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Microscopic findings in key tissues are often critical to determine the cause of death in medical autopsies. The overall quality of histologic sections depends on numerous pre-analytic factors, among which are tissue section size and thickness. We designed a prospective quality improvement study to determine whether a simple intervention of formalin pre-fixation of myocardium, liver, and kidney tissues could improve the ease of cutting and quality of autopsy histologic sections as assessed by histotechnicians and pathologists. Of 46 autopsies included in the study, 21 were randomly assigned to formalin pre-fixation, and 25 underwent routine sectioning without formalin pre-fixation. A significant improvement in overall quality score by histotechnicians was detected in the sections from pre-fixed autopsy tissues compared to the control group (p=0.0327). There was no significant difference in quality score between the two groups as assessed by pathologists. Our autopsy quality improvement study demonstrates that a simple, low-cost intervention of formalin pre-fixation of fresh autopsy tissues for 90 minutes could significantly improve the overall quality of sections submitted for histologic processing.

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Microscopic findings in key tissues are often critical to determine the cause of death in medical autopsies. The overall quality of histologic sections depends on numerous pre-analytic factors, among which are tissue section size and thickness. We designed a prospective quality improvement study to determine whether a simple intervention of formalin pre-fixation of myocardium, liver, and kidney tissues could improve the ease of cutting and quality of autopsy histologic sections as assessed by histotechnicians and pathologists. Of 46 autopsies included in the study, 21 were randomly assigned to formalin pre-fixation, and 25 underwent routine sectioning without formalin pre-fixation. A significant improvement in overall quality score by histotechnicians was detected in the sections from pre-fixed autopsy tissues compared to the control group (p=0.0327). There was no significant difference in quality score between the two groups as assessed by pathologists. Our autopsy quality improvement study demonstrates that a simple, low-cost intervention of formalin pre-fixation of fresh autopsy tissues for 90 minutes could significantly improve the overall quality of sections submitted for histologic processing.

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Introdução: Mastopexia associada à inclusão de implante é uma situação desafiadora para o cirurgião plástico. O objetivo é descrever a colocação de implante submuscular com descolamento anatômico mais pexia firme do tecido glandular usando pontos de fixação do tecido mamário ao muscular e analisar os resultados estéticos das pacientes operadas. Método: Foram realizadas 23 mastopexias com implantes no período entre abril de 2015 e julho de 2017, pelo mesmo cirurgião, sendo as mamas das pacientes marcadas previamente, na posição sentada. Realizou-se incisão no sulco mamário e descolamento até o polo superior da mama no plano subfascial, fixação da glândula ao músculo peitoral maior com 9 a 12 pontos. A seguir, iniciou-se a dissecção do músculo peitoral maior através de sua origem costal e transição com os músculos reto abdominal e serrátil, liberando amplamente na porção inferior. Introduziu-se o implante e completou-se a mastopexia. Os tamanhos dos implantes variaram de 255ml a 355ml. Fotos das mamas de 12 pacientes foram avaliadas por dois cirurgiões plásticos e dois leigos, nos seguintes parâmetros: resultado estético, simetria das aréolas e grau de ptose mamária. As avaliações podiam ser Ruim, Razoável ou Bom. Resultados: A técnica cirúrgica mostrou-se reprodutível, apenas 1 caso de hematoma unilateral, nenhuma infecção, queixas de dor discretas. Apenas um caso foi considerado, por um único avaliador, como Razoável; as demais avaliações consideradas como Bom. Conclusão: O tratamento de ptoses mamárias com colocação de implante submuscular acrescido de pexia da glândula ao músculo peitoral é uma técnica reprodutível e com bons resultados estéticos.

Introduction: Mastopexy associated with implant placement is challenging for plastic surgeons. The objective is to describe the placement of a submuscular implant with anatomical detachment in combination with stable fixation of the breast tissue to the pectoralis muscle and analyze the aesthetic results. Method: Twenty-three mastopexy procedures with implants were performed from April 2015 to July 2017 by the same surgeon, and surgical markings were made in the breasts of the patients in a seated position. An incision was made in the inframammary fold, and the breast tissue was elevated to the upper pole in the subfascial plane and attached to the pectoralis major muscle using 9-12 stitches. Subsequently, the inferior margin of the pectoralis major muscle and the transition from the rectus abdominis muscle to the serratus muscle were dissected to expose the muscle. The implant was introduced and mastopexy was completed. Implant size ranged from 255 mL to 355 mL. Photographs of the breasts of 12 patients were evaluated by two plastic surgeons and two non-medical subjects, who considered the aesthetic results, symmetry of the nipple-areola complex, and degree of breast ptosis. The results were scored as unsatisfactory, satisfactory, or good. Results: The surgical technique was reproducible; there was only one case of unilateral hematoma, no implant infections, and only complaints of mild pain. Only one case was scored as satisfactory by one evaluator, whereas the results of the other cases were considered good. Conclusion: The treatment of breast ptosis with the placement of a submuscular implant in combination with fixation of the breast to the pectoralis major muscle is reproducible and yields good aesthetic results.

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Abstract Most Departments of Pathology around the world have a considerable archive of formalin-fixed paraffin-embedded (FFPE) tissue suitable for molecular assessment. This article points out the potential DNA damage that may occur if basic steps are not followed during processing and storage of these samples. Furthermore, it hopes to establish parameters to optimize quality and quantity of DNA extracted from FFPE tissues.

Resumo A maioria dos Departamentos de Patologia em todo o mundo têm um considerável acervo de tecidos embebidos em parafina e fixados em formalina, que são passíveis para análises moleculares. Este artigo apresenta os danos ao DNA que podem ocorrer se passos básicos não forem seguidos durante o processamento e armazenamento destas amostras. Além disso, procura estabelecer parâmetros para otimizar a qualidade e quantidade do DNA extraído de tecidos FFPE.

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AIMS: To compare Carnoy's solution (CS) and 10% neutral buffered formalin solution (NBF) as tissue fixatives in colorectal cancer specimens. METHODS AND RESULTS: Surgical specimens from patients with colorectal cancer were analysed. Three groups were studied, as follows: group 1 consisted of 16 paired samples fixed in CS and NBF; and groups 2 and 3 consisted of 14 prospective and 80 retrospective samples, respectively, both randomized for fixation in CS or NBF. Groups 1 and 2 were analysed for amount, quality and integrity of DNA. Morphological analysis, including some of the usual special stains and polymerase chain reaction (PCR), were also performed for group 1, and Sanger sequencing for group 2. Immunohistochemical (IHC) reactions for mismatch repair proteins were studied in groups 1 and 3. Fixative performances were similar for morphology, special stains, and IHC reactions, as well as for the amount, quality and integrity of extracted DNA. PCR amplification was not possible in two cases from CS group 1. Sanger sequencing gave conclusive results for the CS samples tested. CONCLUSIONS: Carnoy's solution and NBF are equivalent fixatives for colorectal cancer specimens and are adequate for routine utilization in surgical and molecular pathology.

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Introdução: Para o adequado estudo anatomopatológico dos tecidos obtidos dos pacientes é crucial a boa técnica para a melhor evidenciação das células pesquisadas. É imprescindível que não só a técnica ideal de coloração/marcação seja utilizada, mas também a correta técnica de fixação da peça cirúrgica. Em trabalho prévio pesquisando miofibroblastos e contração na pele restaurada de áreas doadoras de enxertos de pele de espessura parcial, verificamos baixa densidade de miofibroblastos, ao contrário dos estudos em tecido de granulação. Investigando as causas disso, e baseando-se em artigo específico sobre a eficácia da evidenciação imuno-histoquímica com diferentes métodos de fixação tecidual, comparamos a eficácia dos diferentes fixadores, formol a 10% e álcool a 70% para a evidenciação de miofibroblastos em tecido de granulação de úlceras crônicas de 21 pacientes. Método: Estudamos 42 amostras por meio de técnica imuno-histoquímica, utilizando-se o anticorpo anti-Smooth Muscle Actin, nas quais contamos os miofibrobastos em 10 campos com aumento de 400 X. Resultados: Demonstraram-se melhores resultados qualitativo e quantitativo no material fixado em álcool, quando comparado ao fixado em formol, com densidades médias de miofibroblastos de 86,5 e 48 células/mm2, respectivamente, o que nos leva a recomendar o álcool como fixador de tecidos para estas análises imuno-histoquímicas.

Background: The use of a good visualization technique is crucial for an adequate pathological anatomy study of tissues obtained from patients. Optimal staining and fixation techniques of the surgical piece are essential. In a previous study investigating myofibroblasts and contraction in split skingraft donor sites, a low density of myofibroblasts was observed, as opposed to studies in granulation studies. To investigate the causes for this finding and based on a specific manuscript on the efficacy of immunohistochemical visualization using different tissue fixation methods, we compared the efficacy of fixation in 10% formaldehyde and 70% alcohol for the visualization of myofibroblasts in granulation tissues of chronic ulcers in 21 patients. Method: Forty-two samples were studied by immunohistochemistry, using the anti-Smooth Muscle Actin antibody, and myofibroblasts were counted in 10 fields with a magnification of 400X. Results: Better qualitative and quantitative results were observed in alcohol-fixed materials, when compared to those fixed in formaldehyde, with mean myofibroblasts densities of 86.5 and 48 cells/mm2, respectively, which encourages us to recommend the use of alcohol for tissue fixation in immunohistochemical studies.

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