BIOPSY AND AUTOPSY LECTURE#4

BIOPSY
ü Biopsy (bios=life and opsy=look/appearance)
ü Biopsy is the excision and examination of tissue from a living
subject for diagnostic purposes.
ü Preferred: perform the biopsy at the periphery of the tumor
(advancing tumor margin)
ü Careful handling of the tissue is mandatory for sarcoma, and
immediate touch preparation for lymphoma
ü It could be therapeutic
HISTORICAL PERSPECTIVE
ü 1870, Ruge and Joham Vert in Berlin introduced surgical
biopsy as an essential tool for diagnosis.
ü 1889, Emarch put forward an argument that confirmations
should be made before surgeries for malignancies
ü William Halsted: 1st introduced this principle in US
ü1941, study of exfoliated cells from a female genital tract by
Papanicolaou
ü This was adapted to study cells from other body systems
ü Along with this were innovations in various kinds of tissue
preparations and staining techniques
INDICATIONS FOR BIOPSY
ü Any lesion that persist for more than 2 weeks with no
apparent etiologic basis
ü Any inflammatory lesion that does not respond to local
treatment after 10 to 14 days
ü Persistent hyperkeratotic changes in surfaces tissue
ü Any persistent tumescence, either visible or palpable beneath
relatively normal tissue
ü Evaluation and monitoring of tissue rejection after
transplantation – kidney and liver
TYPES OF BIOPSY
1. EXFOLIATIVE CYTOLOGY
ü is now widely used, especially for the diagnosis of malignant
conditions and sites as the cervix, uterus, vagina, and the
bronchial but also in urine and CSF and in fluid aspirated from
the pleural and peritoneal cavities.
ü Smears made from suspected metastasis
ü Desquamated cells
ü Sex hormonal status in females
ü Sex chromatin phenotype
TYPES OF BIOPSY
2. EXCISIONAL BIOPSY
ü Complete removal of lesion provides the MOST RELIABLE
BIOPSY
ü permits the pathologist to examine all of the suspicious tissue
ü Performed under local anesthesia before treatment is
planned, but may be done using frozen section.
TYPES OF BIOPSY
3. INCISIONAL BIOPSY
ü Removal of part of a lesion for histological examination
ü Preferred for large situated tumors that cannot be excised
ü Removal of small piece of tumors
ü Significant tumor remains
TYPES OF BIOPSY
4. ASPIRATION/NEEDLE BIOPSY
ü Aspiration biopsy is the use of a needle and syringe to
penetrate a lesion for aspiration of its contents
ü Infiltrate site with local anesthesia then place a 22G needle
attached to a 10ml syringe in the mass, apply suction while
needle is move back and forth release once aspirate is seen.
ü Cellular material expressed into slide and fixed with 95%
ethanol
 TYPES OF BIOPSY
4. BITE BIOPSY
ü Biopsy in which small pieces of tumor
are removed with special forceps
ü Endoscopic biopsy is example of this
type
 TYPES OF BIOPSY
5. CUTANEOUS BIOPSY
ü Cutaneous biopsy are removed from
the skin lesion
 TYPES OF BIOPSY
6. PUNCH BIOPSY
üIt is larger than 2 millimeter
üStained with H and E.
üGross lesion assessment is very limited
 TYPES OF BIOPSY
7. SHAVE BIOPSY
ü Shave biopsy always present
orientation problems and should be
reserve for secretions requiring only
histopathologic diagnostic
ü Curettage specimens
 TYPES OF BIOPSY
8. WEDGE BIOPSY
ü Specimen is subdivided with a razor
blade
ü Size should be thicker than 3 to 4 mm
ü If EM is used, it should be less than
1mm thin
MARGINAL EXCISION
It refers to excisional or shell out and is a procedure in which the lesion
is not entered but removed.
AUTOPSY
WHAT IS AN AUTOPSY?
ü “See for yourself”
ü A post mortem examination
preformed to determine the cause
of death.
ü Gold standard for confirmation of
a medical disease
TYPES OF AUTOPSY (USE)

1.FORENSIC AUTOPSY (medico-legal autopsy) –

seek to find the cause and the manner of death
and to identify the decedent.
2.CLINICAL OR PATHOLOGICAL AUTOPSIES –
performed to diagnose a particular disease or
for research purposes. To clarify and confirm
medical diagnosis that is unclear prior to the
patients death
3.ANATOMICAL OR ACADEMIC AUTOPSIES –
performed by students. For study purposes only
4.VIRTUAL OR MEDICAL IMAGING AUTOPSIES
– utilizes imaging technologies only, MRI and
CT
TYPES OF AUTOPSY (ANATOMICAL
PART/S)
1. COMPLETE AUTOPSY
ü Requires consent
ü Complete examination of all organs, including the brain
2. PARTIAL AUTOPSY
ü Part of the anatomy
3. SELECTIVE AUTOPSY
ü Restricted to at least a single organ (Ex. MI – heart)
CLASSIFICATION OF DEATH

In a forensic autopsy, a
MEDICAL EXAMINER or
CORONER declares the
death to be:
§ Natural
§ Accident
§ Homicide
§ Suicide
§ Unknown
PRELIMINARIES
1. WRITTEN CONSENT from the next kin-abide by the extent or
restrictions allowed
- Relative: oriented by the attending physician, not the
pathologist
2. DEATH CERTIFICATE (Old: Blue form | New: Blue
border/frame)
- Signed by:
a. Physician
b. Pathologist (back): will sign when PME has been performed
3. MEDICAL ABSTRACT OR CLINICAL DATA
4. MEDICO-LEGAL CLEARANCE
- Suspicious evidence of foul play
- Ex. physical injury
PROTOCOL FOR PERFORMING A FORENSIC
AUTOPSY?
Corpse brought to M.E.
In a new body bag/clean sheets
­ Avoids cross-transfer of evidence
Placed on dissection table
PHYSICAL EXAMINATION
2 Parts:
­ EXTERNAL
­ Physical outer layer – for injuries / cause of death
­ Steps:
1. Photographed
2. Samples taken: hair, nails
3. Undressed, examined for wound: lacerations, abrasions, bruises
4. Measured, weighed, cleaned
­ INTERNAL
­ Internal organs & tissue - evidence of disease, trauma, toxic
substances, organ failure
INTERNAL EXAMINATION
Steps of an internal examination.
1. Incisions
­ “Y”… Behind each ear, down the neck, meet mid-
sternum, continue to the groin.
­ For suspected strangulation – 50% no ext. signs
­ Show fractured HYOID bone
­ “T” … From each shoulder, meet top of sternum,
continue to the groin.
­ Better looking finished product
 INTERNAL EXAMINATION

2. CUTS
Chest cavity cut open w/shears or saw.
3. REMOVAL
1. Letulle’s “En Masse” method – All organs at once
2. Ghon’s “En Bloc” method – Organs removed in sections
4. Organs weighed, examined
 INTERNAL EXAMINATION
5. BRAIN EXAMINATION
1. Incision: from a point behind one
ear, over top of head, to point
behind the opposite ear.
2. Scalp pulled away from the skull,
forward and back. Front flap
over the face, rear flap over the
neck.
3. Skull cut with electric
saw…creates a “bowl”
4. Brain cut from spinal cord, lifted
out of the skull for further
examination.
POSTMORTEM CHANGES
1. ALGOR MORTIS
ü 1st demonstrable change after death is cooling of the body
ü At room temp: 2 - 2.5 °F/hr (1st hr)
ü 1.5 - 2 °F/hr (next 12 hrs)
ü 1°F/hr (next 12-18 hrs)
ü As a rule, the body cools at 1.5°F/hr (50% of cases)
ü Not a reliable indicator as to the time of death
POSTMORTEM CHANGES
2. RIGOR MORTIS
ü Rigidity of the body due to hardening of the skeletal muscles
caused by a series of physiochemical events after death
ü (-) ATP regeneration + acidity formation of locking-
chemical bodies between actin & myosin
ü This interlocking is fixed & produces rigor mortis w/o
shortening of the muscles
ü Sets within 2 hrs. after death (head & neck)
ü Complete within 12 hrs.
ü Persists about 3-4 days
POSTMORTEM CHANGES
3. LIVOR MORTIS
ü Blood supply gravitates to the skin vessels w/c becomes
toneless & dilate after circulation ceases
ü Becomes evident as early as 20 mins after death
ü Fully evident w/in 4-8 hrs.
ü TARDIEN SPOTS: petechiae
POSTMORTEM CHANGES
4. POSTMORTEM CLOTTING OF BLOOD
5. DISCOLORATION OF TISSUE
ü Abdomen: green
ü Formation of sulfur gases (bacteria)
5. PUTREFACTION
6. DESSICATION (MUMMIFICATION)
PRINCIPAL TECHNIQUES
OF AUTOPSY
TECHNIQUE OF R. VIRCHOW
ü Organs are removed ONE BY ONE sequentially.
ü This method has been most widely used
ü Isolated and dissected immediately after removal
TECHNIQUE OF C. ROKITANSKY (IN
SITU)
ü This technique is characterized by IN SITU DISSECTION
combined w/ en bloc technique
ü Body is cut open in the usual fashion
ü Cavities and organs are thoroughly inspected
ü Fluids are collected if needed
ü Organs are dissected while inside the body
TECHNIQUE OF A. GHON (EN BLOC)
ü Thoracic and cervical organs, abdominal organ, and the uro-
genital system are removed as organ blocks
ü By cavity
ü Interrelated to each other
ü Systemic dissection
ü Ex. thoracic cavity (lungs, heart, diaphragm), respiratory
system
TECHNIQUE OF M. LETULLE (EN
MASSE)
ü Thoracic, cervical, abdominal and pelvic organs are removed
en masse and subsequently dissected into organ blocks
ü Best routine method for inspection and preservation of
connections between organs and the organ system
 Procedure Turn over time

Surgical 1 day
pathology
Cytology 1 day

Frozen section 5-15 minutes

Autopsy 1week or 7 days

 Record/specimen Duration

Requisition (3 copies) 2 years

Quality control 2 years

Instrument maintenance 2 years

Clinical pathology lab. 5 years

report
Autopsy forensic report Indefinite

Surgical pathology (BM) 10 years

report
 Record/specimen Duration

Cytogenetics reports 20 years

Serum/other body 2 days

fluids
Pathology BM slides 10 years

Pathology blocks 10 years

Cytogenetics slides 3 years

Cytogenetics 20 years
diagnostics images