Histology

Re: Histology

Michael Woodhouse — Sat, 27 Aug 2011 20:34:25 GMT

We keep a bit in a pot. Have a cupboard with lots of universals, sheep vas deferens going back many years.

I would say 1 in 4 we send off, the others we often keep a bit, unless fairly sure it's just a lipoma.

In real life once a lump has been removed unlikely do do anything else. If it comes back it's probably nasty.

Re: Histology

Richard Fox — Sat, 27 Aug 2011 18:52:26 GMT

Yup I think that about sums it up - If it floats then its fat if it doesn't then it is probably a "haemangipericytoma" as they often look like firm lipomas (common differential on submission) - I used to take lumps off then store them for a few weeks/months if the owners didn't want the tissue sent off - but just chucking it away (unless you are sure what it is) often leads to re-biopsy when it comes back or doesn't heal IME?

Re: Histology

Clive Ansell — Sat, 27 Aug 2011 18:11:03 GMT

I always give the option of, although I might say I feel there is no real need. Lipomas for example; I will say I am 99% happy it is a lipoma -if it looks like, smells like, feels like, behaves like and quacks like a lipoma, it's probably a lipoma - but for 100% confirmation histology is needed - that way my arse is covered. Give the option and let the client decide.

Where clients don't have the money, I offer and advise but it is up to them to make the call and decline if they wish.

One practice I once locumed in used to include histology within the surgical fee for insured animals not giving clients the option.

A petaid a practice I work in occasionally always offer/advise histology, but clients have to pay, it is not usually (can be done if vet feels essential) included within the scheme. most will decline.

Re: Histology

Richard Fox — Sat, 27 Aug 2011 16:04:39 GMT

If lesions could be diagnosed grossly, consistently, then there would be no need for diagnostic pathologists! I would say that about 20% of lesions submitted with a preliminary diagnosis are correct or in the right ball park! (Well in the last 12 years I have been doing pathology)

Re: Histology

Stephen Courtney — Sat, 27 Aug 2011 15:32:43 GMT

[quote user="Robin Grimmer"]

I always recommend histology for everything. I had my fingers burnt once when I thought a mass on a dog's gum was 'just an epulis'. Well it was but unfortunately was acanthomatous epulis not ossifying, and even though doesn;t metastasise is locally invasive. So the dog ended up having some mandible removed and radiotherapy.

[/quote]

Surely that outcome was going to happen anyway? the only issue is if a second surgery was needed to get a diagnosis that should have been made in the first place, or if definitive treatment was delayed resulting in more severe disease. But I agree, there is a strong tendency to attempt to diagnose lumps visually and it should be resisted strenuously!

I spent 2 years in a path lab doing PMs and reading slides including biopsies - and I'm amazed how often my guesses on the outcome of histology are waaaay off!

Re: Histology

Robin Grimmer — Sat, 27 Aug 2011 15:23:12 GMT

Re: Histology

Stephen Courtney — Sat, 27 Aug 2011 15:20:14 GMT

I generally feel if a lump is worth removing, it is worth having histology. But sometimes owners prefer not to spend the money - for instance in older animals that are not candidates for chemo, radiotherapy or further surgery, and of course basic lipomas - confirmed by cytology - that float in formalin - are unlikely to be worth the cost of histology.

It is worth keeping suspicious lumps in formalin 'in case' but I'm not too keen on that because I ended up with a cupboard full of bits of tissue we were keeping 'in case'!

Incidentally, there is no point putting formalin pots with biopsies into the fridge - if anything you just slow down the fixation process. And once fixed they don't need to be in the fridge anyway

Re: Histology

Richard Fox — Sat, 27 Aug 2011 13:39:28 GMT

Interesting :)

Re: Histology

Dagmar Steele — Sat, 27 Aug 2011 11:01:08 GMT

same here, but I found the idea very helpful to keep suspicious lumps in formaldehyde if o can't afford histo, so they can be examined if lump comes back (has been posted here recently) instead of jumping for another surgery without diagnosis.

Re: Histology

Mark Hedberg — Sat, 27 Aug 2011 10:46:52 GMT

Option 3 here; i do it as often as I can but sometimes the money just isn't there.