During a breast lumpectomy, the frozen section suggested clear margins, but the permanent paraffin slide later showed residual tumor.

I needed to confirm the discrepancy, ensure patient safety, and document the findings per protocol.

I reviewed the original tissue blocks, re‑cut additional sections, consulted the senior surgical pathologist, and performed immunohistochemical stains to clarify the margin status. I also notified the surgical team promptly and updated the pathology report with a detailed addendum.

The additional stains confirmed residual disease, leading to a timely re‑excision surgery and preventing recurrence. The case was documented for quality assurance, and the lab’s turnaround time metrics improved.

A 62‑year‑old patient presented with a solitary lung nodule; the morphology was ambiguous between primary lung adenocarcinoma and metastasis from a known colorectal primary.

Select an IHC panel that reliably distinguishes the two origins.

I ordered TTF‑1 and Napsin A (markers favoring primary lung adenocarcinoma) and CDX2 and CK20 (markers favoring colorectal origin). I also included CK7 to assess the CK7/CK20 pattern. The panel results were interpreted in the context of clinical history and molecular testing recommendations.

The tumor was TTF‑1 positive, Napsin A positive, CDX2 negative, and CK20 negative, confirming a primary lung adenocarcinoma. This guided appropriate surgical and systemic therapy, avoiding unnecessary colorectal work‑up.

Our hospital received a referral for a complex sarcoma case late on a Friday afternoon, and the tumor board meeting was scheduled for Monday morning.

I needed to organize the case presentation, gather relevant pathology, radiology, and surgical data, and facilitate a focused discussion despite limited prep time.

I quickly compiled the histologic slides, requested additional molecular testing, coordinated with radiology for imaging review, and sent a concise briefing email to all participants. During the board, I presented the findings, highlighted key uncertainties, and guided the team toward consensus on neoadjuvant therapy.

The team agreed on a targeted therapy plan, the patient started treatment within two days, and the board praised the efficient coordination, leading to a new standard for rapid case reviews.

During routine tissue processing, I noticed that the formalin waste container was overflowing, posing a chemical exposure risk.

Ensure immediate safety, correct the waste handling procedure, and prevent recurrence.

I stopped the workflow, alerted the lab manager, and transferred the excess waste to a secondary container with proper labeling. I then reviewed the waste disposal SOP, identified a gap in daily volume checks, and instituted a twice‑daily inspection log. I also conducted a brief refresher training for all staff on chemical safety.

No exposure incidents occurred, the lab passed the subsequent safety audit with zero citations, and staff reported increased confidence in waste handling protocols.