr. Rohan Joseph, Dr. Christie Maguire Center for Lifelong Learning Alexander, Dr. Michael Forsthoefel, Dr. Alma Littles, Dr. Gary at Westminster Oaks
Winchester, Dr. Tracey Hellgren, Dr. David Dixon, Pam Irwin, and Shannon Boyle. (Not pictured: Dr. John Mahoney)
December 6, 2018 CMS Foundation Holiday Auction 6:30 pm FSU University Center Club
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