Pathology Laboratory - Apollo Cancer Centres

Pathology is one of the sections under the laboratory services which is the principal determinant of diagnosis and predicts the likely clinical course, thereby forming the cornerstone for management.
Specimens received by the pathology laboratory undergo tissue fixation followed by preparation by techniques which helps us to analyse tissues under the microscope. A properly fixed and processed tissue permits proper storage of tissue and utilisation of the tissue for further investigations, including Immunohistochemistry and molecular studies.
The main types of specimens received by the pathology laboratory include Larger specimens of whole organs or parts thereof, which are removed during surgical operations, Pieces of the tissue rather than whole organs removed as biopsies like excision biopsies -tissue is removed with a scalpel (e.g. a skin excision for a suspicious mole), a core biopsy- a needle is inserted into a suspicious mass to remove a core of tissue that can be examined under the microscope (e.g. to investigate a breast lump) and even bone marrow examination for staging/ diagnostic purposes.
For immediate diagnosis and margin status during a surgical procedure (intraoperative assessment), a frozen section is performed. This allows the surgeon to decide the extent of surgery in the operation theatre itself.
Immunohistochemistry

Immunohistochemistry is a laboratory technique used to detect specific antigens (proteins) in tissues for cells based on antigen-antibody recognition. Pathologists use IHC to diagnose if a tumour is benign or malignant, to determine its stage and grade, and to identify the cell type and origin of a metastasis in order to find the site of the primary tumour.
We perform Immunohistochemistry using a fully automated platform for diagnostic, various prognostic and predictive markers in cancer pathology. We have panels designed for carcinomas, sarcomas and lymphomas. Our hormone receptor panel is available as
Lymphoma Panel markers CD2, CD3, CD4, CD5,CD7,CD8, CD10 ,CD15, CD20,CD21,CD23,CD30, CD43, CD56, CD68, CD79a, CD138, LCA, LMP, BCL2,BCL6, MUM-1, Oct-2, BOB -1, CYCLIND1, CD138, KAPPA, LAMBDA, c- Myc, ALK and Non Lymphoma Panel markers ALKD5F3, CD31 ,CD34, CD99, CK,CK(HMW), CK7, CK20, CK5/6, CK8/18, EMA, GATA-3, Glypican – 3, GCDFP-15, SMA, MSA, PSA, PSAP,PLAP, VIMENTIN, DESMIN, HMB45, HER2NEU, CA125,CALDESMON, ,INHIBIN ALPHA,CALRETININ, BEREP4, TTF, GCDFP15, CKIT, CEA(Monoclonal), CEA (polyclonal), SYNAPTOPHYSIN, CHROMOGRANIN, S100, MPO, CALCITONIN, THYROGLOBULIN, MART1,MYOD1,CK19,CDX2,BETACATENIN,CD1a,AMACAR,ANNEXIN,ARGINASE,CD56,HHV8,IgG4,IgG, EMA, PAX-8, PD-1,RCC, S100,SAT-B2,SOX-10, SOX-11, GFAP, IDH-1, ATRX, NF, OLIG-2, P53, P63, KI67, EBER -ISH, MLH-1, MSH-2, PMS-2, MSH-6,BRAF, D240, CKIT, DOG-1, E-cadherin, GRANZYME-B, HEP-1, IgG, IgG4, INI-1, RCC, SALL4, STAT-6,WT-1, FLI.
We also do extensive neuro-oncology immunohistochemistry panels for central nervous system tumours. In addition, our laboratory also uses tests like in situ hybridization for Epstein-Barr Virus, Microsatellite Instability Panel, BRAF testing, and PD-L1 testing (SP142 and SP263), which play an important role in personalising patient management via targeted immunotherapy.

Cytology

Routine and ultrasound-guided fine needle aspiration procedures. Fluid and very small pieces of tissue (individual cells rather than groups of cells, e.g. within fluid from around the lung) can be obtained via fine needle aspiration. This is performed using a thinner needle than that used in a core biopsy but with a similar technique. This type of material is usually liquid rather than solid and is submitted for cytology rather than histology.
Cytology involves the preparation of slides and reporting gynaecological (Pap smears) and non-gynaecological samples (body fluids and cerebrospinal fluid). We perform Liquid Based Cytology using a semi-automated procedure to create a uniform spread of epithelial cells that enables us to provide highly satisfactory results. We also use cell blocks as a routine adjunct to the usual cytological smears made for fluid examination. These cell blocks can then further be utilised for immunohistochemistry and molecular studies.

Haemato-oncology

A department that focuses on blood and blood-related cancers that account for approximately 10% of all cancers. It originates in the bone marrow, which is the main source of blood production and affects the production and function of the blood cells. Blood is made up of three types of cells: Red blood cells, White blood cells, and Platelets. In the case of cancer, the blood production process is interrupted due to the growth of an abnormal type of blood cell. The various types include:

Leukaemia: This is caused by the rapid production of abnormal blood cells in the bone marrow, which affect the bone marrow’s ability to produce red blood cells and platelets.
Lymphoma: This is a type of blood cancer that affects the lymphatic system, which is responsible for producing lymphocytes (a type of white blood cell that fights infection) and for the removal of excess fluids from the body. Uncontrollable growth of these abnormal lymphocytes causes lymphoma that spreads to the lymph nodes and other tissues.
Myeloma: It is the type of blood cancer that affects plasma cells (the white blood cells responsible for the production of disease-fighting antibodies in the body), resulting in a weak immune system.

Flow Cytometry:

Haemato oncology is equipped with a state of the art Flow Cytometry machine that looks for certain substances (markers/antibodies) on or in cells that help identify what types of cells they are. This test can be used to see if the lymphocytes in a sample of blood contain CLL cells. Similarly, flow Cytometry can be used for detecting abnormal white cells called blasts either in the bone marrow or peripheral blood. These blasts, when found in large numbers in peripheral blood or bone marrow, are called acute Leukaemia. Flow Cytometry also enables the identification of various types of Leukaemia. After treatment, flow Cytometry can be used to assess whether blasts are still present or completely eliminated by chemotherapy. This is called detection of minimal residual disease or MRD. Flow Cytometry can diagnose Classical Hodgkin Lymphoma in Lymph Nodes with high sensitivity and specificity along with other Non –Hodgkin lymphomas where a screening test can be done to determine if lymphoma is present or not. Flow Cytometry is used for Immunophenotyping of a variety of specimens, including whole blood, bone marrow, serous cavity fluids, cerebrospinal fluid, urine, and solid tissues.
In Flow Cytometry, a sample of cells from a biopsy, cytology specimen, or blood specimen is treated with special antibodies. Each antibody sticks only to certain types of cells that have the antigens that fit with it. Usually, all it takes to identify a specific type of cell is to create a monoclonal antibody to recognize that cell. Then a fluorescent dye is attached to the antibody, and flow Cytometry can find all the cells that the antibody targets. The cells are then passed in front of a laser beam to generate useful data plots for a skilled cytometrist to interpret. Acute Leukaemia Panel- B-Lymphoid Markers & Acute Myeloid Leukaemia Panel B-Lymphoid Markers includes CD10, CD19, CD20, CD22, Nuclear TDT T- Lymphoid and NK Markers CD1a, C D 2, CD3, CD4, CD5, CD7, CD8, CD56 Myeloid Markers CD13, CD15, CD16,CD33, CD117 Monocytic Markers CD4, CD11b, CD14, CD64 Cytoplasmic Markers – MPO, CD79a and CD3 Non-Lineage specific Markers CD34, HLA DR, CD45, Myeloma Panel Cyto Kappa, cyto Lambda, CD56, CD10, CD38, CD138, CD19, CD28, CD20 & CD45, Chronic B Lymphoproliferative Disorder Panel Kappa, Lambda, CD38, CD10, CD11c, CD19, CD5, CD20, CD103, CD180, CD200, IgM, CD43, CD21, CD3, CD16, CD56, CD7, CD8, CD4, TCR g/d, FMC7, CD23 & CD45, CD34+ Stem cell enumeration CD34, Iso clonic control, Viability dye, Stem count beads.