Poorly Preserved Specimen Under a Microscope

in STEMGeeks4 months ago

A case of 23-year old female with an enlarged left ovary. I received the specimen in poorly preserved condition. Think of a piece of meat soaked in alcohol low concentration and diluted in water for 2 weeks.

Seeing the condition of the specimen, I already knew this was a lost cause but you still got to do your part in processing the specimen. I changed it the solution to 10% formalin in the slim hope that maybe I get to recover some viable portions of the tissue.

At scanning to low power views, you can see everything is predominantly pink or hyalinized. This means necrosis has happened to majority of the areas. The blue parts you see are probably nuclear material the cell expels when dead or bacteria that have colonized the specimen when it was poorly preserved.

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Mucinous ovarian tumors can be benign or malignant but it would depend on how adequate sectioning is made. If the tumor has a widest diameter of 30cm, then we double the amount of sections we send out. A single focus of malignancy changes the diagnosis and prognosis. Because these tumors tend to be as large as watermelons, it's also understandable that malignant parts get so spread apart that the regular 1:1 tissue to section ration to be sent is inadequate. I shared a post about the tumor before here.

A link to an old post showcasing the difference of what is necrotic tissue and not.

The frustrating part about this is that one may never know whether they got a malignant cancer or it was just a benign case. There is a high possibility that they could get subjected to unnecessary chemotherapy for preventive measure but that costs a lot and it's also taxing on the body.

Taken from my previous post(not from this patient), the specimen would look something like this.

To think, this mistake was due to ignorance when the patient was supposed to have the specimen processed as soon as it was taken out to our institution and also the preservative used. They had no funds to pay for the processing which further delayed processing for two weeks. It also didn't help that they failed to appreciate the impact of sending the specimen for processing when it was viable. It's just something that happens once in a while unfortunately. I live in a country with health care systems really fail the vulnerable ones.

This is just my initial impression of the case and it's still pending for complete sign out. For now, it's just asking whether do they really have a malignant tumor or no?

If you made it this far reading, thank you for your time.

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amazing photos!

Thank you for stopping by :)

Damn, that's sad

It is. Up to the clinician's dilemma. The only outcome I would hoe for is to have the patient get observed closely and hope nothing progresses. Hard to treat something as cancer when unsure and it entails additional costs and risks to a patient.

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