The Laboratory services is an integral part of any hospital, where patients’ samples are tested to diagnose diseases. The samples can be blood, urine, stool, pus swab, etc. – on each of these samples, a myriad tests can be done.  For the uninitiated, however, the laboratory is an area where only blood samples are tested and reported within a few hours. True, many diseases are diagnosed by blood reports alone.                                                                                                             

However, one facet of the lab - the HISTOPATHOLOGY section is not widely known to many...  

By the Grace of BHAGAWAN, the Histopathology lab commenced in SSSIHMS, Prasanthigram in 1993.

Histopathology literally means study of diseases in a tissue / biopsy

(Histos=tissue; pathos=suffering/disease; logos=study).

Welcome then, to the fascinating journey of a Biopsy specimen from a patient’s body to the final diagnosis in the histopathology lab (as related by the biopsy sample).

“… Till recently, I was a small bump in my owner’s body – warm, protected and well-nourished.

However, I was growing in size; my owner became anxious and hoped I would go away but you know I can’t just disappear like that.

Finally, the doctor was consulted who decided that I should be cut out and sent to the Lab to know the true nature of my disease.

As is typical of all patients, my owner too postponed the inevitable by a few more months and thus I grew from a small 2 cm bump to a 10 cm lump.

A hasty surgery was planned and on the D-Day I was removed and everyone heaved a sigh of relief

i.e. everyone except the surgeon and my owner.

Because, now, we needed to know:

   what I was made of,

   whether anything of me was left behind in my owner’s body,

   whether I had potential to regrow / recur,

   whether I had already migrated to other parts of the body etc. etc.

In short, whether I was a good guy (Benign) or a villain (Malignant); if malignant (cancerous),

   how bad a cancer was I,

   how well will I respond to specialized treatment and,

   how would it affect my owner’s life.

And who would give answers to all these questions ?

The Histopathology Lab of course, comprising a dedicated team of

Histotechnologists (who have done a specialized course {B.Sc. (M.L.T.)} and

Pathologists (Medical doctors who specialize in Surgical Pathology (M.D.) for 3 years post-M.B.B.S.).

But, to know the final verdict, it requires time - from a minimum of 5 working days to anywhere between 3 - 4 weeks - depending on

   my size,

   the nature of the diagnosis,

   the discussions involved with the radiologists and other experts in the field,

   further special tests if required etc. etc.

(so, you see, its not a like a routine blood test in which you get reports on the same day).

I shall now take you through the actual process in more detail…  basically, I pass through 3 stages…

I. In the Operation Theatre (O.T.) where it all begins…

Before the start of the surgery, the OT nurse is all prepared to receive me in a container filled with a liquid called Buffered Formal saline (Formalin in short). The nurse has already pasted my owner’s demographics on the container so that there are no mix-ups.

Once the surgeon removes me, I am put in formalin after which I become inert i.e. I am no longer infectious to anybody handling me. The formalin “fixes” the specimen i.e. preserves the cell components as they are in the body and prevents their decay.

I am sent in this container accompanied by an e-request with all necessary clinical details about me, to the next destination- The Histopathology Lab.

II. In the Histopathology Lab   

The way I am treated here would make you pity me!   

See Accompanying Video.

Of course we have just shown you a sample demonstration of a very commonly occurring Benign condition - the Lipoma.

The protocols for Cancers of Kidney, Breast, Thyroid, Bladder etc. etc. are much more elaborate and time consuming.

III. In the Pathologist’s Office

As you saw in the video, the Pathologist studies these stained sections under a microscope and makes a diagnosis after carefully considering all aspects of my case.

The slides/sections can vary from 5 per patient to 40-50 per patient depending on the nature of the case.

Many a time I even have to travel back and forth between the Pathologist’s office and the Histopathology lab as :

a). Sometimes the pathologist wants to cut deeper into the block to get a more detailed picture; so I am sent back to the microtome for further cuts.

b). If a parasite is suspected, the pathologist wants to get special tests done to confirm them, for example: Fungal infections, T.B. bacilli etc.- the histotech is an expert in doing all the special tests.

c). If a cancer is diagnosed, then I go through another procedure in the IHC (Immunohistochemistry Lab) wherein special stains are done to describe me further and guide my clinician regarding the further cancer treatment to be administered to my owner.

Such patients are then referred to Higher Oncocentres for specialised treatment.

d) Finally, the pathologist consolidates all data (including the Clinical and Radiological findings), talks to my surgeon, my radiologist, and, if required, consults recent reference publications, to prepare THE FINAL DIAGNOSIS.

This Final Report / Final Diagnosis is the sophisticated name given to me and it is the one which decides the further course of treatment of my owner.

I know this long waiting time before the final diagnosis is worrisome to the patient, but it is necessary to get an accurate report.

Hope, you enjoyed the journey as much as I did… “

I am sure my owner may not have had an opportunity to know about, see, or interact with this silent team of workers handling me or preparing the final report in the Histopathology Lab, but,

I can assure you that the team is fully aware of its immense responsibility in this task afforded by Swami, gets a tremendous satisfaction, and, is ever grateful for the opportunity.

 “As is your Pathology, so is your Practice” … Sir William Osler

Samasta Lokaaha Sukhino Bhavantu