The Pathology Report

 

After a biopsyA medical procedure in which a sample of tissue is removed for examination. Biopsies can range from a small sample drawn into a needle to samples taken during more invasive surgery. is taken the physician who performed the biopsy sends the specimen to a pathologist. The pathologist examines the specimens at both the macroscopic (visible with the naked eye) and microscopic (requiring magnification) levels and then send a pathology report to the physician. The report contains information about the tissue's appearance, cellular make up, and state of disease or normalcy. The pathology report is vital to the treating physician and the patient, as treatment decisions and options are made based on the information the report contains.

Sections on the following page:

Watch a video on breast cancer pathhology

 

 

Gross or Macroscopic Report
The first component of a pathology report is the gross or macroscopic report. This report includes the general appearance of the biopsy. Often times the pathologist will state the site from which the biopsy was taken. Also included is the shape of the tumor in question and whether or not it appears to have well-defined borders. In this section the size of the biopsy is given. Usually both the diameter or length and the weight of the specimen are given. All dimensions or size identifiers are given using the metric system of measurement. This means that lengths or diameters are given in centimeters and weights are given in grams.

NOTE:  There are approximately 2.5 cm in 1 inch and  454 grams in 1 pound.

Microscopic Report
The second section of the pathology report is the microscopic report. This portion contains information and descriptions that the pathologist attains by looking under the microscope. This more technical language describes the biopsy on a cellular level. Atypical is a term used to describe cells that appear to be abnormal when examined. Several factors can define varying levels of atypia. An atypical cell often has a nucleusPlural, nuclei. A subcellular organelle that contains the chromosomes. Present in eukaryotic cells, the nucleus is surrounded by the nuclear envelope. Within the nucleus is a region called the nucleolus in which the parts of ribosomes are constructed. The nuclear pores allow for the import and export of materials. that is larger than usual and contains a larger amount of chromatinA combination of DNA and proteins. Our chromosomes are composed of DNA that is twisted around proteins much like thread on a spool. than is normal. Pathologists also will check the mitotic rate of the cells, which is an indication of how quickly they are multiplying. DifferentiationThe maturation of a stem cell into a fully functional cell. Fully differentiated cells are often not able to divide and many cancers are thought to arise via mutations in the small number of stem cells that remain in the tissue. is a term used to describe how specialized a cell is to perform a specific job in a certain tissue. The less differentiated the cell is, the more atypical it is said to be. Also, of concern in the microscopic report is whether or not it appears that all abnormal cells were removed from the biopsy site. To do so the pathologist uses the microscope to look at the borders of the biopsy. If there is a border of normal cells around the abnormal cells then the biopsy is said to have clear margins and it is assumed that all atypical cells were removed. If however there appears to be abnormal cells that lie at the edge of the removed tissue then the margins are not clear and the pathology report would contain further instruction to your physician. It would include specific information about regions that should receive further treatment, such as, additional surgery or other treatment. More on surgery and 'margins'.

Diagnosis
Normally a pathology report includes one last section, the diagnosis. In this portion the pathologist would give a technical diagnosis that would indicate whether the biopsy is benignA growth that does not leave its site of origin or invade surrounding tissue. Benign growths can get large and are capable of causing illness or even death, depending on the location of the growth. Technically, benign growths are not cancer. or malignantA tumor that has invaded neighboring tissue.. If it is determined that the biopsy is benign then the pathologist would most likely give insight into what level of risk the removed tissue presents to the patient's health in the future and the likeliness that this or other tumors like it would develop into more harmful malignant tumors. If it is determined that the biopsy contains malignant tissue then the pathologist would provide an indication of the cancer's severity based on findings presented in other sections of the report.

In some cases, an additional "comments" section might conclude the report that would list any other testing to be done on the biopsy and any other tests that still have incomplete results. Cancers of some organs are associated with additional specific tests. These additional tests would be included in the report.1, 2

FAQ Cancer Pathology 

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What is pathology?

Pathology is a branch of medicine that studies the cause and nature of disease. In breast cancer pathology, a pathologist examines tissue samples obtained by biopsy or surgery.

How do pathologists get their samples?

In breast cancer pathology samples are taken from breast lesions by means of biopsy or surgery. The types of biopsy used for breast cancer are fine needle aspiration (FNA), core needle biopsy, and excision biopsy.

What do pathologists do with the samples they get?

When a pathologist gets a sample they chemically preserve the tissue and process it for examination. After processing the pathologist examines the sample with a microscope. Different stains are used to reveal important characteristics of the sample.

How do pathologists stage a tumor?

Pathologists use a variety of techniques to determine the stage of a tumor. Pathologists study the characteristics of cancer cells as well as the overall structure of the sample. Pathologists determine the mitotic index (how many of the cells are dividing) and the histologic 'grade', a measure of how abnormal the cells appear. One system used to stage some cancer types tumor is the TNM method, which stands for:

  • Tumor - the size of the tumor
  • Lymph Nodes - whether the cancer has spread to regional lymph nodesA grape-like cluster of lymphatic tissue. Lymph nodes (or lymph glands) filter the lymph fluid that flows through the lymphatic system. Lymph nodes collect fluid from discrete regions of the body and are often examined for the presence of metastasizing cancer cells.A grape-like cluster of lymphatic tissue. Lymph nodes (or lymph glands) filter the lymph fluid that flows through the lymphatic system. Lymph nodes collect fluid from discrete regions of the body and are often examined for the presence of metastasizing cancer cells.
  • Metastasis - whether or not cancer has spread to other parts of the body

Learn more about cancer staging on our page dedicated to that topic.

What is immunohistochemistry (IHC)?

Immunohistochemistry is a technique used to determine the presence and level of specific cellular proteins. IHC measures proteinOne of the four basic types of biomolecule. Proteins are polymers made up of strings of amino acids. Proteins serve many functions in organisms including transport of molecules, structure, cell adhesion and as signaling molecules such as hormones. Many transcription factors, including p53 and Rb are proteins.One of the four basic types of biomolecule. Proteins are polymers made up of strings of amino acids. Proteins serve many functions in organisms including transport of molecules, structure, cell adhesion and as signaling molecules such as hormones. Many transcription factors, including p53 and Rb are proteins. levels using specially labeled antibodiesAntibodies are proteins produced by a type of white blood cell (B cells or B lymphocytes). Antibodies are able to stick very tightly to specific targets. Antibodies are currently being used as anti-cancer drugs (i.e. Herceptin).Antibodies are proteins produced by a type of white blood cell (B cells or B lymphocytes). Antibodies are able to stick very tightly to specific targets. Antibodies are currently being used as anti-cancer drugs (i.e. Herceptin). that can bind to the proteins of interest. Samples with more protein will bind more antibodyAntibody molecules tightly bind to their targets (usually proteins) with great specificity. Antibody binding alerts the immune system to target the bound molecule for destruction. Specific antibodies can be made in the laboratory. Antibody molecules tightly bind to their targets (usually proteins) with great specificity. Antibody binding alerts the immune system to target the bound molecule for destruction. Specific antibodies can be made in the laboratory. and give a stronger signal (stain). This allows the test to reveal not only whether a protein is present but also the relative amount of the protein. Test results are based on the strength of the staining and the percent of cells stained.

What is fluorescence in situFrom the Latin, hybridization (FISH)?

FISH is a technique that measures geneA stretch of DNA that leads to the production of an RNA. The RNA is produced during the process of transcription. This RNA can be used to guide the formation of a protein via translation or can be used directly in the cell.A stretch of DNA that leads to the production of an RNA. The RNA is produced during the process of transcription. This RNA can be used to guide the formation of a protein via translation or can be used directly in the cell. amplificationAlso: gene amplification. An abnormal process in which many copies of the same chromosome region are produced via DNA replication. The result can be a small 'microsatellite' chromosome or a region of DNA within a chromosome with many contiguous copies of a small set of genes. Also: gene amplification. An abnormal process in which many copies of the same chromosome region are produced via DNA replication. The result can be a small 'microsatellite' chromosome or a region of DNA within a chromosome with many contiguous copies of a small set of genes. and chromosomal abnormalities using fluorescently labeled DNAAbbreviation for deoxyribonucleic acid. Composed of very long strings of nucleotides, which are abbreviated as A, C, G and T. DNA is the storage form of our genetic material. All of the instructions for the production of proteins are encoded in our DNA. Abbreviation for deoxyribonucleic acid. Composed of very long strings of nucleotides, which are abbreviated as A, C, G and T. DNA is the storage form of our genetic material. All of the instructions for the production of proteins are encoded in our DNA. probes. The fluorescently labeled DNA matches certain regions of DNA and when the matching regions come in contact they bind with each other. Presence of the stuck probe marks the areas of interest. The amount and location of the of bound probe are then analyzed to identify genes that have been copied abnormally or altered in some major way.

 

Know the Flow: Pathology 

 

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