I did not expect this post to get so much attention! To try and answer the questions starting to pop up in the notes
Spleen submissions and other awkward samples 101:
(TL:DR; Call your lab and submit spleens fresh, chilled, and whole if possible)
- If in doubt, always call your diagnostic lab. They should be able to tell you how they prefer to receive various things and that is the best way to keep your pathologist happy
- Large things do not fix through in formalin. They just don’t. The 1:10 tissue to formalin volume ratio works, but there is a limit. And dense, bloody organs (aka spleens) fix especially poorly
- If any specimen is 1cm thick or less you can be confident that it will fix fairly well in 24 hours. The only spleen I have ever seen manage this came out of a squirrel. A cat spleen can swing it in 2-3 days if given enough formalin. Dog spleens will never fix whole.
- Remember: if it’s not fixing, it’s rotting. And we can’t interpret rot.
- Where I work, our number 1 preferred spleen submission method is a whole spleen, chilled and shipped on ice (NOT FROZEN - freeze thaw artifact really messes up histology), and shipped overnight so we can assess, subsample, and fix what we need the next day. This is what we prefer for legs and really big masses as well.
- Option 2: sub-sample the spleen yourself. With a mass, we do a minimum of 9 sections, <1 cm thick, from the margin of spleen and mass, plus some representative samples of the rest of the spleen. Don’t give us just mass! The centre of the mass is usually just necrosis, hemorrhage, and maybe a bit of EMH. The edge is where we can still reliably see neoplastic cells. (You may like to take and submit photos of the whole spleen fresh with this. We’ll never say no to more information!)
- Someone in the replies mentioned bread-loafing the spleen and fixing it (cutting into the organ at regular, thin intervals like a loaf of bread). I honestly haven’t seen that done, so if your lab suggests it, go for it. I can see how it could work. But I have three concerns: 1) when you cut an organ then let it fix, the shape changes and if you wanted our opinion on the gross appearance as well, we can’t do that reliably. 2) Your cuts might interfere with where we need to cut for the best samples. 3) That might not open the spleen up enough to get the formalin moving around everything in a way that will make it fix. I’m not confident that fluid is going to get in between those cuts in the quantities needed for good fixation.
- For big tumors: These are tricky. If you need margin assessment, cutting into it really isn’t a good idea. Your options are similar to above - submit it chilled, or sub-sample yourself. Again, whole is better for margins. Or accept that the middle of the tumor is going to rot a bit, put it in a huge amount of formalin (1:10 tissue:formalin by volume) then when it gets to us we can identify and ink margins, cut it up in a way that works for us, let it keep fixing, and then process the slides. The middle of a massive tumor is usually necrotic and not much diagnostic use anyway, but this lets the experts make the trimming decisions. Just know that anything unfixed is going to take a little longer for us to get a report out on.
- Again: if you’re not sure, call your lab. Where I work there is a pathologist and resident available 24/7 to ask questions. We prefer if you call during waking, working hours (especially me, if you call in the middle of the night you get the resident first, and we’re not as friendly at 3am), but we’re always there. I would rather you ask me 20 questions than send a sample that’s going to make my life harder and not give you any useful information.
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