Histopathology is the study of diseases of tissues and organs.

The Histopathology service provides essential information to clinicians in the process of diagnosing cancer and other diseases.

Dr Ismail is the Lead Consultant and Phil Baker the Lead BMS (Philip.Baker@asph.nhs.uk). Histopathology has a staff complement of 24 including the Mortuary. Opportunities exist for trained and untrained staff to work in the lab at St. Peter’s.

Please check the NHS Jobs website for the latest information on Pathology jobs.

A Day in the Life ...
A Day in the Life of a Histopathology Trainee

My work usually begins at 9 am but not today. I am on the early schedule so I start at 8 a.m., which is not too bad, since I get to go home early as well.

First things first, to the tearoom, not for some tea but just to put my lunch in the fridge.

All’s quiet at this time of the day. When you start work at 8 o’clock in Histopathology, your main job is to embed the tissue blocks that were processed following dissection yesterday. I check the processor to make sure the program was completed successfully. Yes that’s OK. Next I check the embedding centre to make sure the thermal consol is hot and the cold plate is, well, ah, cold! And the heated forceps, well obviously, hot. At this time, I make a record of the temperature of all the fridges, freezers and the cryostat. Monitoring it everyday, part of the regular maintenance procedures. Not to forget to switch everything on, flotation baths, hot plates, lamps, so everything is ready when the other staff arrive.

Finally, I start embedding. Dissected tissues that were fixed, dehydrated, cleared, and impregnated with paraffin wax, are now carefully orientated in tissue moulds and filled with molten paraffin wax. Then we make them very cold so the wax solidifies quickly to produce our tissue blocks. We call this process “tissue embedding”. The hard wax blocks allow us to cut sections of the tissue only 3 microns thick. There are a lot of blocks to embed and two people are usually needed.

“Good morning!” At quarter to nine, other staff start to come in.
“Hi, how are you?”
“I’m fine, thank you”
“I’m ok, thanks!”

It’s another day in the lab. Mornings won’t be complete without the pleasantries with everybody. And it’s nice because you start the day with a smile. And things seem to fall into place when you do.

It’s really getting to be busy. The blocks are allocated to all the staff that are assigned to microtomy. To continue with my embedding, I told you, there are a lot of blocks!

Finally, the last block. All done. Of course I can’t move to my next section assignment without tidying up. Otherwise, there’ll be wax all over the floor, the embedding center, the chair where I sat, my hair, my face, oh dear!

Today I am assigned to immunohistochemistry. This is so cool. Totally automated, well, almost, I still need to sort the slides though. This is one of the most important sections in Histopathology. Let’s say a patient has a biopsy that contains some tumour cells that cannot be recognized, it would be important for their treatment to find out where the cancer cells came from. And so this is where immunohistochemistry comes in. We use lots of antibodies against different cell types. The type of tumour cell is worked out by the antibodies that attach to the celI.

“I have a call from a doctor who has a patient with an appointment to see him tomorrow morning, - would it be possible to have a diagnosis by the end of the day?” I let one of the Pathologists know. “Can I have the slides ready by this afternoon? I’ve already asked for immuno to be done.” Uh-oh, a reminder from the Pathologist. Well, we just have to make sure that the requests have been attended to ASAP. Any urgent requests have to be done promptly and we make sure that the pathologist concerned gets hold of the slides as soon as possible. It means an early diagnosis for the patient and could mean early treatment as well.

As I said, I start with immuno by sorting out the slides. Some slides would need pre-treatment before staining because the antigens that the antibody will attach to are hidden, like for example oestrogen and progesterone receptors. The number of positive cells in a breast tumour will help indicate which drugs to use in the patients treatment. These cells would have to be microwaved for about 20 or so minutes so that the antigens would be “available” for the reaction. Other antibodies might need enzyme pre-treatment or even the use of a pressure cooker! While the slides are being treated I can take my break. There’s nothing else to do then, except wait, so might as well.

Yum, yum, chocolate biscuits in the biscuit tin. Don’t we have newer magazines today? Read this one, yep, read that, OK. Oh dear, my fifteen minutes are up. Back to work.

So now, its time to load up the slides and the antibodies onto the immunostainer. There’s a program of course that we have set up. It usually takes around 2 hours to finish all the staining.

In the meantime, there are some large blocks to cut. I have just started learning this and I’m lucky I get to use the new microtome, which is really so nice, so hi-tech.

Grrowwl, ooops! Excuse me, that’s my tummy, making noises! Time for lunch.

Usually, when I get back from lunch, the immunostaining has ended and all I have to do next is manual counterstaining of these slides. Of course, we have to check that all the tests have worked perfectly, hence the use of controls. The sections have to be brilliant as well. Even staining, no patchiness. Negative controls are negative. All this done, with the proper label of course, it’s time to hand it to the pathologist.

Oh Oh! My boss has asked to see me. What have I done?

It’s OK. He just wanted to ask how things were going and to let me know there is a tutorial tomorrow. Wow! Time has gone quickly today. Just a few more minutes to spare. I make sure I have done everything I needed to do today and prepare for tomorrow, then, it’s home time! Isn’t it nice to go home and the sun is still shining brightly? Hmmmmm, oh no, it’s starting to rain. BRILLIANT!