AP Informatics serves the Department of Pathology by designing and maintaining imaging systems to record digital images of specimens.Graphical workstations are present for light microscopy, fluorescence, electron microscopy, dissecting microscopy, hand held and
fixed camera still photography, and scanning (flat bed, kodachrome, and large format negative). Output includes inkjet, dyesublimimation, and color laser printers. An image database is being built with a 161GB (usable file space) RAID 5 server. Remote access includes VPN into the lan. Current projects and collaborations include the use of secure methods for real time remote consultation and virtual microscopy.
Autopsy and Perinatal-Placental Services
The Autopsy Service and Perinatal-Placental Service collectively provide comprehensive examinations of the embryo, fetus, first trimester products of conception, stillborn fetus, and post-mortem, child and adults with childhood diseases.
The division of Cardiovascular Pathology offers examinations and consultations on myocardial biopsies, hearts (from autopsy and transplantation) and blood vessels. Gross, microscopic evaluations are available on heart specimens. The range of experience includes transplant pathology, complex congenital heart disease, valvular disease and myocardial diseases. Available techniques for gross specimens include digital photography and conduction system examination.
Cytology-Fine Needle Aspirate
Fine needle aspiration, the sampling of tissue or fluid using a small needle, is offered within Nationwide Children's Hospital and should be scheduled in advance. The pathologist may perform the aspirate, and will routinely prepare the material for examination and check its adequacy by microscopic examination. Specimens for ancillary studies, including microbiologic cultures, flow cytometry, and electron microscopy, can also be obtained.
The Electron Microscopy Service offers examination of specimens by light microscopy in plastic sections and ultrastructural examination by transmission electron microscopy. Additionally, wet mount preparations of ciliated epithelium are done to assess motility. Processing by traditional and rapid microwave techniques is available. Image capture is by digital camera or large format
negatives that can be scanned to produce a digital image. Areas of emphasis include renal pathology, muscle and nerve pathology, genetic-metabolic disorders and pediatric tumor diagnosis.
The GI Biopsy Service offers examinations and consultations on biopsies starting with fresh or fixed biopsies and from glass slides and paraffin blocks. Frozen tissue may be needed for biochemical or molecular testing. In most cases tissue should be sent fixed. The surgical pathologist on call should be notified in advance if a specimen is to be sent fresh and the reason it is being sent fresh. Light microscopy, immunofluorescence, immunohistochemistry, and electron microscopy are techniques available in diagnostic studies. Examination for Hirschsprung's disease includes serial sections and , when needed, acetylcholine esterase stain on frozen sections.
The Hematopathology Services at Nationwide Children’s Hospital, directed by Dr. Samir Kahwash, provide diagnostic services and consultation on hemoglobinopathies and special hematology testing. They are responsible for reviewing peripheral blood and bone marrow changes in major hematological disorders in children, including types of anemias, thrombocytopenias, leukemias and others.
They provide cell marker studies by flow cytometry in hematologic malignancies and reactive conditions with emphasis on correlation with morphologic findings.
The Histology Service offers the processing of fresh tissue, frozen sections, routine and special histochemical stains, immunofluorescence, and immunohistochemistry for a large panel of antigens. Tissue can also be snap frozen in liquid nitrogen for biochemical or molecular studies, fixed for electron microscopy, prepared for flow cytometry, or prepared as touch imprints for FISH studies(fluorescent in situ hybridization). Special handling of specimens can be arranged with the surgical pathologist on call.
Lymph Node & Bone Marrow
Lymph Node evaluation includes morphologic and immunophenotypic examination of lymph nodes using markers tailored for pediatric lymph node disorders. An optimal sample will include touch imprints (Diff-Quick stained and air dried), fresh tissue (or viable cell suspension for flow cytometry), H&E sections (and/or paraffin blocks). Extent of workup and triage of tissue will be based on the differential diagnosis upon examination of stained H&E sections. A cumulative consult report is issued.
Morphologic and immunophenotypic evaluation of bone marrow aspirate smears (giemsa staining), aspirate clots and core biopsies (H&E) for suspected neoplastic and non-neoplastic disorders of childhood. A concurrent peripheral blood smear slide and CBC should also be included with specimen. Extent of workup and triage of tissue is based on initial differential diagnosis. A consult report is issued.
The division of Pediatric Neuropathology and Neuromuscular Pathology offers state of the art examinations of pediatric brain tumors and pediatric muscle biopsies. To augment these studies, the division utilizes the services of an on site Department of Electron Microscopy. Routine techniques include immunohistochemistry and other special stains including muscle histochemistry, a muscular dystrophy panel, electron microscopy (as needed), and digital photography.
The division of Renal Pathology accepts kidney biopsies for the diagnosis or follow-up of native renal disease and evaluation of transplant allograft biopsies. Our evaluation includes light microscopy, special stains, immunofluorescence studies, and electron microscopy. All of these studies are done on site and images can be captured using film or digital microscopy.
The Surgical Pathology and Electron Microscopy Services offer comprehensive examination of patient specimens obtained by needle aspiration, biopsy, resection and other means. State of the art techniques include light microscopy, fluorescence microscopy, electron microscopy, immunohistochemistry, enzyme histochemistry, and an extensive battery of special stains. All of these services are supported by capture of digital images.
The division of Transplant Pathology offers examinations and consultations on biopsies of the following transplanted organs: heart, liver, kidney and lung. Examinations offered on kidney biopsies include immunofluorescence and electron microscopy. Grading of rejection follows the Banff criteria for kidney, the working formulation published in the Journal of Heart and Lung Transplantation (1990) for heart and the revised working formulation published in the Journal of Heart and Lung Transplantation (1996) for lung. The division also offers examination of transplanted organs and tissue samples obtained from autopsy.