Specimen Handling for Specific Tissue Types and Diagnostic Considerations

Enucleation and exenteration specimens

Place enucleation and exenteration specimens to large enough containers with non-leaking lids filled with 10% Formalin
Formalin volume to tissue should be at least 2:1 for optimal preservation and fixation
Secure the lid with paraffin to prevent leaks. Store at room temperature
Place the specimen in double biohazard bags
Place the biohazard bag and required documents in a box with packing material
Send the box via local courier or Fedex, preferably same day delivery or Priority Overnight

Corneal/Conjunctival biopsies (i.e. ocular surface neoplasms)

Cornea and conjunctiva specimens tend to curl at the edges, hampering the margin assessments.
Ideally, these specimens should be placed on a piece of thick paper, cardboard or precut tongue depressor in the operating room.
Ideally, surgeons should orient the lesion placing small sutures or ink in the tissue and with a drawing and specify hour of clock for location so margins may be assessed
The tissue should be left to partially dry for at least 2 minutes while it was flat on thick paper, cardboard or tongue depressor before placing in 10% formalin container.
Secure the lid with paraffin to prevent leaks. Store at room temperature
Place the specimen in a biohazard bag
Place the biohazard bag and required documents in a box with packing material
Send the box via local courier or Fedex, preferably same day delivery or Priority Overnight

Conjunctiva or skin biopsies for bullous diseases such as Ocular Cicatricial Pemphigoid

At least two biopsies, at least 2mm each should be obtained (or a larger biopsy should be divided in the operating room)
Biopsies should target an area of active involvement
Avoid old lesions and areas of dense scarring
Place one tissue specimen in the green direct immunofluorescence vial with Michel’s or Zeus media. Store at room temperature
Place the second tissue specimen in 10% formalin container. Store at room temperature
Place the specimens in a biohazard bag
Place the biohazard bag and required documents in a box with packing material
Send the box via local courier or Fedex, preferably same day delivery or Priority Overnight

Corneal scrapings for Neoplasia or Other Non-infectious Diseases

These are not ideal for diagnosis of ocular surface neoplasms, and a superficial keratectomy should be considered whenever appropriate and feasible.
Wash the instrument used for scraping into Cytolyt media for liquid based-cytology. You can obtain cytolyt from your pathology department in advance. These specimens may be reviewed by UCSF Cytopathologists or Ocular Pathologists
Place the specimen in a biohazard bag
Place the biohazard bag and required documents in a box with packaging
Send the box via local courier or Fedex, preferably same day delivery or Priority Overnight
In the absence of cytolyt, we can attempt preparing a cell block using formalin fixed material. However, diagnostic yield of this process is very low.

Corneal scrapings for Infectious Diseases

Usually done for atypical corneal infectious presentations.
At least two slides need to be submitted, ideally 3-4 slides are requested.
Send material for cultures and PCR directly using appropriate media (culture plates, media for fungal and viral studies, etc)
Let the slides air dry, and place them in a secure slide container wrapped in bubble wrap, if possible, or use a bubble wrap lined manila envelope
Send the specimen and required documents via local courier or Fedex, preferably same day delivery or Priority Overnight

Specimens to rule out lymphoma

Specimen can be submitted fresh in an empty sterile container on regular ice or ice pack with appropriate requisition form filled out and deliver ASAP via local courier or Fedex, preferably same day delivery. Please indicate the question of lymphoma on the requisition. We will divide the sample
Specimen can also be divided in OR and a small piece can be placed in RPMI (just enough to cover the specimen) and the remainder can be placed in 10% formalin. RPMI can be submitted to your local pathology laboratory or to UCSF along with the material in formalin.
Place the specimen in a biohazard bag
Place the biohazard bag and required documents in a box with packaging
Send the box via local courier or Fedex, preferably same day delivery or Priority Overnight

Vitreous

Submit undiluted vitreous in a syringe closed with a syringe rubber cap (not needle)
Submit diluted vitreous in the cassette or bag (directly from the vitrectomy machine)
Please write on the label: site (“right/left eye”) and “vitreous, diluted” or“vitreous, undiluted”
Place in a specimen bag on regular ice or ice pack with appropriate requisition form filled out and deliver ASAP via local courier or Fedex, preferably same day delivery
Please provide a detailed history and any specific questions to be answered in the requisition form
For cytologic evaluation submit at least 200 microliters of undiluted vitreous to cytology
For viral PCR, submit at least 200microliters of undiluted vitreous to microbiology laboratory.
For flowcytometry or cultures, diluted specimen can be used.

Aqueous Humor

Submit fluid in a syringe closed with a syringe cap (not needle).
Please write on the label: site (“right/left eye”) and “aqueous humor”
Place syringe in a specimen bag on ice or ice pack with appropriate requisition form filled out and deliver ASAP via local courier or Fedex, preferably same day delivery
Please provide a detailed history and any specific questions to be answered
Please leave the fluid in the syringe (do not transfer to other container)
For cytologic evaluation submit at least 200 microliters of aqueous humor to cytology
For viral PCR, submit at least 200microliters of aqueous humor to microbiology laboratory.