During a busy endoscopy list, a technologist assists the pathologist at grossing. To save time, she labels the cassettes for the next two cases in advance, opens both formalin containers together and sets them side by side. Case A's requisition reads 'gastric antrum, 2 biopsies'; case B's reads 'sigmoid colon, 5 biopsies'. The dictated gross descriptions read 'case A: five fragments' and 'case B: two fragments', and both containers are now empty. At embedding the next morning, the histotechnologist finds five fragments in cassette A and two in cassette B. What should the histotechnologist do?

Hold both cases and inform the pathologist at once

Ask both endoscopy teams to repeat the biopsies

Swap the two cassette labels to match the requests

Embed both as labeled and flag them at sign-out

A bullet removed at surgery is sent to the laboratory for a police investigation. What does chain of custody add to routine specimen handling?

A signed, timed record of every handover

Fixation in formalin before transfer

Two patient identifiers on the container

Handling only by the reporting pathologist

Why are tissue cassettes labeled with a graphite pencil, a solvent-resistant pen or a cassette printer rather than an ordinary marker?

Alcohol and xylene dissolve ordinary ink

Ordinary ink smudges in the water bath

Ordinary ink runs in the hot paraffin

A uterus arrives in formalin. The medical record number on the container differs from the one on the request form, although the names match. What should the technologist do?

Keep it in formalin and resolve it with the sender

Process it under the number on the request form

Return it to surgery and request a repeat specimen

Correct the container label to match the form

Under CAP requirements, every surgical specimen container must be labeled with at least:

Two patient-specific identifiers

The surgeon's name and the date

Histology specimen reception and accessioning

7 DOH Abu Dhabi (HAAD) lab licensing practice questions on Histology specimen reception and accessioning, part of Histopathology and Cytology. The first 7 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Hard
During a busy endoscopy list, a technologist assists the pathologist at grossing. To save time, she labels the cassettes for the next two cases in advance, opens both formalin containers together and sets them side by side. Case A's requisition reads 'gastric antrum, 2 biopsies'; case B's reads 'sigmoid colon, 5 biopsies'. The dictated gross descriptions read 'case A: five fragments' and 'case B: two fragments', and both containers are now empty. At embedding the next morning, the histotechnologist finds five fragments in cassette A and two in cassette B. What should the histotechnologist do?
1. AAsk both endoscopy teams to repeat the biopsies
2. BSwap the two cassette labels to match the requests
3. CEmbed both as labeled and flag them at sign-out
4. DHold both cases and inform the pathologist at once
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Answer: D · Hold both cases and inform the pathologist at once
Each cassette holds the number of fragments listed on the other patient's requisition, which points to a switch at grossing, when two containers were open at the same time with cassettes labeled in advance. A suspected identification error is a serious nonconformity: work on both cases stops, and the pathologist is told before any slide is cut or reported. Laboratory staff must not relabel blocks on their own, because a count mismatch is strong evidence but not proof; the pathologist leads the investigation using the gross records, the endoscopy reports and, if needed, DNA identity testing. Repeat biopsies are a last resort if the identity cannot be resolved. The lasting fix is to gross one specimen at a time, matching container, requisition and cassette before the next container is opened.
- A: Repeat biopsies are considered only if the investigation cannot resolve the identity.
- B: Relabeling on an assumption could fix the error wrongly and hides it from the investigation.
- C: Embedding and reporting as labeled risks issuing each patient's result under the other's name.
Question 2 · Medium
A bullet removed at surgery is sent to the laboratory for a police investigation. What does chain of custody add to routine specimen handling?
1. AFixation in formalin before transfer
2. BA signed, timed record of every handover
3. CTwo patient identifiers on the container
4. DHandling only by the reporting pathologist
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Answer: B · A signed, timed record of every handover
Chain of custody is an unbroken written record of who held a medicolegal specimen at every point. Each person who receives or passes it on signs and records the date and time, and the item is kept sealed in secure, limited-access storage. A gap in the record can make the evidence unusable in court. Bullets and other foreign bodies are handled with plastic or rubber-tipped instruments so that no new marks are added.
- A: Fixation is not a custody step, and a bullet does not need formalin.
- C: Two identifiers are routine for every specimen, not specific to chain of custody.
- D: Any authorized person may handle it, provided every handover is recorded.
Question 3 · Easy
Why are tissue cassettes labeled with a graphite pencil, a solvent-resistant pen or a cassette printer rather than an ordinary marker?
1. AOrdinary ink smudges in the water bath
2. BOrdinary ink runs in the hot paraffin
3. CFormalin bleaches ordinary ink
4. DAlcohol and xylene dissolve ordinary ink
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Answer: D · Alcohol and xylene dissolve ordinary ink
Processing carries cassettes through graded alcohols and xylene, which dissolve most ordinary marker inks. A cassette that loses its accession and block number cannot be matched safely to its patient or gross description. Pencil, solvent-resistant histology pens and cassette printers keep the label readable through processing and storage. Printed labels taken from the laboratory system also cut transcription errors.
- A: Cassettes do not go into the flotation water bath; only sections do.
- B: The ink is usually lost earlier, in the alcohols and xylene, before the wax step.
- C: Formalin does not bleach ink; the processing solvents dissolve it.
Question 4 · Medium
A uterus arrives in formalin. The medical record number on the container differs from the one on the request form, although the names match. What should the technologist do?
1. AProcess it under the number on the request form
2. BReturn it to surgery and request a repeat specimen
3. CKeep it in formalin and resolve it with the sender
4. DCorrect the container label to match the form
Show answerHide answer
Answer: C · Keep it in formalin and resolve it with the sender
A surgical specimen cannot be collected again, so it is never discarded or rejected outright as a blood sample might be. It stays in fixative while the discrepancy is resolved and documented, usually by the person who collected it, and no report is released until then. Laboratory staff must not relabel a container on their own to make it match the form. The event is recorded as a nonconformity for quality review.
- A: Processing with an unresolved mismatch risks reporting on the wrong patient.
- B: A uterus cannot be collected again; the specimen must be kept.
- D: Staff must not relabel a specimen themselves; the sender must resolve the mismatch.
Question 5 · Easy
Under CAP requirements, every surgical specimen container must be labeled with at least:
1. AThe ward and bed number
2. BThe patient's full name only
3. CThe surgeon's name and the date
4. DTwo patient-specific identifiers
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Answer: D · Two patient-specific identifiers
CAP requires each primary specimen container to carry at least two patient-specific identifiers, such as full name and medical record number. A name alone can be shared by two patients, and a bed number changes when the patient moves. The label goes on the container itself, not the lid, because lids come off at grossing and can be swapped. A container that fails this check is held until the identity is confirmed.
- A: A ward and bed number identify a location, not the patient.
- B: A name alone is not unique; two patients can share it.
- C: The surgeon's name and date do not identify the patient.
Question 6 · Hard
A benign skin biopsy section shows a tiny, separate fragment of adenocarcinoma at its edge. Deeper levels cut from the same block show the same fragment in the same position. The fragment was most likely introduced:
1. AFrom the flotation water bath
2. BFrom the microtome blade
3. CDuring grossing or embedding
4. DFrom the slide stainer reagents
Answer and explanation in LearnFree account
Question 7 · Hard
Three gastric biopsies, each about 1 mm, were placed loose in a standard slotted cassette at grossing. After processing, both the cassette and its lid are empty. What should be done with small biopsies in future?
1. AWrap them in biopsy paper or use a mesh cassette
2. BFix them in Bouin solution instead of formalin
3. CProcess them on a longer overnight schedule
4. DTint them with eosin before processing
Answer and explanation in LearnFree account

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Histology specimen reception and accessioning

A bullet removed at surgery is sent to the laboratory for a police investigation. What does chain of custody add to routine specimen handling?

Why are tissue cassettes labeled with a graphite pencil, a solvent-resistant pen or a cassette printer rather than an ordinary marker?

A uterus arrives in formalin. The medical record number on the container differs from the one on the request form, although the names match. What should the technologist do?

Under CAP requirements, every surgical specimen container must be labeled with at least:

A benign skin biopsy section shows a tiny, separate fragment of adenocarcinoma at its edge. Deeper levels cut from the same block show the same fragment in the same position. The fragment was most likely introduced:

Three gastric biopsies, each about 1 mm, were placed loose in a standard slotted cassette at grossing. After processing, both the cassette and its lid are empty. What should be done with small biopsies in future?