Laboratory of Pathology - Staff

Submitted Service

The resident on “submitted” surgicals is responsible for working up all the referred submitted surgical cases with the staff member on service.

The material accessioned in the laboratory should include a completed outside tissue examination form filled out by the NIH clinician, either via CRIS system for patients with medical record number, or via outside tissue examination form available in the General Surgical Pathology section, for patients who do not have a medical record number.  It is essential that an accompanying pathology report or other document verifying that the slides/blocks/wet tissues submitted belong to the patient in question be available.  When blocks are received, it is customary to prepare our own slides.  Make sure the outside code on the slide label is also an NIH label.

As soon as you get the case from the Histology Laboratory, check and do a workup and decide with your attending if more sections are needed or if you have to request blocks from the referring hospital.  Upon receiving slides, the resident is also responsible for detecting any inadequately prepared slides  (H&Es, and Special Stains) and should communicate findings to the Histology Laboratory and Staff Pathologist on service. Documentation of findings is to be recorded in the Daily Pathologist Slide Review Sheet. A new set of slides should be prepared as soon as possible, not to delay patient care. When you receive blocks you have requested, put our number on the container (to prevent case from being accessioned twice) and take it to the General Surgical Pathology office for the material to be entered as additional material to the appropriate case.

Finish the report in the same fashion you would for an in-house surgical (see under In-House Service). Include in the GROSS description the identity of all submitted slides and blocks, including the outside hospital, as well as the date of the original procedures. 

Our policy is to retain a representative submitted slide in any case in which we render a diagnosis.  Therefore, we will always request permission of the outside referring Institution to keep at least one representative slide of cases, especially if a patient is enrolled in an NIH protocol. If we have prepared our own slides from the paraffin blocks, we may then return submitted slides, if they do not demonstrate significantly different pathologic findings, and only if they have been requested by the outside laboratory.  Requests for return of submitted slides in cases in which we do not have other material must be cleared with the senior staff.  Such requests will usually not be honored if the patient is or has been treated at the Clinical Center.  In addition, we may try to retain a paraffin block in many instances for further studies.

The resident on submitted will serve as back-up for frozen section consultation in the event of an autopsy or multiple frozen sections. 

NCI protocol guidelines require that we document, to the extent possible, the date of diagnostic biopsies.  For submitted surgical specimens, this information should be included in the GROSS DESCRIPTION portion of the report, and should be dictated by the resident.

If you receive duplicate material on a case that is signed out under another S#., issue a report referring to that NIH S# in the diagnostic line.

Signing Out Cases – The cut-off time for signing out cases is 4:15pm.  If we receive any cases after the cut-off time, they will not be processed until the next day.  

Rush Cases – The cut-off time for handling “Rush” cases is 3:00pm.  Any cases received after the cut-off time will not be processed until the next day.  

Additional material (stained/unstained slides, blocks) received before the case has been signed out should be given to the General Surgical Pathology office to be entered as additional material with a “Tissue Examination” form.  Remember to indicate current NIH S#.

If you receive multiple blocks (>5), you should try to select particular blocks to be recut for special stains, etc. after consultation with staff.

Proof report carefully before signing it.  Are outside S #s and C #s correct?