Cellular Pathology, QE Hospital Birmingham

 

The majority but not all of Cellular Pathology tests that are performed and equipment in use are accredited to internationally recognised standards for medical laboratories ISO 15189.  This is important for the Department and for service users as it provides assurance on quality and competence.   There is increasingly an integrated approach across the different UHB hospital sites e.g. Musculoskeletal Pathology and Heartlands Hospital based Cellular Pathology, where staff, equipment and testing may be shared to deliver the highest possible quality services to our service users. The full range and nature of accredited tests is detailed on the United Kingdom Accreditation Service website.  Select this link for the details:  http://www.ukas.com - Schedule of accredited tests for Laboratory 10141 .  The laboratory is currently modernising  H&E, special stains and immunohistochemistry staining platforms to support high quality diagnostic cellular pathology reporting and to ensure full traceability of samples within the laboratory.  Consequently not all IHC analysers, special stains and antibodies have been assessed by UKAS.  Others have been reviewed by UKAS early in 2020 and so again are not currently covered by UKAS Accreditation to ISO15189.   Should the laboratory demonstrate to UKAS that they satisfy ISO 15189 requirements for those new tests and platforms, then the UKAS website is updated to reflect that updated repertoire and further specific test details are also included below:

 

Specialist Services  within Cellular Pathology  Accredited Tests
MOHS Mohs, is microscopically controlled surgery used to treat common types of skin cancer. Yes
Neuropathological Smears The Department provides a rapid diagnostic service for intra-operative brain tissue specimens. Yes
Cytopathology  The Department provides the diagnostic cytopathology services for the Trust including fine needle aspirations, endoscopic brushings and washings, EUS-FNAs , serous fluids urines and CSF.  Yes
Muscle Biopsy Service Muscle biopsies are performed as part of the investigation of a clinically suspected neuromuscular disorder when other less invasive tests have not provided a firm diagnosis. Yes
Electron Microscopy Service The Electron Microscope Unit is used routinely at magnifications of between 1500 and 70,000 times to examine the ultrastructure of cells and their surroundings.   Yes

 

 

Immunohistochemistry 
Assay Code Diagnostic purpose Accrediation status  Future progress
AAT Alpha-1-Antitrypsin deposits  UKAS Omnis  
ACTH         Adrenocorticotropin hormone
expressing cells
not on scope 2020 ETS
AE1         Classification of
epithelial tumours
 UKAS Omnis  
AFP Alpha-1-Fetoprotein expressing cells not on scope 2020 ETS
Alpha Dystroglycan   not on scope  
ALPHA-B-CRYST           not on scope  
Alpha-SARC       Alpha-Sarcoglycan Staining protein  UKAS AS 48  
Assay Code Diagnostic purpose Accrediation status   
AMACR        Racemase Alpha-Methylacyl-CoA Racemase not on scope 2020 ETS
AMYLOID A         Demonstration of
 Amyloid A
not on scope  
AR adenoca of prostate, breast and ovarian ca not on scope 2020 ETS
ATRX         Glioma identification not on scope  
BAPP        Anti-Alzheimer Precursor Protein A4  UKAS AS 48  
B-CAT         Beta -catenin expressing cells  UKAS Omnis  
BCL2        B-cells  UKAS Omnis  
BCL6        B-Cells  UKAS Omnis  
BOB1         B-cells  UKAS AS 48  
BSCYTO (MNF116)        Epithelial cells  UKAS Omnis  
C4d        not on scope  
C9           not on scope 2020 ETS
CA 125        Identification of
serous ovarian cancer
 UKAS Omnis  
CA19.9        Epithelial cells, Sialyl Lewis
containing glycolipids
 UKAS Omnis  
Calcitonin        Calcitonin Expressing cells not on scope  
CALPONIN         Calponin expressing cells  UKAS Omnis  
Calretinin        Identification of
malignant mesotheliomas
not on scope 2020 ETS
CD10        CD10 expressing tumours not on scope  
CD117         CD117 expressing cells. Mast Cells.
Cajal Cells
 UKAS Omnis  
CD123        CD123 expressing cells  UKAS Omnis  
CD138  B-cells. Plasma Cells  UKAS Omnis  
CD14        CD14 expressing cells  UKAS Omnis  
CD15        Hodgkin Cells. Reed-Sternberg
Cells.
 UKAS Omnis  
CD19        B-Cells  UKAS Omnis  
CD1a        Lymphoblasts. Langerhans Cells.
Thymocytes
 UKAS Omnis  
CD2           not on scope  
CD20        B-Cells  UKAS Omnis  
CD21        Follicular Dendritic Cells, B-Cells  UKAS Omnis  
CD23         Follicular Dendritic Cells, B-Cells  UKAS Omnis  
AE1         Classification of
epithelial tumours
 UKAS Omnis  
CD25 Identification of Interleukin 2 receptor not on scope 2020 ETS
CD3        T-Cells  UKAS Omnis  
CD30        CD30 positive carcinomas such as
embryonal carcinoma
 UKAS Omnis  
CD31        Endothelial cells  UKAS Omnis  
CD34        Vascular and Lymphatic Vessels.
Cells of myeloid lineage
 UKAS Omnis  
CD4            UKAS Omnis  
AFP Alpha-1-Fetoprotein expressing cells not on scope 2020 ETS
CD43         T-Cells, B-Cells  UKAS Omnis  
CD45 LCA        Tumours of
lymphoid origin
 UKAS Omnis  
CD5 4C7        T-Cells  UKAS Omnis  
CD56        NK Cells, T-Cells  UKAS Omnis  
CD57            UKAS Omnis  
CD68 PG-M1        Leucocytes  macrophages  UKAS Omnis  
CD68-KP1         Macrophages and Monocytes  UKAS Omnis  
CD7         Macrophages. Monocytes. Cytokeratin 19 expressing cells  UKAS Omnis  
CD79        T-Cells  UKAS Omnis  
CD8        B-Cells  UKAS Omnis  
CD99        CD99 expressing cells not on scope  
CDX-2        Adenoca in GI tract  UKAS Omnis  
CEA         Carcinoembryonic Antigen positive
cells
 UKAS AS 48  
CEA POLY         Carcinoembryonic Antigen positive
cells
 UKAS AS 48  
CG               Neuroendocrine Cells.  UKAS Omnis  
CK14
(CYTO14)
  not on scope 2020 ETS
CK19 epithelial tumours with CK19 expression not on scope 2020 ETS
CK8/18 cyto 8/18 expression  UKAS Omnis  
CMV CMV infected cells  UKAS Omnis  
C-MYC          not on scope 2020 ETS
Collagen IV   not on scope  
CRP          not on scope  
CRYPTO           not on scope  
CyclinD1 mantle cell lymphoma  UKAS Omnis  
CYTO 17           not on scope  
CYTO 19         CK19  positive Epithelial Cells not on scope 2020 ETS
CYTO 20        Epithelial Cells (colonic type)  UKAS Omnis  
Alpha-SARC       Alpha-Sarcoglycan Staining protein  UKAS AS 48  
CYTO 7        (CK7) Cytokeratin 7 expressing cells  UKAS Omnis  
CYTO 8 (CAM5.2)        shows simple epithelium  UKAS Omnis  
Cytokeratin AE1/AE3        Classification of   UKAS Omnis  
D2-40        Podoplanin epithelial tumours  UKAS Omnis  
DES         Smooth muscle cells. Striated
muscle cells. Reactive mesothelial
cells
 UKAS Omnis  
DOG-1 GIST  UKAS Omnis  
DYSFERLIN 1.40        Dysferlin Protein  UKAS AS 48  
DYSTRO C        Dystropin (C-terminus) protein  UKAS AS 48  
DYSTRO R        Dystrophin (Rod Zone) protein  UKAS AS 48  
EBV         EBV POSITIVE CELLS  UKAS Omnis  
ECAD      Ductal and lobular breast ca  UKAS Omnis  
EMA         Epithelial Cells.   UKAS Omnis  
EMERIN        Emerin Protein  UKAS AS 48  
EP4            UKAS Omnis  
ER alpha EP1        Assessment of oestrogen receptor status  UKAS Omnis  
ESA         epithelial marker  UKAS Omnis  
FACTOR 13a          not on scope 2020 ETS
FACTOR8           not on scope  
FSH         Follicular Stimulating Hormone
expressing cells
 UKAS Omnis  
Gastrin        Gastrin producing tumours not on scope 2020 ETS
Amylase   not on scope  
GCDFP-15        Identify breast mets not on scope 2020 ETS
GFAP         Identification of astrocytes  UKAS Omnis  
GH         Growth Hormone  UKAS Omnis  
Glucagon   not on scope  
GLUT/SYNTH        Glutamine Synthetase expressing
cells
 UKAS AS 48  
GLYCO C         red cell precursor marker not on scope 2020 ETS
GLYPICAN3        Glypican-3 expressing cells  UKAS Omnis  
GRANZ         Lymphocytes. NK cells. T-cells not on scope 2020 ETS
HAIRY CELL         Hairy Cell Leukemia  UKAS AS 48  
HBCAG           not on scope  
HBSAG            UKAS Omnis  
HCG           not on scope 2020  ETS
HEPATOCYTE         Hepatocyte Cells not on scope 2020 ETS
HSV HSV positivity  UKAS Omnis  
HHV8         Human Herpes viris (type 8) latent nuclear antigen  UKAS Omnis  
HIV         HIV + not on scope 2020 ETS
HMWCK basal cells and
squamous epithelium
 UKAS Omnis  
HSP 70          not on scope  
IDH        astrocytoma  UKAS Omnis  
IgA           not on scope  
IgD           not on scope  
IgG      not on scope  
IgG4         Ig4 expressing cells  UKAS Omnis  
IgM           not on scope  
Arginase Hepatobiliary Pathology not on scope  
INSULIN         Insulin producing cells  UKAS Omnis  
KAPPA         plasma cells  not on scope 2020 ETS
Ki-67        Proliferating cells  UKAS Omnis  
Lambda   plasma cells not on scope 2020 ETS
LH        Luteinizing Hormone expressing
cells
 UKAS Omnis  
MAP2   not on scope  
MAST  CELL        Tryptase Mast Cells not on scope  
MDM2   not on scope  
Melan-A        Melan-A expressing cells  UKAS Omnis  
Melanosome HMB45        Melanocytes  UKAS Omnis  
Merkel Cell   not on scope 2020 ETS
MESO         Mesothelial Cells  UKAS AS 48  
MHCf        Skeletal Muscle fast fibres  UKAS AS 48  
MHCs        Skeletal muscle slow fibres  UKAS AS 48  
MITO           not on scope  
MLH1        MutL Protein Homlog1 Expressing
cells
not on scope 2020 ETS
MSH2 FE11        MutL Protein Homlog2 Expressing
cells
not on scope 2020 ETS
MSH-6         MutL Protein Homlog6 Expressing
Cells
not on scope 2020 ETS
MUC 1            UKAS Omnis  
BAPP        Anti-Alzheimer Precursor Protein A4  UKAS AS 48  
Mum-1 B-cells in the light Zone of germinal centre / plasma cells  UKAS Omnis  
MYELIN PLP        Myelin PLP protein not on scope  
MYELOPX         Myeloid cells  UKAS Omnis  
MYO-D1        Myosin not on scope  
MYOGENIN         rhabdomyosarc  not on scope  
Myoglobin   not on scope  
NAPSIN A           not on scope 2020 ETS
NEU-N          Neurones  UKAS Omnis  
Neurofilament Protein        Neurones. Axonal processes  UKAS Omnis  
NSE           not on scope 2020 ETS
OCT 2   not on scope  
OCT 3/4 Octamer/binding Transcription
factor OCT3/4     
OCT3/4 expressing cells  not on scope 2020 ETS
MHC smooth muscle    UKAS AS 48  
P16         Heart and Neck/Gyane  UKAS Omnis  
p53        P53 protein  UKAS Omnis  
P62         P62 Protein not on scope  
#REF!   #REF!  
BCL2           UKAS Omnis  
PAX-5  (BSAP)      B-Cells  UKAS Omnis  
Pax-8    UKAS Omnis  
PERFORIN           not on scope  
PGP 9.5           not on scope  
PGR Assessment of progesterone
receptor status. Meningioma Cell
 UKAS Omnis  
PLA2R 1/300          not on scope  
PLAP         Placental Alkaline Phosphatase
(PLAP) Expressing cells
not on scope 2020 ETS
BCL6        B-Cells  UKAS Omnis  
PROLACTIN         Prolactin expressing cells  UKAS Omnis  
PRP1/10000          not on scope  
PSA Prostate luminal epithelial cells.  UKAS Omnis  
PSAP            UKAS Omnis  
S100         S100 protein expressing cells  UKAS Omnis  
SDHA 1/100        SDHA expressing cells not on scope 2020 ETS
SDHB        SDHB expressing cells not on scope 2020 ETS
SMA Smooth Muscle myosin / Myoepithelial cells   UKAS Omnis  
SMMYO    UKAS Omnis  
SNF5          not on scope  
SPECTRIN PARAFFIN           UKAS AS 48  
STAT 6  1/1000          not on scope  
BOB1            UKAS AS 48  
SV40           not on scope 2020 ETS
Synapto Neuroendocrine Cells.  UKAS Omnis  
TAU           not on scope  
TDT        Thymocytes not on scope 2020 ETS
THYROG         Thyroglobulin expressing cells not on scope 2020 ETS
B-SARC          not on scope  
TOXO           not on scope  
TSH         Thyroid Stimulating hormone
expressing cells
 UKAS Omnis  
TTF         Already using same Ab as HGS  UKAS Omnis  
UBIQ           not on scope  
VIMENTIN         Mesenchymal Cells not on scope 2020 ETS
WT1 Wilms’ Tumour 1 Protein (WT1)
expressing cells.
not on scope 2020 ETS

 

Special stain and Eynzme Histochemistry 
Protocol Diagnostic purpose Accredited Future progress
Alcian Blue acid mucins Yes  
Alcian Blue/PAS/d Acid and Neutral mucins Yes  
Congo Red   Amyloid Yes  
Elastic van Gieson Elastin Fibres Yes  
Gram/Gram Twort Gram positive and Gram negative
organisms/Fungi, Pneumocystis
Yes  
Grocott's Methenamine Silver Haematopoietic Tissue Yes  
Haematoxylin van Gieson Collagen, connective tissue Yes  
Long Giemsa Haematopoietic Tissue Yes  
Long Ziehl-Neelsen Lipofuscin No  
Martius Scarlet Blue Fibrin Yes  
Masson's Trichrome Collagen, connective tissue Yes  
Modified Giemsa Helicobacter-type organisms Yes  
Modified Masson Fontana Melanin Yes  
Modified Ziehl-Neelsen Mycobacterium Leprae No  
Mucicarmine Mucin No  
Orcein Hepatitis B Surface antigen
Copper associated protein
Yes  
Periodic Acid Methenamine Silver Glomerular Basement Membranes Yes  
Periodic Acid-Schiff Glycogen, neutral mucins, fungi,
glomerular Basement Membranes
Yes  
Periodic Acid-Schiff - Diastase Carbohydrate, fungal organisms/ glomerular basement menbranes  Yes  
Perls Iron Yes  
Reticulin Reticulin fibres at 3µm and 2µm Yes  
Rhodanine Copper Yes  
Toluidine Blue Mast Cell Yes  
Von Kossa Calcium Yes  
Warthin-Starry Spirochetes, Helicobacter pylori Yes  
Ziehl-Neelsen (Acid Fast Bacillius)  Acid-Fast Bacilli (Mycobacterium) Yes  
Cytochrome C Oxidase staining
PMU_S010
Marker of mitochondrial activity Yes  
Gomori Trichrome staining
PMU_S005
Abnormal Mitochondria Yes  
Haematoxylin and Eosin staining
PMU_S004
Basophilic and eosinophilic Yes  
Muscle Acid Phosphatase staining
PMU_S013
structures Yes  
Myosin Adenosine Triphosphatase
Staining pH 9.4 & pH 4.6
PMU_S012
Demonstration of lysosomes Yes  
Major Histocompatibility Complex
PMU_S055
Demonstration of fibre typing Yes  
NADH Staining PMU_S009 Upregulation indication of inflammatory response. Yes  
Periodic Acid – Schiffs (PAS)
Staining PMU_S007
Demonstrate abnormal mitochondria and fibre typing. Yes  
Phosphorylas staining Demonstrate muscle glycogen Yes  
Succinate Dehydrogenase staining Phosphorylase activity Yes  
Sudan Black staining Marker of mitochondrial activity Yes  

 

Minimum Dataset required for Cellular Pathology Requests

In order to process specimens it is essential that request forms are fully completed in a clear and legible format. The use of patient ID stickers is permitted however please ensure you use the full patient sticker NOT the smaller blood tube sticker. All specimens received into Cellular Pathology must meet the agreed laboratory minimum dataset; any specimens not meeting the criteria will be returned to the requesting department.Please ensure that any important information (e.g. clinical history, bleep number etc.) is clearly indicated on the form and ensure that any priority or urgent cases are marked as such.

  • Trust cases can be requested via a theatre book or by completing an internal UHB histopathology / cytopathology request form. 
  • GP and dental practices should complete the external request form which can be supplied on request from the Department and for internal service users this link http://www.uhb.nhs.uk/laboratory-request-forms.htm shows this request form together with specific request forms used within the Trust (QE site)  for liver and breast biopsy cases.

Specimen Labelling and Multi-Part Cases

If more than one specimen from the same patient attributed to a case is sent they should be clearly indicated as part 1, 2, 3 etc. with an note on the request form detailing the site of the specimen.

Hazardous Specimens

Specimens arising from patients with known or suspected transmissible diseases (e.g. tuberculosis, viral hepatitis, HIV) must be clearly labelled as such to prevent unnecessary risk to laboratory staff.

Specimen Containers 

When requesting stock a member of staff from the Cellular Pathology department will inform the requestor when they will be ready for collection by the portering staff. Consumables provided by the lab should be transported via the porters so please allow time for preparation and transport.  Please note specimens must be despatched to the Department within a secondary bag or secure transport box with sufficient absorbent material to absorb/contain any potential spillage.

Transportation of Specimens

Specimens are collected at regular intervals from theatres and all relevant departments via portering services. Urgent and unfixed (dry/not in formalin) specimens should NOT be left until the next routine collection – telephone portering services and arrange for a member of staff to bring the sample(s) to the laboratory without delay.

Urgent Reporting

Occasionally it may be necessary for a requesting clinician to highlight a specimen as clinically urgent. If an urgent report is required it should be clearly identified or indicated on the request form. Urgent requests should be sent to Cellular Pathology via the porters without delay.

To ensure that cases are not delayed within the laboratory please make sure that the request form is correctly completed and all sections are filled in properly. Once received urgent cases will be highlighted by the specimen reception and prioritised appropriately in the departmental workload.

UHB, Department of Cellular Pathology

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