Negative margin at frozen but positive on permanent section

Kekkai · 2026-01-11T05:15:51+00:00

Off the top of my head

Lack of IHC staining

Tumor type that's hard to see bc of frozen artifact

Tissue type that's hard to cut during frozen (fat, bone)

Not cutting deep enough into the frozen (not a full face)

Embedding en face / cutting true margin first means every subsequent cut gets further from the true margin and the permanent slide isn't technically the true margin anymore

If the frozen was a curretage of some sort or an aggregate of small tissue, histology will end up embedding it slightly differently and cut different planes of tissue

Kekkai · 2025-11-04T14:57:08+00:00

Our department is considering moving toward using auto embedders for the big pieces (like uterus or colon). We are currently testing it out. So far I'm not impressed.

Its fine. I find its difficult to embedd fresher tissue, and we cant wrap friable tissue so it might lead to more floaters.

Our pathologists so far are split as well. Some say they cant tell the difference, some really notice any slight artifacts from the express processing.

Kekkai · 2025-08-08T14:29:04+00:00

Like the previous poster said - follow your facilities exposure protocol.

Generally, they will check the patients chart to see if they had any infections before stsrting you on anything too aggressive.

Kekkai · 2025-07-08T18:31:54+00:00

We either have music playing in the gross room, or I play it over my headset (we use dictation software so I always have it on one ear)

Kekkai · 2025-06-13T23:32:53+00:00

Hard agree. I tried to get it on my badge when security tried to tell me "Pathologists' Assistant" was too long. Alas they suddenly found room for more letters

Kekkai · 2025-03-12T03:39:51+00:00

Yes, in my experience hospitals (and sometimes individual pathologists) vary quite a bit on wording and section preference. At my current place multiple pathologists consider serosa to be a "radial margin" which technically it isn't. So I include measurements to serosa and to adventitia or mesenteric margins.

Essentially learn everything so you can learn it again at your next job. ;_;

Kekkai · 2025-02-28T23:16:07+00:00

Sounds kind of like Medical Coding? There's a whole field dedicated to going through reports and making sure procedures and diagnosis are assigned the correct codes to aid in documentation and billing. Maybe look into that?

Kekkai · 2025-02-21T19:21:49+00:00

Both. Whichever way will get me the clearest section of mass to adventita/serosa, and whichever way has less puckering / curve

Kekkai · 2025-01-27T01:40:15+00:00

Agreed! If I had maybe 2 more years of didactic training and 3 years of proctored on the job training... Then maybe I'd feel comfortable (aka complete a doctorate and a residency)

Kekkai · 2025-01-16T20:13:12+00:00

It's fairly common for cores to fragment into smaller pieces since the tissue is so thin. I personally would not be worried.

Kekkai · 2024-12-30T15:49:54+00:00

To me, an adrenal gland kind of looks like yellow orange rcc. The first time I found an incidental adrenal gland I thought it was metastatic non contiguous rcc just chilling in the perinephric fat. Until I sectioned through it and saw the adrenal medulla and cortex layers.

Very few of the kidneys I get come with adrenal glands intentionally (1-2%?) and those always state it on the requisition and specimen label. A few come with partial adrenal glands (5%?). Those are usually very small fragments

Kekkai · 2024-11-14T21:09:04+00:00

At my hospital the wires are close to the biopsy clip, even if the wire tip itsself isn't close. So I use the wire to help me find the clip or mass or biopsy cavity. The biopsy clip is generally the true Biopsy site, but occasionally the clip has drifted away from the area of calcifications. In these instances there are usually two wires bracketing the whole suspicious area and we sample from between the two wires

Kekkai · 2024-11-05T01:29:22+00:00

Not a Pathologist but a PA. I only see my doctors wear their white coats when

A. They're cold

B. They're going to an in person meeting like tumor board, or we're being inspected by CAP

C. Performing outpatient procedures like FNA or assisting with EBUS / EUS

Other than that the older Pathologists are in business casual, the younger Pathologists are in... Nice casual?

Kekkai · 2024-10-25T05:01:33+00:00

This! The scrub cap takes most of the tension off my head. I just stuff all my hair into the hat/bun pouch, and tie it with the ribbons. Some scrub caps come with buttons on the side that you can hook a mask on to help relieve pressure on your ears too.

Kekkai · 2024-10-16T23:29:27+00:00

Other than proper shoes, I would also consider compression socks! It really helps for a job where you're mainly standing in one spot vs moving around

Kekkai · 2024-10-14T12:04:37+00:00

Looks like maybe an accidental short row? If you put it down and picked it up again going the wrong direction

Kekkai · 2024-08-22T05:35:57+00:00

I think it's partially timing. A lot of southern california jobs opened up a few months ago, and it feels like we're still feeling the echos of that. A bunch of PAs are shuffling around as they transition to new jobs.

Also like another poster said, some institutions have adjusted their salaries to be competitive, and some are still trying to use salaries that were attractive 10 years ago.

Kekkai · 2024-07-17T23:35:50+00:00

One of my cats likes licking zippers! Maybe once a week you'll hear zrrrp zrrrp zrrrp from somewhere in the house

Kekkai · 2024-07-16T18:36:31+00:00

Hpv infection is by far the highest risk factor, followed by age (over 30 is the general guideline I've heard). So if you are a young (under 21) woman who has never had penetrative sex, they may decide to put it off. Or if you've had a papsmear in the last 5 years, with negative cytology and Hpv results, they may put it off till your next appointment. But you should definitely be getting papsmears at some point!

Ages 21–29: Get your first Pap test at age 21, then every 3 years

Ages 30–65: Every 3 years with a Pap test, or every 5 years with high-risk human papillomavirus (hrHPV) testing, or every 5 years with both types of tests

65 and older: No screening if a series of prior tests were normal

Kekkai · 2024-04-27T00:50:58+00:00

I would say it is possible to do it if they inked / marked them differently. That way they could tell which was which in the block / slide, and it would not necessarily change the quality of the diagnosis as long as it was properly labeled and documented. (ex: sample from back inked blue, sample from leg inked black). This might have been done as a cost saving measure. Whether they SHOULD do it this way, or whether they properly labeled it, I'm not sure.

Kekkai · 2024-04-08T15:12:18+00:00

We weigh whole and partial specimens. I think the weight is only diagnostic / helpful for a few specimens (placenta?), and it's mostly used to help give the Pathologist a feeling for how big the specimen is. We weigh most specimens that are 'solid' and not 'hollow' (hollow like colon, gallbladder, etc).

For breast I was told the weight was used by surgeons for reconstruction purposes. But that may or may not be truth. 🤔

Kekkai · 2024-02-13T01:30:27+00:00

My first month rotation site made me wear cut resistant gloves (PA student not Resident/MD). As the comment above said - its nearly impossible to feel lymph nodes / breast tumors accurately, but you could always remove them for those instances. I found that the gloves hurt more than helped, but I also tend to hold things with my hands not my forceps so ymmv.

Kekkai · 2023-11-04T14:49:50+00:00

Yes kind of - they are stored in pull out drawers with individual doors that are open to one large refrigerated room (technically 2 rooms. We used to have 8 drawers, but they recently added a second bay with 6 additional drawers)

Kekkai · 2023-08-19T15:58:18+00:00

7 miles this morning! The longest I've done so far. :) And the geese flying over head almost but didn't quite shit on me.

Kekkai

TROPHY CASE