HISTOPATHOLOGY UNIT

Head of Unit Dr. Nik hasimah Nik Yahya

Phone +603 2615 5555 extension 5595/5619
Email nikhasimah@gmail.com

1. INTRODUCTION

Histopathology Unit is divided into 3 subsections:

i. Routine laboratory
ii. Specialised laboratory
(Special stain, immunohistochemistry and molecular histopathology laboratory)
iii. Neuromuscular laboratory

2. WHERE TO FIND US

Routine Histopathology and Specialised Laboratories are located within the main laboratory
complex of Pathology Department. The Neuromuscular and Molecular Laboratory is
situated in Institute of Neurology at Level 1. Diagnostic consultation with histopathologists is
at Pusat Diagnostic Anatomik Patologi (PDAP), which is situated at Dermatology Institute
next to Dermatology Auditorium.

3. TO CONTACT US:

1. Head of Unit and Consultant Pathologist (Dr. Nik Hasimah Nik Yahya) : 5619
2. Histopathology office : 5595
3. Report enquiry : 5603
4. Pathologist : 5619, 5707, 5704
5. Microscopy Room (Medical Officer and Scientific Officer) : 6851
6. Routine, Special Stain and Molecular Histopathology Laboratory : 5605
7. Neuropathology Laboratory : 6651
8. Senior Medical Lab Technologist : 6572
4. SERVICES PROVIDED

1. General histopathological examination of tissue (routine HPE)

2. Frozen section
3. Histochemistry (Special Stain) – refer to Appendix 1 for list of special stain
4. Immunohistochemistry (IHC) – refer to Appendix 2 for list of antibodies for IHC.
5. Immunofluorescent microscopy (IMF) – refer to Appendix 3 for list of antibodies for
IMF.
6. Enzyme histochemistry – refer to Appendix 4 for list of enzymes for enzyme
histochemistry.
7. Clinical autopsy
8. Molecular histopathology (Her-2 In-situ hybridization) for breast cancer

5. SUBSPECIALTY SERVICE

1. Paediatric pathology
2. Neuropathology
3. Renal pathology
4. Neuromuscular pathology
5. Urological pathology
6. Gynecological pathology
7. Bone and soft tissue pathology
8. Dermatopathology

List of Consultant Pathologists with subspecialties and their contact details can be found in
Appendix 5.

6. OUT-OF-HOURS SERVICE

A histopathologist is rostered for 24 hours call to cater for frozen section and clinical
autopsy services as well as surgical pathology consultation. He / she can be contacted
through the hospital operator.

7. HOW TO MAKE A REQUEST FOR ROUTINE HISTOPATHOLOGY

EXAMINATION OR OTHER HISTOPATHOLOGY SERVICE.

7.1 General (routine) histopathology.

Use PER-PAT 301 carbonized request form filled in with relevant clinical information for
all histopathological examination requests. If the report is needed urgently, please mark
the request form URGENT clearly at the top right hand corner.

Histopathology Laboratory requires a set of request form (3 carbonized copies) for each
request. A request with multiple specimens only requires one set (3 carbonized copies)
of request form.

7.2 Frozen section.

All requests for frozen section examination must be preceded by appointment and
discussion with the Surgical Pathologist on-call at least 1 day before the operation. This
is followed by filling up of the request form for the frozen section and submitting it to the
Histopathology Laboratory for notification.

Request form for frozen section (HKL/JP/HI/AK-05-02) is available at the

Histopathology Office. (Appendix 6 - A).

Please inform the laboratory at extension 5605 or Medical Officer/Pathologist at ext.

6851 if the frozen section examination is cancelled.

All cases scheduled for frozen section examination are best placed first in the operating
list. So it can be done during normal working hours.

7.3 Clinical autopsy

Clinical autopsy or postmortem examination is conducted to ascertain the cause of

death in non-medicolegal cases. This service is only provided for patients who died in
Kuala Lumpur Hospital.

The following procedure should be followed:

1. The requesting doctor shall first obtain written consent from the next of kin.
Use Borang Keizinan Bedah Siasat Mayat Klinikal (Autopsi Klinikal HKL/JP/HI-BP-
02). This consent form is available at the mortuary counter of Forensic Department,
Kuala Lumpur Hospital.

2. In cases where the next of kin is not available, the Hospital Director and one medical
specialist will have to give their consent.
3. In case of a foreigner where the next of kin is not available, consent from their
respective embassy officials is required.

4. The clinician who requests for post-mortem shall communicate directly with the
Histopathology Medical Officer or Pathologist on call.
 5. Postmortem examination is usually performed during office hour but requests can be
made after office hour if necessary.

6. During office hour, the Medical Officer/ Pathologist on call for clinical postmortem
can be contacted at extension 6851 or 5603.

7. After office hour, the Histopathology Medical Officer and Pathologist on call can be
contacted through telephone. Duty roster of Histopathology Medical Officer
/Pathologist on call and their contact numbers are available at the mortuary counter
of Forensic Department (ext. 6695) and hospital operator.

8. A clinical summary together with the case notes and consent form shall be sent to
the Medical Officer or Pathologist on duty.

9. The requesting specialist from the clinical department is required to be present

during the autopsy.

7.4 Specialised histopathology services / Referrals

Histopathology Unit provides specialized histopathology services in areas as listed

above. Referrals or cases for expert or second opinion are welcome.

i. For consultation :
 The client (pathologist or clinician) can communicate directly with the
Pathologist specialized in the respective field.

ii. Referral for expert or second opinion :

 For HKL patients that need expert or second opinion, the requesting doctor
(clinician) is required to fill up the request form as routine cases and submit it
to Histopathology Laboratory together with the specimen (paraffin embedded
tissue, stained and/or unstained slides). Paraffin embedded tissue is
preferred if the cases need further ancillary studies or staining.

 For outside cases, the material together with referral letter should be sent to
Histopathology Laboratory. The request should be directed or addressed to
the specific Pathologist depending on the specialty. The fax number where
the report needs to be sent to should be provided by the requesting doctor.

 The general referral cases or cases other than the above listed subspecialties
will be reported by the pathologist on call on that particular day.
 If the case has been reported elsewhere, a copy of the report should be
provided.
8. SPECIMEN COLLECTION AND CONTAINERS

All specimens for routine histological examination are to be fixed in 10% neutral buffered
formalin (NBF) in a suitable clean leak-proof container.

The containers should have wide opening and if possible with screw cap to prevent
leakage.

The volume of formalin used must be at least 10 times the volume of specimen to be fixed.
Do not put large specimen in small containers as this would prevent proper fixation of the
tissue and also distort the specimen.

All specimen containers should have the same identification details as that written on the
request forms.

Multiple small specimens such as gastrointestinal biopsies should ideally be mounted on a

piece of filter paper and immediately put in formalin.

Specimens from different anatomical sites should be sent in separate containers, properly
labelled and must be clearly itemized in the request form.

For cases that require confirmation of the adequacy of surgical excision, the margins of the
specimen must be marked or tagged accordingly by sutures or by diagrammatic
representation of the excised specimen.

Specimen for frozen sections should be sent in a clean container without fixative.

Specimen for enzyme histochemistry (acetyl cholinesterase) studies is to be sent fresh

immediately without fixative in closed containers and moistened with normal saline to
prevent drying.

8.1 Muscle biopsy

All requests for muscle biopsy must have prior arrangement with the pathologist
concerned or Medical Lab Technologist (MLT) at extension 5605 at least one day
before the procedure.
(Usually the biceps or quadriceps muscle would suffice in most cases)

Important information to be included in the request form are :

 Creatine kinase level
 LDH
 Contact no. of treating clinician relevant hospital fax number
 Familt history of similar problems.
For open biopsy:
 Remove at least one good cylinder of muscle measuring 1.0x0.5x0.5 cm, the
smaller diameter being the cross-section of the muscle.
  For optimal processing muscle specimen must be wrapped with aluminium foil
and sent fresh in an air tight, dry and clean container.

 The specimen should be transported in a container containing ice or gel ice.

(Never use dry ice).

 Do not tie the muscle to stretch it and do not put tissue on gauze.

The laboratory will accept fresh muscle biopsy specimen up to 4 hours upon removal
but please remember that optimal result requires the specimen to be as fresh as
possible.

8.2 Renal biopsy

Prior arrangement with the Pathologist concerned is preferred for very urgent requests.

Two specimens are recommended for each case for proper histopathological
evaluation, i.e formalin fixed tissue for ordinary light microscopy examination and fresh
tissue for immunofluorescent staining.

Renal biopsy tissue for immunofluorescence:

 Take at least 3 mm core of fresh tissue.

 The specimen should be sent fresh in a clean air tight container.

o If the specimen cannot reach the laboratory immediately, the fresh tissue
should be put in phosphate buffer, properly packed and transported in ice or
gel ice.

 Do not put fresh tissue specimen on gauze.

9. DESPATCH AND TRANSPORTATION OF HISTOPATHOLOGY SPECIMEN

Specimens for routine histopathological examination should be sent directly to

Histopathology Laboratory (not at the common specimen reception counter).

Fresh tissue specimen for frozen section, immunofluorescent staining and enzyme
histochemistry should be sent immediately to Histopathology Laboratory.

Fresh tissue should be properly packed and transported in ice or dry ice if the specimen
cannot reach the laboratory immediately (especially specimen from other hospitals).

For frozen section, the specimen should be sent immediately upon removal to
Histophatology laboratory by a doctor who will wait for the report.

Muscle biopsy specimen should be sent to Histopathology Laboratory (Pintu 6).

10. HISTOPATHOLOGY REPORTS

Reports of biopsies for histopathological examination which are labelled ‘urgent’ will be
available within 1 week after receipt of the specimens by the laboratory (unless the case
needs further staining, second opinion etc).

NOTE: Please leave the requesting doctor’s name and contact number on the request form
for early flagging of results.

Results of frozen section will be immediately communicated to the surgeon via telephone or
the doctor who brought the specimen to the laboratory.

10.1 Report enquiry

Report enquiries can be made via extension 5603. Accession number of the specimen
(HPE number) can be obtained using Labviewer in the respective ward or clinic. The
accession number is the last five digits of the request code which starts with
33XXXXX. Please identify your request according to specimen sent to the laboratory.

The requesting doctors are welcome to discuss the cases directly with the reporting
Pathologist or Medical Officer concerned at extension 6851.

10.2 Collection of report

 All histopathology reports shall be collected by respective clinics / wards /
department from histopathology office.
 Request for a second copy shall be made in writing or using form
PERMOHONAN MENDAPATKAN SALINAN LAPORAN HPE UNIT
HISTOPATOLOGI (HKL/JP/HI-BP-04) (Appendix 6 - B)

11. AFTER OFFICE HOURS SPECIMEN

All specimens for routine histological examination taken after office hours should be fixed in
the usual manner (in formalin) in the respective OT or ward and keep at room temperature.
The specimen should then be despatched to the Histopathology Laboratory during
operating working hours and Saturday from 900 am to 1200 noon.

12. INTERDEPARTMENTAL CLINICOPATHOLOGY CONFERENCE

Histopathology Unit conducts clinicopathology conference (CPC) with the major clinical
departments in Kuala Lumpur Hospital on a monthly basis. The schedule for the whole year
is issued before every new year begins.

The clinical department concerned is required to submit the list of patients to be discussed
to the Histopathology Office at least one week before the schedule date.
Enquiries about clinicopathology conference should be communicated directly to the
Medical Officer in charge or Pathologist concerned at extension 6851 or 5603.

13. TAKING OUT PARFFIN BLOCKS/SLIDES FROM HISTOPATHOLOGY UNIT.

Patients’ paraffin blocks and slides are archived in Histopathology Unit.

For certain valid reasons the unit allows the clinician to take diagnostic material (paraffin
block / slide) from the Unit. The following procedures must be followed.

i. The request to borrow the diagnostic material must be made by a specialist.

ii. The requesting specialist needs to fill up a form PERMOHONAN PEMINJAMAN /

PENGAMBILAN BAHAN DIAGNOSTIK UNIT HISTOPATOLOGI (HKL/JP/HI-BP-01)
(Appendix 6 - C) which is available at Histopathology office.

iii. The completely filled form should be submitted to Histopathology Office and the
material can be taken within 3 working days upon submitting the form to the office.

iv. The paraffin block and stained slides must be returned to Histopathology Office
within 1 month.

14. TAKING OUT TISSUE FROM HISTOPATHOLOGY UNIT.

All specimens (tissue) sent to and officially received by Histopathology Laboratory will be
kept in the unit up for 3 months after the official report is released.

The Histopathology Unit allows the patient to take their tissue, organ or limb back upon
request. Please follow this procedure.

i. The patient or next kin must make a formal request by filling up a form
PERMOHONAN PENGAMBILAN SPECIMEN / TISU UNIT HISTOPATOLOGI
(HKL/JP/HI-BP-02) (Appendix 6 - D).

ii. This form is available in Histopathology Office.

iii. The completed form should be submitted to Histopathology Office.

iv. The tissue is released only after the specimen has been reported by the Pathologist.

15. REQUEST TO OBTAIN MICROSCOPIC IMAGE FROM HISTOPATHOLOGY UNIT.

Microscopic images are not archived as routine but images can be provided upon request.

A request shall be made or endorsed by specialist.

i. For presentation :
 The requesting doctor should communicate directly with the Pathologist
concerned.

 A request shall be made by filling up a form i.e PERMOHONAN

MENDAPATKAN GAMBAR HISTOPATOLOGI (HKL/JP/HI-BP-03)
(Appendix 6 - E). Which is available at the Histopathology Office. The
completed form should be submitted to the Histopathology Office.

ii. For publication :

 The requesting doctor shall communicate directly with the Pathologist
concerned followed by filling up the request form.

 The abstract of the publication should be provided and the Pathologist

concerned who reported the case should be included as co-author.

The microscopic histopathology images will be available within 2 weeks upon submission of the
form. Only soft copy of the images is provided and the requester should provide a CD before
collecting the images from the unit.

16. RESEARCH

 The histopathology unit welcome research projects or studies to be done in

collaboration with our unit.

 All collaborative studies or research projects must have approval from the Head of
Pathology Department.

 A copy of research proposal must be provided.

 One pathologist from the unit shall be appointed as collaborator or co-researcher.

 The researcher will be assisted by the appointed Pathologist to retrieve the materials
required if the research project requires archival material from this unit.

 All archival slides can be borrowed for review in the unit only.

 If paraffin blocks are required for further testing, sections should be done at the
allocated station in this laboratory.

 No archival material should be taken out from Histopathology Unit.

 Appendix 1
LIST OF ANTIBODIES FOR HISTOCHEMICAL STAIN
1. Alcian Blue
2. Congo Red
3. Cresyl Fast Violet
4. Fouchet (Bile)
5. Giemsa
6. Gomori Trichrome
7. Gram
8. Grocott-Gomori Methena Silver (GMS)
9. Leder Giemsa
10. Luxol Fast Blue
11. Masson Fontana
12. Masson Tichrome
13. Martius Scarlet Blue
14. Melanin Bleach
15. Mucicarmine
16. Oil Red O (Fat)
17. Orcein
18. PAAG
19. Periodic acid Schiff (PAS)
20. PAS / Alcian Blue
21. PAS + D
22. PAS + D/ Alcian Blue
23. Perl Prussian Stain
24. PTAH
25. Reticulin (Gordon/Sweet)
26. Rubeanic acid
27. Schmorl's reaction
28. Toluidine blue
29. Van Gieson
30. Von Kossa
31. Verhoeff Elastic Van Gieson (EVG)
32. Wade Fite
33. Warthin Starry
34. Ziehl-Neelson
 Appendix 2
LIST OF ANTIBODIES FOR IMMUNOHISTOCHEMICAL STAIN
1. ALK protein
2. AMACR
3. Amyloid A
4. Alfa-feto protein A
5. Alfa-1 anti trypsin
6. ACTH (AdenocorticontrophinHormon)
7. B-CATENIN
8. BCL 2
9. BCL 6
10. BSEP
11. CA 125
12. CD 1 - ALPHA
13. CD 2 (T-Cell)
14. CD 3(T cell)
15. CD 4
16. CD 5(T cell)
17. CD 7
18. CD 8
19. CD 10
20. CD 15(Hodgkin's)
21. CD 20(B cell)
22. CD 21
23. CD 23
24. CD 30(Ki-1) Antigen
25. CD 31(Endothelial cell)
26. CD 34
27. CD 43 (Hematologi)
28. CD 56 (NKT-cell)
29. CD 61 (Hematologi)
30. CD 68(Macrophage)
31. CD 79 Alpha(B cell)
32. CD99 (Mic2 Gens)
33. CD 117
34. CD 138 (Hematologi)
35. CD 163
36. CD235a - Glycophorin A (Hematologi)
37. CDK4
38. CDX2
39. Calcitonin
40. Caldesmon
41. Calretinin
42. CEA(Carcino Embryonic Antigen)
43. Chromogranin
44. CK 5/6
45. CK 7
46. CK 19
47. CK 20
48. CK AE1/AE3
49. CK MNF 116
50. CMV (Cytomegalovirus)
51. C4d
52. C1q
53. C3
54. Cyclin D1
55. D2 40
56. Desmin
57. DOG 1
58. E-Cadherin
59. EBV(Epstein Barr Virus)
60. EMA (Epithelial Membrane Antigen)
61. ER(Estrogen receptor)
62. ERG
63. Epithelial antigen
64. F8 (Factor V111 R Ag)
65. Fli-1
66. FSH(Follicle Stimulating Hormone)
67. GFAP(Glial fibrillary acidic protein)
68. GH(Growth Hormone)
69. GLUT 1
70. H-Caldesmon
71. HER-2
72. Hepatocyte Antigen
73. HHV8
74. HMW CK
75. HbSAg (Hep. B Surface Antigen)
76. HL ADR
77. HPL
78. HCG(H. Chorionic Gonadotropin)
79. HPV (Human papilloma virus)
80. HMB45
81. HSV
82. IDH 1
83. Inhibin
84. IgA
85. IgG
86. IgM
87. KI 67
88. Kappa
89. Lambda
90. LCA(Leuco. Com. Antigen)
91. LH(Luteinizing Hormone)
92. Lysozyme
93. Mammaglobin
94. MDR3
95. Melan A
96. MUM 1
97. MPO (Hematologi)
98. Myogenin
99. Myoglobin
100. MYO D1
101. MUC-2
102. MUC-4
103. Napsin A
104. NEU-N
105. NSE(Neurone Specific Enolase)
106. NB84
107. NF (Neurofilament)
108. PSA (Prostate Specific Antigen)
109. P16
110. P40
111. P53
112. P57
113. P63
114. PAX 5
115. PLAP
116. PR (Progesteron Receptor)
117. Prolactin
118. PAX 8
119 RCC
120. SAT B2
121. SMA
122. SNF5 (INI-1)
123. SOX 10
124. STAT 6
125. SV40
126. Synaptophysin
127. S100
128. Tdt
129. TFE3
130. TLE 1
131. TSH
132. TTF1
133. Thyroglobulin
134. Toxoplasma gondii
135. Vimentin
136. Wilm's tumour 1
 Appendix 3

LIST OF ANTIBODIES FOR IMMUNOFLUORESCENT STAIN

1. IgG

2. IgA

3. IgM

4. C3

5. C1q

6. Fibrinogen
 Appendix 4

LIST FOR ENZYMES FOR ENZYME HISTOCHEMICAL STAIN

A/ RECTAL BIOPSY FOR HIRCHSPRUNG’S DISEASE

Acetylcholinesterase

B/ MUSCLE BIOPSY FOR NEUROMUSCULAR DISORDER

1. Acid phosphatase

2. Alkaline phosphatase

3. AT Pase (pH 4.3 TO 10.9)

4. Cytochrome Oxidase

5. Cytochrome Oxidase /Succinate dehydrogenase

6. NADH-TR

7. Succinate dehydrogenase
 APPENDIX 5

CONSULTANT HISTOPATHOLOGISTS, SUBSPECIALTIES AND

CONTACT DETAILS

Pathologist Name Field Of Subspecialty Email Address Tel Ext. No.

Dr. Arni Talib
Head Of Department
Dr. Nik Hasimah Nik Yahya
Head Of Unit
Datin Dr. Fauziah Kassim
Dr. Suryati Mohd Yusoff
Dr. Zanariah Alias
Dr. Razmin Ghazali
Dr. Noraini Mohd. Dusa
Dr. Rosna Yunus
Dr. Hemlata Kumari
Gnanasegaram
Dr. Zuliatul Faizah Baharom
Dr. Subasri Armon
Paediatric Pathology arni.talib@yahoo.com.my 5594/5619
Renal Pathology nikhasimah@gmail.com 5619
Neuropathology drfauziahk@gmail.com 5623
Neuromuscular Pathology drsuryati88@gmail.com 5707
General Histopathology &
zanzainal@yahoo.com 5707
Cytology
Gynaecological Pathology razmin1967@gmail.com 5243
Bone And Soft Tissue
noraini.mdusa@gmail.com 5704
Pathology
Urological Pathology yrosna@yahoo.com.my 5704
Transplant Renal Pathology hm.kumari12@gmail.com 5244
Training in Dermatopathology zuliatulfaizah@gmail.com 5243
General Histopathology &
sarmon2003@gmail.com 5244
Cytology

Note: Please be informed that all Histopathologists now have moved to PUSAT
DIAGNOSTIC PATOLOGI ANATOMIK which is situated at level 1, Institute of
Dermatology Block next to Dermatology Auditorium.
 APPENDIX 6 - A

BORANG PERMINTAAN FROZEN SECTION

 APPENDIX 6 - B

PERMOHONAN MENDAPATKAN SALINAN LAPORAN HPE UNIT

HISTOPATOLOGI
 APPENDIX 6 - C

PERMOHONAN PEMINJAMAN / PENGAMBILAN BAHAN DIAGNOSTIK

UNIT HISTOPATOLOGI
 APPENDIX 6 – D (1)

PERMOHONAN PENGAMBILAN SPECIMEN / TISU UNIT

HISTOPATOLOGI
 APPENDIX 6 – D (2)

PERMOHONAN PENGAMBILAN SPECIMEN / TISU UNIT

HISTOPATOLOGI
 APPENDIX 6 – E

PERMOHONAN MENDAPATKAN GAMBAR HISTOPATOLOGI