experiences of specimen dissection
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Experiences of Specimen Dissection. Andy Munro. Histology Specimen Dissection. Ninewells Histology Department. Accredited by CPA (UK) Receives over 30 thousand cases / year 15 consultant pathologists 5 trainee pathologists 5 BMS Involved in Specimen Preparation - PowerPoint PPT PresentationTRANSCRIPT
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Case Study: Colorectal Cancer
Rebecca MungallMumin Abla
The University of the West of ScotlandApplied Biomedical Science BSc Students
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Colorectal Cancer: An IntroductionColorectal cancer, a cancer of the colon or rectum, is the third most common cancer in the UK, with the second highest fatality rate of all cancers.
(Fig.1: Anatomy of the Large Intestine)KEY: 1: Cecum; 2: Ascending Colon; 3: Right Hepatic Flexure; 4: Transverse Colon; 5: Left Hepatic Flexure; 6: Descending Colon; 7: Sigmoid Colon; 8: Rectum.
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Risk FactorsRisk factors associated with developing colorectal cancer can be divided into 2 main categories; modifiable and uncontrollable .
Preventable Risk Factors:
•Diet•Alcohol consumption•Smoking•BMI
Non Preventable Risk Factors
•Genetic/hereditary conditions(FAP, HNPCC)Family history of colorectal cancer•Presence of certain medical conditions (Crohn’s/ulcerative colitis)•Previous cancer diagnosis
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Signs and Symptoms
Colorectal cancer may present with symptoms such as:
• A change in bowel habits
• Rectal bleeding or blood in stool
• Persistent abdominal discomfort
• Anemia
• Increased infections
Early stage, asymptomatic colorectal cancers are
Often detected during the bowel screening program..
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Treatment Plan and Monitoring
Treatment:
• Surgery
• Chemotherapy
• Radiotherapy
Monitoring:• Medical history and physical
examinations• Regular colonoscopies• Imaging tests• Blood tests for tumor markers
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Case Study – Haematology
Parameter Result Units Ref. Range
Hb 10.6 (LOW)
g/dL (13.5-18.0)
HCT 0.342(LOW)
L/L (0.370-0.470)
RDW 17.6 (HIGH)
% (11.0-16.0)
MCH 26.9 (LOW)
pg (27.0-32.0)
(XN10 Automated Haematology Analyser)
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Haematology: Blood Film
Poikilocytosis
Anicytosis
Hypochromic cells
Elliptocytosis
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Case Study: Pathology
• The patient underwent a colonoscopy, with biopsies, on 10/11/2014
• Biopsy analysis: Moderately differentiated adenocarcinoma, primary origin.
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Sigmoid Colon Excision
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Normal Section vs Tumour Section
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Invasion
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Lymph Node Analysis
Normal Lymph Node Metastatic lymph Node
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Immunocytochemistry
CK 20 POSITIVE CK 7 NEGATIVE
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Immunocytochemistry
CDX-2 POSITIVE CEA POSITIVE
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Immunocytochemistry
TTF-1 negative Positive control
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Immunocytochemistry
CA 125 NEGATIVE POSTIVE CONTROL
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Staging
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Case Study: Microbiology
Signs of sepsis:
• High temperature
• Lowered blood pressure (septic shock)
• Tachycardia
• Organ failure (Gram negatives)
Send specimens to Microbiology
laboratory for blood culture analysis.
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Blood Culture Analysis
• Continuous Monitoring• Easy to use• Reliable• Fully automated
BactAlert Analyser
CO2 + H2O ↔ H2CO3 ↔ HCO3- + H+
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Gram Stain
Gram Positive Blood Culture Gram Negative Blood Culture
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Culture
• Faecal Streptococci; e.gStrep. gallolyticus Enterococci spp
• Aerobic and anaerobic species; e.g. E. coli, B. fragilis
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Antimicrobial Susceptibility
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Identification: MALDI-TOF
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Sepsis: Clinical Significance
• Organ failure (Gram negatives)
• Coma
• Respiratory Problems: Ventilation
• Increased risk of contracting additional infections due to intravenous lines etc.
• Broad-spectrum antibiotics: More susceptible to resistant ‘superbugs’ such as C.difficile
• Potentially fatal
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Case Study: Biochemistry
• Blood sample taken into a gold top, Serum Separator Tube containing gel to allow serum separation.
• Tests requested:
❖ CEA
❖CA125
❖CRP
❖LFT
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CEA – Carcinoembryonic Antigen
• Monomeric Glycoprotein
• found in GI tract
• Tumour marker measured in biochemistry
• detect residual disease
• monitor chemotherapy after CRC
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First Reaction
Sample R2
(Ruthenium Labelled Antibody)R1/Biotinylated
Antibody
9 Minute incubation
Sample R1/R2 Mixture
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Second Reaction
Sample R1/R2 Mixture Streptavidin-coated Microparticle
9 Minute incubation
Complex bound to micro-particles via interaction of
biotin and streptavidin
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Second Reaction Continued
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Signal
(Light)
Conc.
Calculation of Result
(μg/L)
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Patient CEA Results
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Conclusion• CRC is still the leading cause of death
• Current screening techniques: (Colonoscopy, FS, FOBT)
• Fecal Molecular Marker
• Vaccines?
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Thank you for listening
Please feel free to ask any questions at this point.
With thanks to all of the staff at Wishaw General Hospital, especially our training officers, for all of their help and for giving us this opportunity.