Listen to Article
We know that our work as histologists is an important part of patient care, and what we do can help doctors save lives. But since we’re not working directly with patients, sometimes we may not always remember that there’s a person behind every piece of tissue we handle.
“I like how pathology plays such a vital role even though we’re generally behind the scenes—but with being behind the scenes, that comes with an increased likelihood of dissociating the patient from the specimen since we’re only working with small pieces of them,” said Tiffany Mainella, M. ED., HTL(ASCP), Education Coordinator for Digital Pathology at the Mayo Clinic. “It’s important to remember that there’s someone in every sample we handle. Every one of those specimens comes with a patient’s story, a history, a family that we need to remember can change in an instant based on what we provide to the pathologist.”
In the NSH Remembering Why—a Review of Patient Case Studies webinar, Mainella gives us a look at how she handles different types of cases and utilizes best histology practices to ensure that the work she does ultimately helps patients get the care they need.
In one case, Mainella discusses a 29-year-old woman who began feeling pain in her shoulder when running. Despite receiving medication and physical therapy for about a year, the patient was still experiencing the pain, so she was given an MRI. A mass was found on the left scapula that was consistent with Ewing sarcoma. The patient went through chemotherapy and about six months later, had a surgical resection of the tumor.
“She tolerated surgery very well. Pain is being well-managed, and it’s recommended that she resume chemo just to make sure that there are no lingering tumor cells,” Mainella explained. “She’ll have occasional imaging done to confirm that there’s still no tumor. So, this was a good outcome and hopefully the patient will go on to live a very full complete life.”
Mainella explains the role histologists can play in helping a patient get such a good outcome. When handling these types of samples, it’s important that a decalcification soak is done in the pre-processing phase before sectioning into pieces for the cassettes. This allows the pieces to stay in the structure that histologists need to continue their work.
“This might be for a couple hours, or if it’s really hard it might be 24-plus hours, but sometimes with the known tumors it doesn’t take as long because that tumor is already softening the bone a little bit,” she said.
Then during processing, Mainella stresses that another decalcification soak and rinse may be needed, particularly for bone marrow biopsies. During the embedding process, chunking may occur, so to avoid that, tissue can be placed on the cassette at a bit of an angle, so the blade doesn’t hit one side and chunk out. During microtomy, Mainella says another soak in 5% HCL may be necessary to further soften the tissue to get a good, full face section for the pathologist. To ensure that you’re consistently giving pathologists a high-quality product, Mainella suggests that you always keep your workstation tidy.
“I'm a big stickler for staying organized and clean around the microtome because it can reduce static if you don’t have all the scraps building up,” she said. “Also, what happens if a piece of that bone does chunk out? It might not be a big piece and easily visible, so rather than having to try to sort through all of the debris, it would be so much easier to find if there wasn’t so much buildup around the stage in the base.”
When you’re busy at the bench, it may not be top of mind that every case you work on is a piece of someone—and the work you do can have a major effect on the rest of their lives. Mainella’s case studies are a good reminder of why histotechnologists really do what they do. For more details about Mainella’s Ewing sarcoma case study, a look at how she handled an amyloidosis case, and suggestions on how histologists can always think about the patient they never see in their daily work, check out the NSH Remembering Why—a Review of Patient Case Studies webinar.
#Blog
#Laboratory Operations
#2025#GeneralAnatomicPathology