Histopathology in clinical medicine

    Histopathology refers to the microscopic examination of tissue in order to study the manifestations of disease. Specifically, in clinical medicine, histopathology refers to the examination of a biopsy or surgical specimen by a pathologist, after the specimen has been processed and histological sections have been placed onto glass slides. In contrast, cytopathology examines free cells or tissue micro-fragments.

     The tissue is then prepared for viewing under a microscope using either chemical fixation or frozen section. If a large sample is provided e.g. from a surgical procedure then a pathologist looks at the tissue sample and selects the part most likely to yield a useful and accurate diagnosis - this part is removed for examination in a process commonly known as grossing or cut up. Larger samples are cut to correctly situate their anatomical structures in the cassette.

Processing:-

     Water is removed from the sample in successive stages by the use of increasing concentrations of alcohol. Xylene is used in the last dehydration phase instead of alcohol - this is because the wax used in the next stage is soluble in xylene where it is not in alcohol allowing wax to permeate the specimen. This process is generally automated and done overnight. The wax infiltrated specimen is then transferred to an individual specimen embedding container. Finally, molten wax is introduced around the specimen in the container and cooled to solidification so as to embed it in the wax block. This process is needed to provide a properly oriented sample sturdy enough for obtaining a thin microtome section for the slide.

     Once the wax embedded block is finished, sections will be cut from it and usually placed to float on a water bath surface which spreads the section out. This is usually done by hand and is a skilled job  with the lab personnel making choices about which parts of the specimen microtome wax ribbon to place on slides. A number of slides will usually be prepared from different levels throughout the block. After this the thin section mounted slide is stained and a protective cover slip is mounted on it. Frozen section processing:-

     The second method of histology processing is called frozen section processing. This is a highly technical scientific method performed by a trained histoscientist. In this method, the tissue is frozen and sliced thinly using a microtome mounted in a below-freezing refrigeration device called the cryostat. The thin frozen sections are mounted on a glass slide, fixed immediately & briefly in liquid fixative, and stained using the similar staining techniques as traditional wax embedded sections. The advantages of this method are rapid processing time, less equipment requirement, and less need for ventilation in the laboratory.

Staining of processed histology slides:-

     This can be done to slides processed by the chemical fixation or frozen section slides. To see the tissue under a microscope, the sections are stained with one or more pigments. The aim of staining is to reveal cellular components; counterstains are used to provide contrast.

     The most commonly used stain in histology is a combination of haematoxylin and eosin Haematoxylin is used to stain nuclei blue, while eosin stains cytoplasm and the extracellular connective tissue matrix pink. There are hundreds of various other techniques which have been used to selectively stain cells. Other compounds used to colour tissue sections include safari, Oil Red O, congo red, silver salts and artificial dyes. Histochemistry refers to the science of using chemical reactions between laboratory chemicals and components within tissue. A commonly performed histochemical technique is the Perls' Prussian blue reaction, used to demonstrate iron deposits in diseases like Hemochromatosis.

     The histological slides are examined under a microscope by a pathologist, a medically qualified specialist who has completed a recognised training program. This medical diagnosis is formulated as a pathology report describing the histological findings and the opinion of the pathologist. In the case of cancer, this represents the tissue diagnosis required for most treatment protocols.

Authors can share their research in our journal  through online portal by using

this @ mail : nephrology@eclinicalsci.org

With Regards,

David Paul

Editorial Assistant

Journal of Clinical Nephrology and Research

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