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HISTOLOGICAL EXAMINATIONS

Η ιστολογική εξέταση ασχολείται με την εξέταση ιστικών δειγμάτων κάτω από το μικροσκόπιο. Τα δείγματα υπόκεινται σε επεξεργασία και απαιτούν μια σειρά από προπαρασκευαστικές ενέργειες για να εξεταστούν και αναλυθούν, ανάλογα με το είδος του ιστού και το είδος της εξέτασης που ζητείται. Για την εξαγωγή διαγνωστικών συμπερασμάτων άμεσα κατά τη διάρκεια μιας χειρουργικής επέμβασης, διενεργείται «ταχεία βιοψία». Δείγματα που ορίζονται ως μεγάλα περιλαμβάνουν ολόκληρα όργανα ή τμήματα αυτών, τα οποία αφαιρούνται με την εγχείρηση. Παραδείγματα μπορεί να αποτελούν μια μήτρα που αφαιρείται με υστεροτομία, το παχύ έντερο ύστερα από μια κολεκτομή, ή οι αμυγδαλές ύστερα από μια αμυγδαλεκτομή. Οι ιστολογικές εξετάσεις αφορούν στους ακόλουθους τομείς:
When talking about histological examination one refers to the process of examining histological samples under the microscope. The samples are subjected to treatment and need a series of preparatory steps in order to be examined and analyzed depending on the type of tissue and the type of examination required. Whenever there is a need for an immediate diagnosis during the performance of a surgery, a rapid biopsy is performed. Specimens that are classified as large include entire organs or pieces thereof which have been removed during surgery. Examples can include a uterus removed with the performance of a hysterectomy, the large intestine removed with a colectomy or the tonsils removed after a tonsillectomy. In general histological examinations can be classified under the following categories:
BREAST HISTOPATHOLOGY A pathologist’s contribution concerning ailments that appear on the breast is found in the following actions:
  • Diagnosing the ailment
  • Determining whether the prognosis and subsequent treatment are commensurate
The two primary techniques used for diagnostic purposes in this case are:
  • Fine Needle Aspiration Biopsy (FNA or FNAB) for the collection and testing of individual cells from the area under examination
  • Core Biopsy (the collection of a small piece of the suspect tissue). In case a tumor in the breast is found, the examination by the pathologist is going to provide the medical team with the following information which are crucial for the subsequent prognosis and treatment:
 
  • Histological grading
  Sample of mammography depicting a cancerous lumpectomy marked with a localization needle. The needle intersects the tumor lengthwise and the clip marks the area of the core biopsy.  
  • Stage of the tumor
  • Existence of lymphatic infiltrates
  • Appraisal of surgical margins
  • Existence of metastatic spots on lymph nodes
  • Appraisal of hormonal receptors existence as well as cerbB-2 receptors for anti-HER-2 treatment
HISTOPATHOLOGY OF THE FEMALE REPRODUCTIVE SYSTEM The ailments that can afflict the female reproductive system can include ailments of the vulva, of the vagina, of the uterus (ectocervical, endocervical, endometrial, myometrial) as well as of the appendages (fallopian tubes, ovaries). The most common of those are:
  • Tumors
  • Cervical prolapse
  • Amenorrhea (lack of menstruation)
  • Dysmenorrhea (painful menstruation)
  • Infertility
  • Menorrhagia (large amount of blood during menstruation)
  • Molar pregnancy
  • Ectopic pregnancy
  • Infections (fungal, bacterial or viral)
The pathologist’s role in this area of histopathology includes:
  • The performance and appraisal of cervical smears (PAP tests) to detect the existence of precancerous distortions
  • Cervical biopsies to detect the existence of precancerous distortions or the existence of cancer
  • Performance and appraisal of endocervical or endometrium scrape tests, to check the contents of the uterine cavity in case of menstrual disruptions or in case of hyperplasias and neoplasias.
  • Hysterectomies (surgical removal of the uterus)
  • Ovariectomy (surgical removal of the ovaries)
  • Salpingectomy (surgical removal of the fallopian tubes)
HISTOPATHOLOGY OF THE MALE REPRODUCTIVE SYSTEM Common ailments afflicting the male reproductive system include:
  • Hyperplasia of the prostate gland (adenomatous hyperplasia)
  • Chronic prostatitis
  • Carcinoma of the prostate gland
  • Orchitis
  • Testicular and scrotum tumors
  • Inflammations and tumors of the penis
Some indicative actions performed by the pathologist in this subgroup of histopathology include:
  • Needle prostate biopsies to determine the presence of a tumor. To assure an accurate diagnosis the biopsy material is exhausted after procuring unstained samples from it for our archive in order to be in a position to perform immunohistochemistry examinations at a later point in time if the need arises. Double or triple stains are performed to reduce costs without compromising the validity of the immunohistochemistry tests.
  • Transurethral resection of the prostate (TURP). If the need arises we exhaust the collected material to achieve the most accurate and conclusive diagnosis possible.
  • Testicular biopsies – azoospermia and ypospermatogenesis appraisals
  • Orchiectomies
  • Radical prostatectomies
HISTOPATHOLOGY OF THE HUMAN UROLOGICAL SYSTEM Common ailments afflicting the the human urological system include: dysuria, hematuria, nocturia, enuresis, incontinence, polyuria, urinary retention, orcheodynia, renal colic etc. Samples typically examined:
  • Kidney biopsies (to eliminate the existence of malignancies)
  • Ureter biopsies
  • Bladder biopsies
  • Urethra biopsies
  • Samples collected after surgery from the aforementioned organs, which, after being submitted to the necessary preparatory treatment are examined in order to determine the nature of the existing tumor and put together the definitive diagnosis upon which the urologist surgeon and the rest of the medical team responsible for the patient will base the subsequent surgical/therapeutical treatment.
DERMATOPATHOLOGY Common ailments of the skin include:
  • acne, vitiligo, hair loss, various scars
  • rosacea, fungal infections
  • systemic diseases (eg systemic lupus erythematosus)
  • keratoses, warts
  • warts (HPV infection)
  • carcinomas of the skin
  • benign skin tumors
  • Melanocytic nevi (Skin moles)
  • Melanoma
The scientific team of “Microdiagnostiki” possesses the necessary experience as well as the corresponding diagnostic techniques to provide you with a precise diagnosis. GASTROINTESTINAL PATHOLOGY AND PATHOLOGY OF THE DIGESTIVE SYSTEM Non-neoplastic – inflammatory diseases:
  • Reflux – gastroesophageal reflux (GERD)
  • Barrett’s esophagus
  • Gastritis – infection with helicobacter pylori (helicobacter pylori)
  • Idiopathic inflammatory bowel disease (crohn’s disease, ulcerative colitis)
  • Microscopic colitis
  • Infectious colitis / pseudomembranous colitis
  • Celiac disease – malabsorption syndrome
  • Diverticula – diverticulitis
  • Chronic pancreatitis
  • Cholecystitis – lithiasis cholecystitis
Benign and malignant neoplastic diseases:
  • Esophageal papillomas
  • Esophageal carcinoma
  • Polyps stomach, small intestine and colon
  • Gastric carcinoma
  • Carcinoma small & large intestine
  • Anal warts
  • Genital wart
  • Anal carcinomas
  • Benign and malignant tumors pancreas
  • Benign and malignant tumors of the liver
  LYMPHATIC SYSTEM DISORDERS Diseases that cause swelling of the lymph nodes:
  • Infectious diseases such as tuberculosis, infectious mononucleosis
  • Systemic diseases such as sarcoidosis
  • Neoplastic diseases such as Hodgkin and Non-Hodgkin’s lymphomas, leukemias
  • Metastasis of malignant tumor in the lymph nodes
In order to properly diagnose such disorders an extensive range of tests and examinations is needed (a combination of immunohistochemistry, histological examinations and/or histochemistry). “Microdiagnostiki” can guarantee in such cases the proper and strategic management of the collected material as well as provide the necessary expertise for a definitive diagnosis.   DISORDERS OF THE HEMOPOETIC SYSTEM Main neoplastic diseases of the bone marrow and the blood;
  • Acute Myelogenous Leukemia (AML)
  • Myelodysplastic Syndromes (MDS)
  • Myeloproliferative neoplasms (MPN)
  • Chronic Myelogenous Leukemia (CML)
  • Polycythemia vera (PV)
  • Essential thrombocythaemia (ET)
  • Chronic neutrophilic leukemia (CNL)
  • Chronic Eosinophilic Leukemia (CEL) / Idiopathic Hypereosinophilic Syndrome (iHES)
  • Chronic Idiopathic myelofibrosis (CIMF)
  • Myeloid neoplasms associated with eosinophilia and PDGFRA rearrangements of genes, PDGFRB and FGFR1
  • Acute Lymphoblastic Leukemia (ALL)
  • Chronic Lymphocytic Leukemia (B-CLL)
  • Multiple Myeloma (MM)
  • Mantle cell lymphoma (Mantle Cell Lymphoma)
  • Marginal Zone Lymphoma (Marginal zone b-cell lymphoma of malt type)
  • Follicular lymphoma (Follicular Lymphoma)
  • Diffuse large B-cells (Diffuse Large B-Cell Lymphoma)
  • Burkitt’s lymphoma
  • Anaplastic Lymphoma (Anaplastic Large Cell Lymphoma)
  FETUS AUTOPSY What is a fetus autopsy? A fetus autopsy consists of a detailed surgical examination of the fetus’s body in order to better understand the reasons behind its demise. The examination helps uncover anomalies that may otherwise not become apparent.   What are the most important reasons to conduct a fetus autopsy and what kind of information can be retrieved by it? The most usual reason is the determination of the cause of death of the fetus. As for the information that can be gleaned by the examination, it usually concerns:
  • Information about internal problems that lead to death which don’t make themselves apparent nor can they be recognized by an external examination of the fetus’s body.
  • Important information concerning any future conception as well as any future healthcare needs that might arise in the family, are linked to the cause of death of the fetus and need to be addressed.
  • Acquisition of medical knowledge that might prove useful in other similar cases.
Who performs the autopsy? The histopathologist (anatomic pathologist) is usually the one performing the examination by studying the various organs, tissues and bodily fluids (cytologist) and coming up with a diagnosis. How much time is there in order to decide to go ahead with an autopsy? There is no set time limit for the decision. Having said that it is useful to mention that the sooner an autopsy is performed the more information a pathologist can gather. What is the procedure of an autopsy? The procedure followed depends on the age of the fetus, the medical history of the mother and the conditions of death. The tests may be limited to an external examination, however it is possible that an internal examination may also be conducted (“internal examination” of the organs, the tissues and of the bodily fluids). What is the procedure followed during an external examination? Some or all of the following may be performed:
  • Examination of the surface of the ear, the throat and of the skin.
  • Examination of the placenta and the umbilical cord.
  • External photographs may be taken.
  • A skin sample may be collected in order to test the chromosomes.
What is the procedure followed during an internal examination? An autopsy is not unlike a surgery. The internal examination is done by making an incision to the fetus’s body which is sutured after the tests are completed and which usually starts from the lowest part of the throat moving towards the pubic bone. If the head is also to be examined, the incision is done at the back of the skull.     How long does the autopsy take? It is usually completed in a day. However it is possible that up to several weeks may be needed in order for all the tests to be completed and provide conclusive results, depending on the king of the examination performed. After the conclusion of the examination the body of the fetus is immediately returned to the parents.