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Fluid Aspirations from Tumors: How to Proceed

During Working Hours

  • The OR may call the service pager for a pick up or the specimen will be taken to the gross room to be accessioned
  • The PA will dictate a gross description, print a cassette and take the specimen, requisition form, cassette and lid to cytology (6th Floor, C-wing PUH).
  • The cytotechnologist spins the fluid into a pellet and determines how to proceed based upon the pellet size.
  • If the pellet is large enough, Histo Gel is added and it will be submitted for processing as a cell block. If it is too small for a cell block two cytospins will be made and stained with Papanicolaou stain and Diff Quick stain.

Cyst fluid from primary vs. metastatic tumor

  • Follow the above instructions under During Working Hours

Craniopharyngioma cyst fluid

  • At the time of intra op consultation, you should prepare a smear, preferably on positively charged slides (they have a white frosted end)
  • Let the slide dry completely and then do a DQ stain (follow instructions posted in frozen section rooms, both at Presby and Children).
  • Coverslip with a drop of water and examine the slide under the microscope (with and without polarized light).
  • Try to capture an image as soon as possible in Copath PicsPlus.

Cyst fluid from a possible infectious process

  • Make sure you talk to the surgeon and appropriate cultures have been taken in OR.
  • Then follow the above instructions under During Working Hours.
  • Consider ordering Gram/Grocott/PAS/AFB on the cell block

During Evenings or Weekends

  • If a request for fast processing and reading (STAT specimen) is made by the surgeon, you can take the specimen to Hematology after hours or during the weekends. They will prepare cytospin and cell block for you. You could then take the cytospin slides and stains them in the frozen section room.
  • If this happens a Saturday afternoon or after hours on a day preceding a holiday, you would have to notify the PA on call or Frank Fusca, who would contact the histotech on call to come the next day to process the block. They would page you to come to histology, sign a form and collect the slides to be read.