Surgical
Pathology
Cleveland Clinic Reference Laboratory provides expertise in a broad
range of surgical pathology specilaties. See Pathology Consultation in
the Test Directory for guidelines on submitting. Pathologists are available for consultation on submitted cases.
Bone Marrow Consultation
Cleveland Clinic Reference Laboratory offers a full range of
expert consultative services for bone marrow evaluation and
interpretation.
Full morphologic interpretation of bone marrow specimens by staff
hematopathologist is available. Services include: evaluation of prepared
peripheral blood smears, bone marrow aspirate smears, touch imprints,
core biopsies and clot sections (if available). In some cases,
additional studies may be performed on this material such as
cytochemistry or molecular studies at the discretion of the pathologist.
See Bone Marrow categories in the Test
Directory for specimen requirements.
Flow cytometric immunophenotyping services are available on bone marrow
samples for the evaluation of suspected hemotalogic malignancy. This
includes a morphologic review of submitted stained or unstained aspirate
smears along with four-color flow cytometric analysis and interpretation
by a staff hematopathologist. This review includes an initial
morphologic evaluation to determine the appropriateness of the panel
requested. See Flow Cytometry categories in the Test
Directory for specimen requirements.
Dermatopathology
Cleveland Clinic Reference Laboratory offers a complete service of
processing and sectioning paraffin sections of skin biopsy with
expertise in the microscopic evaluation. See Dermatopathology in the Test
Directory for skin biopsy submission guidelines.
Electron Microscopy
Consultation
Services consist of ultrastructural examination of biopsy, renal disease
and surgical specimens utilizing both scanning and transmission electron
microscopy. Emphasis is also placed on differential identification of
poorly differentiated neoplasms. Other activities include
ultrastructural diagnosis of disease processes in muscle, nerve, skin,
blood cells, heart and other tissues. Special studies are available for
identification and quantification of mineral particles (e.g. asbestos)
in tissue specimens. See Electron Microscopy categories in the Test
Directory for specimen submission guidelines.
Histopathology
Cleveland Clinic Reference Laboratory offers service in complete processing and sectioning
of routine paraffin sections with expertise for the microscopic
evaluation in virtually all specialties. See Histopathology in the Test
Directory for specimen submission guidelines.
Lymph Node
(or other tissue) Biopsy Consultation for Lymphoma
Cleveland Clinic Reference Laboratory offers comprehensive expert
consultative servivces for the evaluation of lymphoproliferative
disorders. A full range of ancillary techniques (flow cytometric
immunophenotyping, immunohistochemistry, and molecular diagnostics) are
available. Several levels of service are offered:
- Flow cytometry only - specimens may be sent fresh in tissue
culture medium for flow cytometric immunophenotyping for
interpretation by the referring pathologist. See Flow Cytometry categories in the Test
Directory for specimen requirements.
- Flow cytometric immunophenotyping with histopathologic
evaluation - clients may send fresh tissue in tissue culture
medium for flow cytometric immunophenotyping. When routinely
processed tissue is available, histologic slides and paraffin blocks
are forwarded fir comprehensive evaluation and diagnosis. See Flow Cytometry
and Surgical Pathology Consultation in the Test
Directory for specimen requirements.
- Consultation, paraffin-embedded tissues - specimens
(slides and tissue blocks) may be sent for diagnostic consultation.
Ancillary studies will be performed (immunohistochemistry, molecular
diagnostics) if required. See Surgical Pathology Consultation in the Test
Directory for guidelines on submitting slides and blocks for
interpretation.
Muscle and Nerve Biopsy
The staff of Cleveland Clinic Reference Laboratory offers expertise
in neuropathology with specialty in muscle ands nerve disorders. The
laboratory provides the technology and expertise to perform a battery of
enzyme histocehemical stains for these specimens. See Muscle or Nerve
Biopsy in the Test
Directory for specimen submission guidelines.
Special Stains
A wide variety of special stains are available for microscopic
evaluation. See Special Stain in the Test
Directory for specimen submission and the Special Stain
table.
Immunohistochemistry
and Immunofluorescence (DIF)
A wide variety of immunohistochemical, cellular immunoperoxidase and
immunofluorescence stains are available. See Immunohistochemistry and
Direct Immunofluorescence in the Test
Directory for specimen submission guidelines and the Immunohistochemistry
table for stains offered.
Her-2/neu Testing
Cleveland Clinic Reference Laboratory utilizes the FDA approved
fluorescence in situ hybridization assay for detection of Her-2/neu
gene amplification. See Her-2/neu in the Test
Directory for specimen submission guidelines.
Submission Requirements
(Surgical Pathology)
Federal Law and good medical practice require pertinent information to
be included on each test request with all submissions as follows:
- Label each container or slide with patient's name, physician's name and source of specimen. Client account number should also be included. Complete an
Anatomic Pathology Requisition Form (PDF)
and send with specimen. Use block print.
- Include all pertinent clinical information including patient's age, sex, clinical impression, anatomical location of tissue and ICD9 diagnosis code on the
Anatomic Pathology Requisition Form (PDF).
- Provide all billing information including ordering
physician's name and UPIN and third party or patient billing data.
Specimen Rejection Criteria
(Surgical Pathology)
Client Services will notify the client of unacceptable specimens and test cancellations. Listed below are causes for specimen rejection:
- No patient identification on
Anatomic Pathology Requisition Form (PDF)
- No patient identification on specimen container or slides
- No account/physician number and none available
- No account/physician name
- Specimen leaked from container
- Slides broken beyond repair on receipt
- Slides/Anatomic Pathology Requisition Form (PDF)
separated on receipt and not properly identified
- Conflict between name of patient on specimen and name on
Anatomic Pathology Requisition Form (PDF)
- Specimen obviously not properly preserved
- No test or source indicated on
Anatomic Pathology Requisition Form (PDF)
Cytology
Extensive expertise in cytologic interpretation is available
in the Cytopathology Laboratory. Specimens examined include
cervical-vaginal smears, sputa, bronchial, esophageal, gastric, urinary
tract and various body fluids (including urine, pleural, peritoneal, pericardial,
gastric, duodenal, synovial, cerebrospinal, mammary nipple discharge) as
well as needle aspirates from various organs including breast, lung,
bone, prostate, thyroid. lymph node and deep organs. The principle
emphasis is the evaluation of preneoplastic or neoplastic changes. The
Cytology Laboratory can also asses irradiation changes and presence of
viral inclusion bodies and other infecting pathogens. Cytopathologists
are available for consultation on submitted cases. See Surgical
Pathology Consultation in the Test
Directory for guidelines on submitting slides and blocks for
interpretation.
ThinPrep Pap Test
The Cytology Laboratory provides the technology and expertise to process
and diagnose ThinPrep PAPs. The ThinPrep Test was cleared by the FDA in
1996 as an alternative for the conventional PAP smear. See Cytology,
ThinPrep PAP in the Test
Directory for specimen submission guidelines.
Digene Hybrid Capture IIHPV DNA Test, the molecular detection of HPV
DNA, can be performed on the same gynecologic (ThinPrep PAP) specimens
submitted to the laboratory in CYTYC Thin Prep PreserveCyt™ solution. See
HPV DNA Assay in the Test
Directory for specimen submission guidelines.
Contact the Client
Services for ThinPrep Pap Test supplies.
Submission
Requirements (Cytology)
- Federal Law and good medical practice require pertinent
information to be included on the Cytology
Test Requisition (PDF)
form with all submissions as follows:
- Patient's name, date of birth, and ID number, if any.
- Source of material submitted (cervical, endocervical, vaginal or other body site).
- Ordering physician's name and telephone number.
- Last menstrual period (LMP).
- Hormonal status (e.g., post-menopausal, gravid).
- Exogenous hormone therapy (including birth control pills, treatment for endocrine-responsive malignancy, estrogen creams).
- Use of intrauterine device (IUD).
- DES exposure
- Histories of abnormal cytology, systemic chemotherapy, gynecologic surgery, cryosurgery, electrocautery or laser surgery.
- Date of last gynecologic smear.
- Any other pertinent history (e.g., non-GYN history of previous surgery, presence of other masses, etc.).
- Designate patients at high risk for cervical cancer including, for example, previous gynecological history of dysplasia or higher, HPV infection, HIV infection, multiple sexual partners, grossly visible lesion, early age of sexual intercourse, DES exposure, smoker, abnormal vaginal bleeding, prior abnormal Pap smear or history of malignancy.
- Label all slides and specimen containers with the patient's name and site(s) collected.
Federal law prohibits acceptance of unlabeled specimens.
- Collect all Pap smears according to NCCLS guidelines.
Specimen Rejection
Criteria (Cytology):
Client Services will notify the client of unacceptable specimens and test cancellations. Listed below are causes for specimen rejection:
- No patient identification on Cytology
Test Requisition form (PDF)
- No patient identification on slide
- No account/physician number and none available
- No account/physician name
- Specimen leaked from container
- Slides broken beyond repair or receipt
- Slides/Cytology
Test Requisition form (PDF)
separated on receipt and not properly identified
- Conflict between name of patient on specimen and name on
Cytology
Test Requisition form (PDF)
- Specimen obviously not properly preserved
- No test or source indicated on Cytology
Test Requisition form (PDF)
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Surgical
Pathology:
Cytology:
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