1. General Procedure For Submission Of Specimen

Place all tissue specimens in 10% formol saline contained in a bottle immediately after collection. If the specimen is small, the volume of the fixing solution should be 10-20 times that of the specimen.

Label the bottle with the patient’s name and registration number, the site of origin of the specimen, the address of the hospital or clinic, and the numbers, including the dates, of previous oral pathology reports if any. Every specimen must be accompanied by a completed request form giving full particulars of the patient including the chief complaint, the duration of the complaint, as well as the preliminary and differential diagnosis. Also include the relevant radiological information if the specimen is from a bony lesion.

Seal the bottle hermetically, otherwise close it securely. The sealing of the lid margins with wax is excellent. To avoid damage during transport, pack the bottle with sufficient absorbent material in a strong case. PLEASE DO NOT PACK IN DRY ICE, this may cause freeze artefacts. Flexible plastic bottles are ideal. Mark the package with the words “FRAGILE – HANDLE WITH CARE” AND “TISSUE SPECIMEN FOR ORAL PATHOLOGY”. If an early report is required, include the word “URGENT”.

2.  Specimen Collection And Preparation

Do not paint the surface of the area to be biopsied with gentian violet, iodine or any other darkly coloured antiseptic. Take thin, deep wedge sections from the substance of the lesion across the border into normal tissue rather than large shallow specimens from the surface. The specimen should be at least 1.0 x 0.5 x 0.5cm³ in size. Fix the tissue immediately upon removal in 10% formol–saline contained in a bottle – DO NOT SQUEEZE SPECIMEN INTO A NARROW–MOUTHED BOTTLE. If the specimen is thin, place it on a piece of blotting paper before dropping it into the fixative. This is to prevent the tissue from curling. Encapsulated material should be opened to allow the preservative to reach the inner contents. A repeat biopsy should be performed if the adequacy or representativeness of the first specimen is in doubt.

When marginal or composite sectional studies are required, mark the excised specimens with different coloured sutures.

Note: Biopsy specimens must never be ruined by being crushed, as a result of the use of toothed forceps. The use of electrocautery for biopsy is usually contraindicated as it makes the diagnosis of the tissue difficult. Diagnosis of specimens is also made difficult by rough handling and the use of unsuitable instruments during surgery. Delayed or imperfect fixation further exacerbates the problem.

Diagnosis of bony lesions should be established by a combination of clinical, radiological and pathological investigations supplemented, when necessary, by biochemical and haematological data. The levels of calcium, phosphorus, alkaline phosphatase, and acid phosphatase in serum are important in some conditions, e.g., hyperparathyrodism, Paget’s disease, metastatic carcinoma and myeloma. Bone marrow cytology and plasma and urinary proteins are important in multiple myeloma, while haematological investigation is essential in malignant lymphomas and leukaemic involvement of the bone.

2.2  Imprint

Tissue imprints provide an excellent means of studying tumour cells especially of the lympho-reticular system. Make imprints of the biopsy tissue by gently touching the freshly cut surface with clean glass slides. Allow the imprints to dry in air, or fix them in 95% methyl alcohol before sending them to the laboratory.

2.3.  Smear

Tissue smears from the mouth, stained by Periodic Acid Schiff (PAS) reaction, is useful in the diagnosis of oral candidiasis. Scrape the affected mucosa, e.g., buccal mucosa, tongue, etc., with a spatula or tongue depressor by a firm single scraping motion. Next, make smears of the scrapings on clean glass slides by a single spreading motion. Avoid moving the scraper back and forth as this will cause the cells to curl or twist. Place the smear immediately in 95% alcohol. Leave it in the alcohol for at least 20 min before staining it.

3.  Patient Consultation

Oral Medicine patient consultation is conducted at the Oral Surgery Department, Hospital Kuala Lumpur. Please call the Oral Surgery Department (telephone number: 03-26155555 extension 5723 or 03-26155723) for an appointment. Standard referral procedures to Specialists clinics in government hospitals are applied.