Unboxing Some Monsters of the Week

in STEMGeekslast month

It’s my turn at cutting specimens again and things are fairing well. This day’s start is quality over quantity where I get few cases but each case takes more than half an hour minimum to process. It consists mostly of the entire internal female reproductive system.

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I put rulers on cause it contained the patient's data on top :P

The way to dissect this specimen is taking each part as if they are their own separate organs. So each part requires measurements of their own. No photos on the step by step process on this post but the way I go about is starting from the Uterus > Right and Left Ovaries > Right and Left fallopian tubes > Cervix.

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I get all sorts of containers for these type of specimens. Some come in buckets while other occasions the entire organ system just fits into the mini cup. So unboxing them can just be a surprise on their own. Some unpreserved, some have missing parts declared, and some had bad labels that just throws me off my rhythm when cutting. You got to be in the zone when you cut otherwise each specimen is a dragging experience.

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I used around four knives on this monster and finally gave up around 3/4 of the way and handed the bread loafing to our mortician. This thing has the size of a baby’s head and the density of a few kilo of watermelon. It’s just myoma on gross examination so it’s fairly easy to process and sign out.

Some variations in the steps happen when there is a malignant tumor suspected from the clinical diagnosis. But for the general benign cases like myoma, the last parts are left to focus on the tumor once I finish up the external parts. It depends on your rhythm once you get acquainted with these specimens, some go by the book and follow the step by step top to bottom, out to in, and etc.

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Here’s an unrelated case where the specimen was received without preservative on. They just handed the specimen in saline solution (not a preservative) and this looked like a lump of flesh in red juice on the container. I had it transferred to another container and replace it with regular concentration of formalin reserved for tomorrow’s cutting session. The specimen needs some time to let the formalin seep in otherwise it’s all too soft to cut.

Looking forward to what surprises await me in the following days.

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

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This is possibly a stupid question but at the top of the post, you said 'patient'. Does this mean the patient was still alive but minus her reproductive system (on your cutting desk!) or is the 'patient' no longer alive? This leads me to ask you about the terminology used when dealing with specimens from the living and deceased?

No difference in terminology, a specimen can just be a fleshy piece of object that came from someone. Sometimes it's from a cadaver or someone recently being cut open to get a sample of it.

So as there is no difference in terminology, I presume there is also no difference in procedure for the 'handling' of the sample? As part of a deceased person, there is no special consideration made for family wishes or religion etc, how did you find dealing with 'lumps of a dead person' when you first started in this career path and how did you learn to remove any emotional link if there was one? ...finding it difficult to explain what I mean, sorry but it's really fascinating so thanks!

I presume there is also no difference in procedure for the 'handling' of the sample?

Depends on the type of specimen, some are more sensitive to decay while some require more time to sink in formalin like fatty tissues. We have a consent signed first explaining what's going to be done and some considerations do include religious views and etc.

When I see products of conception and there's a fetus in the specimen, I don't process it and separate it from the batch if I can identify it. Those are then given to the family for burial if they want it. The point of having the histopath report, one of the many, is just proving something happened scientifically on record and when you see the fetus grossly, it's not that difficult to put the mother was actually pregnant and had a miscarriage so they can claim insurance and other benefits.

how did you find dealing with 'lumps of a dead person' when you first started in this career path and how did you learn to remove any emotional link if there was one?

I have a stoic and nihilistic view to begin with. You ever held a limb of a dead animal, have it soaked in formalin and cooled it's no different from a human hand but less hairy. We're all just bags of conscious flesh trying to live. Some think of it less and some more conscious of it, some just know how to separate work from emotions that you'll be the agent of bad news if it's malignant.

I don't have those feelings when I started and later started thinking about it more which is the opposite of the process. But my point of view still remains firm, the specimens are just pieces of flesh that I just have to do process and do my job. No different than someone sending their urine or feces for examination.

Appreciate the excellent and informative reply. As I said, really interesting post so thanks again and have a great weekend :-)

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Errr, would that newly formalin preserved specimen be any good after being completely botched in saline?

It's fine, it just got out of its host 2 hours before it came on our department. Formalin penetrates at a rate of 0.4cm per hour anyway. That chunk of tissue will be fine if it's just normal saline used. But it's a different story if it was a breast tissue and malignant because those specimens would often require immunohistochemical stains and you can't stain well when receptors aren't preserved well.

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