VAGINAL CYTOLOGY

Diagnostic Cytology
- Microscopic examination of cells from
different body sites for diagnostic
purposes
I.

Exfoliative Cytology
- Microscopic study of cells that have
been de-squamated from epithelial
surfaces
- May be found in smears that have
been spontaneously been shed or
physically removed from epithelial
and mucous membranes
Vaginal
Buccal mucosa
Body fluids (e.g. sputum, urine,
pleural fluid, peritoneal fluid,
gastric juice and cerebrospinal
fluid
- Spontaneous
exfoliation

observed in normal cells due to

constant growth and replacement with
new cells (malignant tumor cells)
Recommended for:
a) Detection of malignant cells in body
fluids, mainly used for staging cancer.
b) Detection of precancerous cervical
lesions in women (cervicovaginal
smear/Pap smear).
c) Assessment of female hormonal
status in case of sterility and
endocrine disorders. *This is achieved
by
microscopic
evaluation
for
determination of maturation index
(MI), based on examinati9on of
smears taken from the lateral vaginal
walls.
d) For determination of genetic sex
most of the nuclei of females exhibit
conglomeration
of
chromatin,
representing XX chromosomes (Barr
Body), which may be demonstrated in
the smears from buccal or vaginal
mucosa
e) For detection of infectious agents.

Specimens:
Non-gynecologic specimens
1. Respiratory tract specimen
Are obtained to exclude the possibility
of malignancy or infectious agents,
especially
from
patients
with
immunodeficiency syndrome
Includes:
Sputum
Bronchoalveolar
lavage/bronchial
washing
(BAL/BW)
Bronchial brushing (BB)

2. Peritoneal, pleural and pericardial fluids

Accumulation of this fluids usually
indicates a pathologic process
Malignant cells in serous effusions
usually
indicate
metastatic
involvement (higher stage of cancer)
3. Breast secretions
Nipple discharge
extremely low diagnostic yield
for
diagnosis
of
breast
carcinoma
due to a benign breast lesion
such as duct ectasia and
papilloma
due to endocrine problems
cytologic
examination
is
potential
detection
of
malignant cells in patients with
clinically
undetected
carcinoma
Spontaneous
nipple discharge

usually
a
result
of
hormonal
imbalance in young patients
Bloody secretions benign intraducal
papilloma
should be
considered
clinically
4. Urinary tract specimen
Major goal is diagnosis of malignancy,
usually urothelial origin
Prostatic carcinomas are rarely found
Types of specimen:
Voided
urine
(should
be
discarded due to overnight
degeneration of cells
Catheterized
specimen
(preferred, esp. for females)
Washings from bladder or renal
pelvis
*NOTES:
- For males, voided urine is sufficient
- For females, catheterized specimen is
recommended to prevent contamination of
specimen with vulvar cells
- Early morning specimens yields the greatest
number of cells (but usually distorted due to
prolonged bladder retention
- For reliable results, urine specimens may
have to be collected and examined twice
(one in the early morning and another in the
day)
5. Body cavity effusions
Important diagnostic value in patients
with a known history of cancer
Positive effusion for malignancy is the
first presentation of cancer of
unknown origin
Types of specimen:
Pleural fluid
Ascetic/abdominal fluid

 Peritoneal washings
Pericardial fluids
Cerebrospinal fluids
Gynecological specimens
Vaginal hormonal cytology
- Relatively inexpensive
- Performed regularly without undue risk, even
in pregnant women
Vaginal smears
- Best taken from the upper lateral third of the
vaginal wall *more accessible and less likely
to be contaminated y cellular debris or
vaginal discharges
ADVANTAGES:
Inexpensive
May be performed regularly
No undue risk (even for pregnant woman)
NOTE:
Smears should be examined first under Low
magnification :
a) to assess the quality of the smear and
staining
b) to detect the presence of RBSC and
leukocytes and mature superficial pyknotic
acidophilic cells.
(Quantitive evaluation of the smear is under
40x objective).
Cells found in Cervico-vaginal smears
- Wide variety of vaginal cells may be present
that may determine the stage of sexual
period of the patient in the time of ovulation.
1. Mature superficial cells
- Polygonal squamous cells
- 45-50 m in diameter
- Usually identified by the presence of
pale, pink-staining cytoplasm and
dark pyknotic nuclei (<6m in
diameter)
- True acidophilia characteristic of
superficial
vaginal
cells
under
estrogen influence *not a reliable
index of maturation
- Pseudo-acidophilia observed due to
the drying of smears especially before
fixation, prolapsed and drying of
vaginal epithelium, infection and
chemicals
2. Intermediate cells
- Medium sized polyhedral or elongated
cells
- With
basophilic
and
vacuolated
cytoplasms
3. Parabasal cells

Round to oval cells with small dense

basophilic cytoplasm
15-30 m total cell diameter
Smaller than intermediate cells
Have large vesicular nucleus
Normally found:
From two weeks of age to
puberty
After childbirth
With abortions
After menopause

Other cells that may be found in Cervico-vaginal

Smears:
1. Navicular cells
- Boat-shaped intermediate cells
- Strong tendency to fold or curl on
edges
- Suggests
a
combined
estrogenprogesterone effect
- Found in the latter half of the
menstrual cycle, during pregnancy
and menopause
2. Pregnancy cells
- Round, oval or boat-shaped cells
- Translucent
basophilic
cytoplasm,
observed greatest at the center of the
cell, due to glycogen accumulation,
pushing the nucleus to the side or
towards the cell membrane
This
appearance
is
characteristic due to a deeper
blue stain of the cytoplasm at
the periphery
3. Endometrial cells
- Small cells, slightly cylindrical with
less basophilic cytoplasm
- Occurring in tightly packed groups of
3 or more
- Found during and 1-10 days after
menstruation
- Shed in response to ovarian hormones
4. Endocervical glandular cells
- Occur in large groups or small sheets
- Cytoplasm is usually stained pale
blue/gray
- Finely vacuolated
- Indistinct cell borders
- Nuclei with finely granular chromatin
- Honeycomb appearance when viewed
on end
GYNECOLOGICAL
SPECIMENS
STAINING
PROCEDURE:
Principle: To provide a standardized method for
staining gynecologic specimens.
Equipment: Shandon Varistain 24-3
Method:
SOLUTION
TIME(in
seconds)

80%isopropyl alcohol

10

70%isopropyl alcohol

10

50%isopropyl alcohol

10

Water

45

Hematoxylin
Mercury Free
Water

(Harris)

45
5

Water

Water

50%isopropyl alcohol

10

Ammonium Hydroxide

60

70%isopropyl alcohol

80%isopropyl alcohol

95%isopropyl alcohol

10

OG-6

30

95%isopropyl alcohol

10

95%isopropyl alcohol

10

EA-50

120

95%isopropyl alcohol

10

95%isopropyl alcohol

95%isopropyl alcohol

100%isopropyl alcohol

100%isopropyl alcohol

100%isopropyl
xyless
Xyless

10

alcohol/

20

Staining Technique: Papanicolau Method (Pap

smear)
Papanicolau
- Advocated
the
diagnosis
of
malignancy
by
microscopic
examination of a group of isolated
cells
- Had developed a staining method
which identified stages in the
maturation of exfoliated squamous
epithelial cells
- Able to formulate a method with
which malignant cells could be
identified
Pap smear
-

Originally indicated for vaginal smears

to detect human uterine and cervical
cancers
Has been applied for evaluation of
practically all types of specimen
received in cytology laboratories

Considered the staining method of

choice for exfoliative cytology
It is considered to be the staining
method of choice for exfoliative
cytology.
Using a spatula or brush, the
transformation zone of the cervix is
circumferentially scraped and the cells
are smeared or spun down onto a
slide.

NOTE:
- Recommendations for the frequency
of PAP screening vary but in general
the first smear should be at age 21
years or within 3 years of onset of
sexual activity, and there after on an
annual basis.
- After age 30, women who have had 3
consecutive normal cytology results
should be screened every 2-3 years.
- When the PAP test is abnormal, a
colposcopic examination of the cervix
and vagina is performed to delineate
the lesion and to target the areas to
be biopsied.
- Normal
cytoplasmic
staining
in
superficial cells may be either red or
blue; superficial cells-squamous.
- There is reduction in cytoplasm and
the increase in the nucleus-tocytoplasm ratio, which occurs as the
grade of the lesion increases (LSIL
koilocytes-HSIL
(CNII)-HSIL(CNIII)).
*HSIL-High
Grade
Intraepithelial
lesions
- < This reflects the progressive loss of
cellular differentiation on the surface
of the lesions from which the cells are
exfoliated.>
Advantages:
a) Transparent blue staining of cytoplasm is
obtained due to the action of high alcoholic
content of the cytoplasmic counterstain,
allowing overlapping cells to be seen and
identified.
b) Excellent nuclear detail is produced
c) Color change is predictable and of great
value in identification and classification of
cells, producing a good differential coloring of
basophilic and acidophilic cells
d) It is valuable in comparing cellular
appearances in smears with their counterpart
in similarly stained sections.
MODIFIED
PAPANICOLAU
STAINING
PROCEDURE:
- Provides optimum nuclear detail
information, which is important for
cytologic evaluation of Pap smears,
non-gynecological and FNA cytologic
specimens:
1. Stain conventional Pap smears by routine
Papanicolau staining procedure.

2. For Pap smears prepared with liquid-based

techjnique , an automated stainer should be
used.
3. To avoid contamination:
a) Stain
non-gynecologic
and
FNA
specimens separately
b) Do not stain fluid specimens in close
proximity to other cases
c) Stain suspicious cases separately when
necessary
d) Assess cellularity of fluids and FNA
specimens and stain those with high
potential
for
cross
contamination
separately.
4. Change all stains weekly or as needed
depending on work load.
5. Discard first rinsing alcohol daily, advance
subsequent rinses and place new alcohol as
the last rinse. Do the same for xylene.
6. Smear should not be allowed to dry in
between any of the staining steps.
7. Keep a record of changes in staining
procedures next to the stainer.
8. All problems with staining should be
identified,
monitored,
corrected
and
recorded.
II.

Negative pressure should be released

before the needle is withdrawn
Bloody specimens may be avoided by
using small gauge needle and release of
negative pressure right before the
withdrawal of the needle

FNA Technique for Non-palpable masses

1. Aspirate fluid under the fluoroscopy,
computed tomography, ultrasound or any
appropriate radiologic technique
2. Release suction when the material
appears in the syringe
3. Material should remain within the needle
only (for non-cystic masses)
4. Procedure should be repeated 3-4 times
5. Material is expressed on a properly
labelled slide and immediately fixed with
95% alcohol using a spray fixative
6. For cystic lesions, fluid should be
submitted fresh in the syringe without
fixative

Fine Needle Aspiration Cytology

o A simple, safe and rapid cytologic
technique that has been commonly
used for diagnosis of cancer
o Completely replaced the use of tissue
core biopsy in many clinical conditions
o Superficial masses usually done by
the clinicians, or in some centres by
the pathologists
Breast
Thyroid
Peripheral lymph nodes
o Deeply seated lesions performed
under
laparoscopy,
computerized
tomography (CT scan) or ultrasound
(sonography)

FNA Technique for Palpable masses (breast,

thyroid, soft tissue and lymph nodes)
1. Palpate the target lesion
2. Sterilize the overlying skin
3. Fix the lesion with one hand between the
index fingers and the thumb
4. Introduce the needle (22-23 gauge)
*NOTES:
- size of the attached syringe depends on
factors such as depth of lesion and the
potential fluid content of the underlying
lesion (e.g. cyst)
- Needle tip should be moved back and
forth when it is within the target for an
adequate and representative sampling
- Needle
can
be
withdrawn
and
repositioned in different angles for better
sampling (only 3 passes on angles)

AUTOPSY
What is Autopsy?
- A thorough examination of a body after
death to determine:
o Cause of death
o Manner of death
Note:

Recognize the importance of treating

every autopsy case as if it were
infectious. (Universal Precautions)
Practice Bio-safety: To reduce risks of
accidental exposure to infectious material
via:

Puncture
wounds
(needles,
sharpes)
o Splashes (mucous membranes)
o Inhalation
o Pre-existing wounds
Calculate the time of death at external
examination.
The body cools, in general, at a rate of
approximately 1C per hour.
Temperature is most accurately measured
internally = liver or rectal.
o

Why Is Autopsy Performed?

- Verification of cause of death
- Medical advancement
Two Types Of Autopsy
- Hospital autopsy
- Forensic autopsy
Hospital Autopsy
- Performed for academic purposes
- Subject to medical confidentiality
- Patient already identified
- May be performed by pathology assistant
Forensic Autopsy
- A matter of public interest and record
- Must be performed by pathologist
- Performed under legal authorization/mandate
- Provides
objective
report
without
interpretation
In forensic autopsy death is placed in five
categories:
1. Natural
2. Accident
3. Homicide
4. Suicide
5. Unknown
Autopsy Techniques
1. Virchows technique
2. Rokitanskys technique
3. Ghons technique
4. Letulles technique
Tools For Autopsy
1. ENTEROTOME large scissors are used for
opening the intestines. The bulb-ended blade
is inserted into the lumen (the hollow inside)
of the gut. The bulb keeps the internal blade
from perforating the gut from the inside.
2. SKULL CHISEL for the separation of the top
of the calvarium from the lower skull, thus
exposing the brain and its coverings
(meninges).
3. HAGEDORN
called the sailmaker's
needle, this is a large needle with an eye for
sewing up the body after the autopsy is
finished. The stitching is similar to that used
on the outer covering of baseballs.

4. RIB CUTTER These look like small pruning

shears and are used to cut through the ribs
prior to lifting off the chest plate.
5. SCALPEL This differs from the surgeon's
scalpel in having a longer handle for reaching
deeper into body cavities. The disposable
blade is usually a #22 size, which is the
largest.
6. TOOTHED FORCEPS The teeth on these
"pickups" lend strength in gripping heavy
organs for removal. In surgical pathology,
teeth are a liability in that they increase the
risk
of
cross
contamination
between
specimens, so untoothed forceps are used
there.
7. SCISSORS used for opening hollow organs
(such as the gallbladder) and trimming off
tissues.
8. HAMMER WITH HOOK The hammer
(perhaps
the
Beatles'
inspiration
for
"Maxwell's silver hammer") is used with the
chisel to separate the calvarium from the
lower skull. The hook is handy to pull the
calvarium away.
9. BREADKNIFE Also referred to simply as the
"long knife," this is used to smoothly cut solid
organs into slices for examination, display,
and photography of the organs' cut surfaces.
10. VIBRATING SAW Also referred as the
"Stryker saw," is the instrument of choice for
removing the brain. The blade reciprocates
rapidly with a small amplitude. This action
prevents the saw from cutting soft tissues,
notably
the
pathologists
hand.
The
disadvantage of vibrating saws is that they
throw up more potentially infectious aerosols
than do hand saws.
Note:
1. Enterotome large scissors are used for
opening the intestines. The bulb-ended blade
is inserted into the lumen (the hollow inside)
of the gut, and the instrument is smoothly
stripped down the length of the intestine. The
blunt bulb keeps the internal blade from
perforating the gut from the inside.
2. Skull chisel After scoring the calvarium (the
vault-like part of the skull that holds the
brain) with the vibrating saw or hand saw,
the chisel is used to gently finish the
separation of the top of the calvarium from
the lower skull, thus exposing the brain and
its coverings (meninges).
3. Hagedorn called the sailmaker's needle, this
is a large needle with an eye for sewing up
the body after the autopsy is finished. The
stitching is similar to that used on the outer

covering of baseballs. Heavy twine, which is

much coarser than suture, is used for the
procedure
4. RIB CUTTER These look like small pruning
shears and are used to cut through the ribs
prior to lifting off the chest plate. Some
prosectors actually use pruning shears from a
hardware store, which are much less
expensive.
5. SCALPEL This differs from the surgeon's
scalpel in having a longer handle for reaching
deeper into body cavities. The disposable
blade is usually a #22 size, which is the
largest commonly available.
6. TOOTHED FORCEPS The teeth on these
"pickups" lend strength in gripping heavy
organs for removal. In surgical pathology,
teeth are a liability in that they increase the
risk
of
cross
contamination
between
specimens, so untoothed forceps are used
there.
7. SCISSORS These are otherwise unremarkable
scissors used for opening hollow organs (such
as the gallbladder) and trimming off tissues.
They can also be used for blunt dissection by
means of an "opening" motion, rather than
the more familiar "closing" motion used in
cutting.
8. BONE SAW This hand saw is rarely used
today, most often by pathologists who fear
infection from aersols thrown up by the much
more vigorous vibrating saw (see below). The
hand saw can be used to saw through the
skull, but it's very slow-going compared to
the vibrating saw.
9. HAMMER WITH HOOK The hammer (perhaps
the Beatles' inspiration for "Maxwell's silver
hammer"?) is used with the chisel to
separate the calvarium from the lower skull.
The hook is handy to pull the calvarium away.
10. Breadknife: Also referred to simply as the
"long knife," this is used to smoothly cut solid
organs into slices for examination, display,
and photography of the organs' cut surfaces.
Particularly
facile
prosectors
pride
themselves on being able to do almost all of
the soft tissue dissections (including stripping
the gut from the mesentery and opening the
heart chambers) with this large, unlikelylooking blade. The example shown here
includes a disposable blade. Models with
permanent, resharpenable blades are also
available.
11. Vibrating saw: The vibrating saw, also
referred to eponymously as the "Stryker
saw," is the instrument of choice for most
prosectors faced with removing the brain.
The blade reciprocates rapidly with a small
amplitude. This action prevents the saw from
cutting soft tissues, notably the prosector's
hand. The disadvantage of vibrating saws is
that they throw up more potentially
infectious aerosols than do hand saws.

Virchows technique
- Organs are removed one by one
- Order of organ removal: CSTA
o Cranial cavity
o Spinal cord
o Thoracic
o Abdominal
Note:
- Rudolph Carl Virchow (13 October 1821 5
September 1902) was a German doctor,
anthropologist,
pathologist, prehistorian,
biologist and politician, known for his
advancement of public health. Referred to as
"the father of modern pathology", he is
considered one of the founders of social
medicine.
- Virchow also developed a standard method
of autopsy procedure, named for him, and
many of his techniques are still used today.
He is also credited with inventing the liver
probe, a device used to take the temp. of a
dead body.
Rokitanskys Technique
- In situ dissection combined with en bloc
removal
- Most commonly used
Note:
- Baron Carl von Rokitansky (German: Carl
Freiherr
von
Rokitansky, Czech: Karel
Rokytansk) (19 February 1804 23 July
1878),
was
a Bohemian physician, pathologist,
humanist philosopher and liberal politician.
Gohns Techniques
- Thoracic, cervical, abdominal, and urogenital
organs are removed as organ blocks. (TCAU)
- Most commonly used in Philippines.
Note:
- Removal of organs in regional and functional
groups
(cervical,
thoracic,
abdominal,
genitourinary)
- 1) Preservation of inter-organ relationships.
- 2) Easier for one person.
Letulles Technique
- Thoracic, cervical, abdominal, and pelvic
organs removed en masse and dissected into
organ blocks
- Suited for inspection of connections between
organ systems
- Quick to do
Note:
- Letulle (en masse) Technique
- Removal of organs together in toto
- 1) Allows for rapid preparation for mortuary.
2)
Excellent
preservation
of
interrelationships
of
various
organs.
3) May offer greater safety to prosector
(dissection outside confines of body).

Post-mortem Changes
Death complete cessation of metabolic and
functional activities of the organism/body as a whole
3 Primary Changes (Death):
1. Circulatory failure
- Absence of pulse
- No heartbeat
2.
3.
-

Respiratory failure
Loss of rise and fall of the chest
No sign of breathing
Nervous failure
No response/absence of reflexes

2.
3.
4.
-

Mummification
Skeletonization
Adipocere
Advance decomposition
release of fatty fluid from the body

Methods for the Estimation of Time of Death

1. Rate Method
- Body changes, blood changes, plant/animal
indicators
2. Concurrence method
- Environmental changes that may indicate a
particular time of death.

Secondary Changes after Death

1. Rigor mortis
- severe rigidity/spasm of the muscle
- interlocking of myosin and actin secondary to
lactic acid build-up
- Manifestation: 1-6hours
- Maximum: 6-24hours
- Persists: 12-36hours, skin starting to decay
- After 3-4days, the body will soften breakage
of actin and myosin

Process
General System/Procedure of Autopsy
1. A request for the autopsy is submitted
2. Consultation with relatives
3. Proper identification of the body
4. Gross examination
5. Autopsy proper and acquisition of specimen
for microscopic examination
6. Microscopic examination

2. Livor mortis
- In latin, Livor means bluish color, mortis
means death
- Settling of the blood in the lower portion of
the body causing a purplish-red discoloration
of the skin
- Heavy red blood cells sink
- Congested in the capillaries in 2-4hours
maximum is 8-12hours

Releasing of reports
Pre-autopsy Requirements
1. A consent for the autopsy should be obtained
first from the nearest of kin.
a) Husband/wife
b) Father/mother or a child
c) Brothers/sisters
d) Grandparents
e) Second degree relatives/guardians

Tardeus spots/Petechial haemorrhages

- rupture of capillaries after death resulting to
petechiae like hemorrhage
- secondary to asphyxiation
- indicator if the dead body was moved
- may indicate asphyxia if evident is the sclera
- Law: Do resuscitation procedure even if the
patient is dead on arrival.

2. Included in the consent form at least three

witness signatures that are not close
relatives to the patient.

3. Algor mortis
- Latin: Algor meaning coolness
- reduction in body temperature following
death
- will equalize to the environment temperature
- steady decline until matching ambient
temperature
- 1-7oF/hour until the body is near ambient
temperature
- Glaister equation: for determining the
approximate time period since death based
on body temperature
- 98.4F-Rectal temperature in Farenheit/1.5
Postmortem Tissue Changes
1. Decomposition
- autolysis: by enzymes from lysosome
- putrefaction: by bacteria

3. Explained fully and clear enough to the

relatives.
4. In medico-legal cases death with
questionable circumstances, a medico-legal
officer/an appropriate agency like NBI/PNP is
consulted.
5. Relatives of the patient are not supposed to
be in the autopsy room during the procedure.
Autopsy Proper
Extent of the autopsy
- Can be found in the requisition form
a) Partial autopsy specific body component is
only involved
b) Complete (Full) autopsy whole body
involvement
External examination
- Identifying marks
- Features to note

Internal Examination
- Basic incision Y for maximum exposure
- Deflect skin and muscles
- Cut the ribs
- Organs are first inspected in-situ
- Collect samples for post-mortem
- Internal organs are removed in blocks
- Pull skin over skull to expose for cutting
Note:
- For hospital autopsies, organs stay with the
pathologist
- For forensic autopsies, organs are placed
back inside the body.

in a solution of formalin for up to two weeks.

Although two weeks is the optimal time to fix the
brain, it can be sufficiently fixed in a shorter period
in order to facilitate the return of the brain to the
body prior to burial in selected cases.
6. Weighing the organs
All removed organs are weighed and studied
individually. Most organs are cut up in sections by a
scalpel.
7. Draining of intestines
Intestines are drained in a sink to
undigested food and feces that remains.

remove

8. Opening of the stomach

The stomach is cut open on its greater curvature
and the contents are examined.
Steps on Autopsy
1. External examination
The pathologist records the results of the external
examination and lists all physical characteristics.
The body must be measured and weighed and
placed on an autopsy table. An autopsy table is
waist-high stainless steel with running to facilitate
washing away all the blood that is released during
the procedure. The autopsy table is a slanted tray
(for drainage) with raised edges (to keep blood and
fluids from flowing onto the floor).

9. Taking samples for microscopic analysis

Microscopic samples of most organs are taken for
further
analysis.
Finally, all major blood vessels are cut open and
examined lengthwise.
10. Returning organs to the body
The organs are placed back in the body, and the
body will sometimes be filled with a filler material.
The head and body are then sewn up. The brain is
returned to the body, except in the cases where the
brain has been retained for further tests.

2. The first cut known (Y incision)

The first cut known as the 'Y' incision is made. The
arms of the Y extend from the front of each shoulder
to the bottom end of the breastbone. The tail of the
Y extends from the sternum to the pubic bone and
typically deviates to avoid the navel. The incision is
very deep, extending to the rib cage on the chest,
and completely through the abdominal wall below
that. The skin from this cut is peeled back, with the
top flap pulled over the face.

11. Sewn up of the Y incision

Once the Y incision is sewn up, the autopsy (without
brain and tissue analysis) is complete.

3. Internal examination
The ribs are then sawn off and the sternal plate or
anterior chest wall is cut away, to expose the organs
underneath. The most common way to remove the
organs is known as the Rokitansky method. Organs
are removed by cutting off their connections to the
body and are usually removed as one.

Toothed forceps
- Used for packing the body, lifting tissue,
swabbing and many other purposes.
- The teeth on these lend strength in gripping
heavy organs for removal.

4. Removing the brain

The brain is removed using a transverse incision (in
a crosswise direction) through the brainstem, cutting
the connection from the base of the brain to the
spinal cord. The brain is then either cut fresh or is
placed in a 20% solution of formalin to fix it for
future analysis.
5. Fixing the brain
In cases like homicide or where there is a complex
pathology of the brain, a detailed study of the brain
may be necessary. In its fresh state the brain is very
difficult to cut, so in order to make it easier for the
neuropathologist to examine, the brain will be fixed

Instruments
Bone saw
- Hand saws are rarely used these days.
- The hand saw can be used to saw through
the skull, but it's much slower than the more
commonly used vibrating saw.

Scalpel
- This differs from the surgeon's scalpel in
having a longer handle for reaching deeper
into body cavities.
- The disposable blade is usually a #22 size,
which is the largest commonly available.
Rib cutters
- These look like small pruning shears and are
used to cut through the ribs prior to lifting off
the chest plate.
Surgeons needles
- Large needles for sewing up the body after
the autopsy is finished. The stitching is

similar to that used on the outer covering of

baseballs.
Heavy twine, which is much coarser than
suture, is used for the procedure.

Skull chisel
- After scoring the calvarium with the hand
saw, the chisel is used to gently finish the
separation of the top of the calvarium from
the lower skull, thus exposing the brain and
its coverings (meninges)
Enterotome
- These large scissors are used for opening the
intestines. The bulb-ended blade is inserted
into the lumen (the hollow inside) of the gut,
and the instrument is smoothly stripped
down the length of the intestine. The blunt
bulb keeps the internal blade from
perforating the gut from the inside.
Hammer with hook
- This is used with the chisel to separate the
calvarium from the lower skull. The hook is
handy to pull the calvarium away.

Bread Knife
- Also referred to simply as the "long knife,"
this is used to smoothly cut solid organs into
slices
for
examination,
display,
and
photography of the organs' cut surfaces.
- Particularly
facile
prosectors
pride
themselves on being able to do almost all of
the soft tissue dissections (including stripping
the gut from the mesentery and opening the
heart chambers) with this large, unlikelylooking blade.
- The example shown here includes a
disposable blade. Models with permanent,
resharpenable blades are also available.
Vibrating Saw
- also referred to eponymously as the "Stryker
saw," is the instrument of choice for most
prosectors faced with removing the brain.
The blade reciprocates rapidly with a small
amplitude. This action prevents the saw from
cutting soft tissues, notably the prosector's
hand. The disadvantage of vibrating saws is
that they throw up more potentially
infectious aerosols than do hand saws.