LIBRO DE OBSEQUIO SORPRESA 1 BREAST CANCER

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Histological Diagnosis of Implant-Associated Pathologies
Fixed Bone Tissue
Bone tissue is also fixed in formalin. Decalcification is usually carried out with commercial
solution using an acid decalcifying agent along with an added citrate buffer to help
prevent cellular swelling and distortion during the process or with a mild solution such
as ethylenediaminetetraacetic acid (EDTA). Both of them work well for immunohistochemical
reactions.
For evaluation of metabolic bone conditions such as osteopenia, osteomalacia, and
renal osteodystrophy, undecalcified bone sections in resin are required after fixation in
Carnoy’s solution (glacial acetic acid:chloroform:alcohol in a ratio of 1:3:6) and dehydration
in ethanol before the resin embedding process.
Macroscopic Examination
Macroscopic examination is a very important part of the tissue processing that can significantly
affect the histological diagnosis. Tissue description should be reported with accurate
measurement of each sample and extensive sampling performed, optimally with no less
than five tissue blocks/case. Pictures of the implant components should always be taken,
and of tissue specimens when appropriate. Arthroscopy and ultrasound-guided needle
biopsy specimens should be submitted in their entirety. In particular for needle core biopsy
samples, the specimens should not be left in formalin solution for more than 2–3 h so as
to avoid curling and twisting of the cores. Furthermore, they should be described at macroscopic
examination with recording of the number and relative dimensions, collected with
tweezers and arranged in parallel in the processing cassette between two foam pad inserts
to preserve orientation, subject to standard processing, embedded parallel and slightly
oblique, cut in four different tissue block levels at 5-μm thickness, and stained with standard
H&E.
Take-Home-Message
5 5 Pertinent clinical data and the type of prosthesis should be available to the pathologist
at the time of histological examination.
5 5 Each of the tissue samples (three to six tissue samples) measuring at least 1–3 cm
should be collected at implant revision surgery “close to the prosthesis” and
“far from the prosthesis,” and osseous tissue should also be collected when feasible.
5 5 Each of the tissue samples collected during arthroscopy (three to six samples)
should have a diameter of at least 1 cm.
5 5 The collection site of the tissue samples must be recorded for the analysis of the
distribution of the wear material.
5 5 Tissue samples should be extensively sampled at macroscopic examination with
tissue sections taken according to the size of the specimen.
5 5 The cellularity and type/amount of the wear particles should be routinely recorded
semi-quantitatively (none, slight, moderate, marked) in the microscopic description
of the pathology report.