Application of large format tissue processing in the histology laboratory

In clinical, research and veterinary laboratories of North America, large format histology has more recently been improved with newer equipment and better methodology. Large tissue specimens are frequently sliced in the grossing room and processed in multiple smaller, standard size tissue cassettes. Justifiably, submitting more blocks inherently lends itself to a greater confidence in the accuracy of the diagnosis, yet guidelines for tissue sampling often suggest taking fewer samples. For example, large tumor specimen protocols recommend taking one standard-sized tissue block for each cm diameter of tumor. However, cancers are the culmination of many complex changes in cell metabolism and often appear dissimilar at different tissue locations. As these changes have an uncertain behavior, many other tissue samples are often taken from areas that appear to have either a variable texture or color. Consequently, at microscopy, the complete tissue sample may need to be reassembled like a jigsaw puzzle as the stained sections are frequently presented over many slides. This problem has easily been overcome by using large format cassettes since the entire cross-section of the tissue sample can often be viewed on a single slide. Because these cassettes can effectively hold up to 10 times the volume of conventional standard size cassettes, they are a more efficient way of assessing large areas of tissue samples. This system is easily adapted for all tissue types and has become the established method for assessing large tissue samples in many laboratory settings.