Clinical Pathology

Observe the morphology of cells obtained from cervical scraping, sputum, urine, etc., and mainly judge benign or malignant.

Cells obtained from various organs and body fluids are examined under a microscope, and quality is determined mainly from the cell morphology. Cytologists perform screening (screening out abnormal cells in cytology), and if there are abnormal cells, they are diagnosed together with a Cytodiagnosis Specialist.

Sampling method and specimen preparation

After collecting the cells, quickly apply it to the slide glass. For liquid specimens, after centrifugation (using a centrifuge to sediment cell components), the resulting cells are smeared onto glass slides. Fix with 95% ethanol and stain with Papanicolaou staining, dry fixation with Giemsa staining, etc. according to the purpose, and prepare specimens. We observe the sample under a microscope and judge whether it is good or bad based on the cell morphology. Since the needle is thinner than biopsy, there is less bleeding, the burden on the patient is light, and the examination can be performed many times. The three-dimensional structure of the tissue mass is difficult to understand, and it is not suitable for tumor subtyping.

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If there are abnormal cells, all the cytological examiners discuss and make a final diagnosis together with the Cytodiagnosis Specialist. It takes about 1 to 2 days to prepare the specimen, and the diagnosis is made in about 2 to 3 days after collecting the specimen.

If necessary, immunostaining is performed from the cytological specimen, and if there is a remaining sample, a cell block specimen is prepared. We are considering. Depending on the case, we make a cell specimen from a liquefied specimen (LBC; Liquid based cytology) and make a diagnosis.

A specimen is prepared from a biopsy or surgical specimen, and the histological image is observed. We strive to understand not only good and bad, but also the extent and condition of lesions.

What is histopathological examination?

Specimens are prepared from biopsy specimens or surgically removed organs or tissues by picking up part of a lesion with a stomach or colon camera, or cutting out part of a skin lesion with a scalpel. , a pathologist observes and diagnoses under a microscope.

Diagnosis from specimen preparation

Organs and tissues removed by biopsy and surgery are fixed in formalin. If the fixation is complete, the lesions and specimens are observed with the naked eye on the next day, the necessary parts for diagnosis are selected, and the necessary number of tissues are embedded in cassettes. After dehydration and degreasing, it is impregnated with paraffin to create a paraffin block. Since the paraffin block can be sliced thinly, the sliced sample is placed on a glass slide (thinly sliced). In this state, nothing can be seen, so the tissue is stained with hematoxylin and eosin and observed under a microscope by a pathologist. In addition to qualitative diagnosis of lesions, we also evaluate the spread of lesions and margins of resection as needed. Search by adding immunostaining, such as susceptibility to hormone therapy and chemotherapy.

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Pathologist makes the final diagnosis. The number of days required for diagnosis is about 2-3 days after collection for biopsy specimens, and about 1-2 weeks for surgical specimens. If it contains calcified components, it may require decalcification (operation to make it easier to cut), and it may take several days to prepare the specimen and make a diagnosis.

また、特殊な領域（リンパ腫関連、腎生検、肝生検）に関しては、院外の専門家の協力を得て診断しています。難解な症例は、国内外の専門家にコンサルテーションしています。

Gastroenterology (internal medicine, surgery, Diagnostic Radiology), hematolymphoma (Hematology), mammary gland (Breast Surgery, cytodiagnosis, ultrasound), central nervous system (brain surgery), female reproductive organs (Obstetrics and Gynecology and gynecology), urology (Urology) and renal biopsy (Nephrology) conferences are held every week.

It is performed during surgery to determine the treatment policy. Freeze the tissue to prepare a specimen and make a diagnosis in a short time.

What is intraoperative rapid diagnosis?

During surgery, the resected part is frozen and a specimen is prepared for diagnosis in order to determine the surgical strategy and confirm the extent of resection. Frozen sections, compared to normal formalin-fixed tissue specimens, have wrinkles in the sections, crushed cells when the tissue is frozen, and no corners of the excised tissue specimen can be used as specimens. In some cases, it does not lead to results, and other findings may be found when reexamination is made at a later date after formalin fixation.

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We check specimens with as many pathologists as possible, and inform the surgeon of the diagnosis within about 30 minutes from submission to diagnosis. If there are many specimens or specimens that are difficult to prepare, it may take some time. After surgery, the frozen specimen is thawed, fixed in formalin in the same way as a normal histopathological examination specimen, embedded, sliced and stained, and the diagnosis is confirmed 2 to 3 days later.

We perform an autopsy on the corpse of a patient who unfortunately passed away to understand the cause of death and terminal condition.

What is autopsy?

Pathological autopsy is the dissection of the corpse of a patient who died due to an illness, and the direct observation of the organs, tissues, and cells for detailed medical examination. This makes it possible to make highly accurate pathological diagnoses, correctly understand the cause of death, and examine the spread of lesions, the appropriateness of treatment, and lesions that were not known before death.

With the consent of the bereaved family, a pathologist and a clinical laboratory technologist perform the examination at a dedicated facility within the hospital. Incisions are made mainly in the chest and abdomen, and the organs are removed and searched. If necessary, the brain and spinal cord are also taken out and examined. In addition, depending on the course of life, other tissues, blood, etc. may also be collected and searched.

Since our hospital is also a teaching hospital, not only the education of our Senior Resident, but also the support of young clinicians in their studies is an important task of pathologists. Pathological autopsies, in particular, are essential for them to provide better medical care in the future and grow as non-self-righteous clinicians. We ask for your understanding and cooperation when the attending physician asks for a pathological autopsy, which is beyond our power.

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A pathologist who is Autopsy Qualification as stipulated by the Autopsy Preservation Law performs the operation. A standard thoracic and abdominal dissection takes about 2 to 3 hours, but it may take longer depending on the brain dissection, post-surgery condition, and physique. An incision will be made from the chest to the lower abdomen, but after the autopsy is completed, the body will be sewn up and returned to the bereaved family in a fully clothed state. Incisions and sutures are made in areas that cannot be seen while the patient is clothed. Even when a head incision is made to search for the brain, the incised wound is not visible from the front and is sutured.

After the autopsy is completed, tissue specimens are prepared if necessary, and a pathological autopsy certificate is compiled several months later and reported to the attending physician. Depending on the case, the clinical course and pathological findings are presented at the CPC (Clinical Pathology Review Committee), and the appropriateness of diagnosis and treatment, consistency and discrepancies between images and laboratory findings, etc. We are discussing with doctor of various departments, early clinical residents, and other occupations.

For those who wish to receive training or work in pathology at our hospital

Senior Resident

Our hospital's pathological diagnosis program is a program that collaborates with local city hospitals and universities. Please refer to the following for details.

In pathology at our hospital, we place importance on the continuous and three-dimensional understanding of macroscopic findings to histological findings, and their association with clinical information. With the initial goal of being able to diagnose pathological anatomy, typical surgical cases, and biopsy cases on his own, he has been conducting training while repeating conferences with each department and taking turns in charge of organs. It is a training content that can be recommended for those who want to acquire the basics as soon as possible. There are many opportunities for presentations at hospitals and local meetings, and there are many opportunities to talk directly with clinicians and learn about their way of thinking, which is unique to hospitals.

The number of out-of-hospital specimens of referred patients has increased year by year, and there were 435 cases last year. In fact, it is rare that the histopathological diagnosis at the referral source is wrong, but there are cases where it is necessary to compare the histological image with the specimen at our hospital. When performing invasive treatments such as chemotherapy, radiation therapy, and surgery at our hospital, it is necessary to confirm that the tumor is malignant, and to confirm the tissue type for treatment methods and drug selection. I would appreciate it if you could attach the pathological specimen to the letter of introduction.

Our hospital does not provide pathologist outpatient services.

An increasing number of hospitals are opening pathologist outpatient clinics where pathologists explain pathological findings to general patients, but our hospital does not have the leeway to do so. Please forgive us for creating a distribution map of lesions, explaining it to clinicians at a review meeting in the hospital, and assisting the clinicians to explain.