How Pathology Works: What Happened to My Tonsils?

Hundreds of thousands of people have surgery every day all over the world. In many of these cases, organs or tissue are removed. Have you ever wondered what happens to that tissue after its removed? If you thought that they just chuck it in the trash bin, well you've skipped a whole bunch of important steps. Here is, in a nut shell, what happens to your removed parts.

1. Specimens are packed up and sent to Pathology
When anything is removed from the body, the doctors want to make sure that everything checks out. Whether its the appendix that looks really inflamed, or the tonsils that are the size of golf balls, the doctor just wants to make sure that everything is as it should be. So the specimen in put into a container with one of the following: Nothing, saline, or formalin. If it might be a while before Pathology will see the specimen, it will be placed in formalin, which is a mixture that contains formaldehyde, a tissue preservative.

If the doctor wants to make sure that, for example, all of a diseased tissue has been removed, then a frozen section will be done. A frozen section is when tissue is frozen at -15^o and slivers of tissue placed onto glass slides. These slides are then dyed quickly so a doctor can look at them and say " Yes, you removed all the cancer" or " No, I am still seeing diseased. Go back and removed more." This is better than sending a patient home to then find out that not all of the " bad" tissue was removed in the first place.

2. Pathology gives the specimen a number
Everything that comes through the pathology department's door gets a number and, with that, a code. This code will later tell Histology (getting there, hold your horses) how to treat the specimen. This also gets tied to billing.

3. Grossing the specimen
Now this does not mean "Ew, gross". One of the most important examinations one can do to a specimen is simply doing a gross examination, or looking at it with your eyes. The pathology assistants, or pathologist themselves, will describe what the specimen looks like. This includes color, size, shape, texture, and any anomalies of note. Then the specimen will be cut and representative sections will be sent to Histology to make slides. These sections are important because it is these sections that the pathologists will see and determine if the tissue was indeed diseased or in some cases, normal.

4. Making slides.
Later on, Histology ( Still under the Pathology umbrella) will get the representative chunks of tissue. These pieces of tissue are put in wax and made into blocks. These blocks are then shaved into infinitely thin slivers. These slivers are then put onto glass slides and dyed with certain chemicals, staining the tissue different colors. These stains will turn certain cells and part of the tissue different colors. Remember the codes from earlier? Some types of tissues need specific stains. This is where the codes come into play. Attached to the codes are a list of stains. So when a histologist sees that a specimen is a CPT4 code, they know that certain stains will be done on that specimen and not on the specimen with the CPT3 code. The slides are then given to the pathologist.

5. Looking at slides
The pathologist gets the slides and looks at them under a microscope. What they are looking for depends on the specific case. In some cases they are simply confirming what was already known ex. " Yes this appendix is enlarged and inflamed. This was appendicitis." In other cases, they are trying to figure out what the patient has based on the cells in the tissue, which can sometimes be determined ( or guide in the right direction) by looking at the slides.

After some time, THEN the tissue is thrown out, unless there is a specific reason for keeping it. So the next time you are getting a weird mole removed, or a breast reduction, or have appendicitis, just think of all the people who get to see it just to make sure you are going to be okay.