1. Routine Tissue Examination and Diagnosis
This service constitutes the majority of our work and generally includes gross and microscopic examination and diagnosis of oral, head and neck surgical biopsy and excision specimens. (See separate Obtaining Maximally Diagnostic Oral Tissue Specimens). Rarely, certain specimens are only examined grossly—primarily for medicolegal identification purposes. Special histochemical stains are performed when needed to further identify cell products, exogenous materials or microorganisms. Immunohistochemical stains are utilized when needed to identify the histogenesis or to classify poorly differentiated neoplasms. Obviously, these special studies take longer than the usual overnight turnaround time for uncomplicated specimens and additional charges are incurred.
2. Direct Tissue Immunofluorescence Examination
This highly specific analysis is used primarily for the diagnostic confirmation of immunologically mediated vesiculobullous diseases such as mucous membrane (cicatricial) pemphigoid and pemphigus vulgaris. However, it can also be helpful in the confirmation of atypical cases of oral lichen planus as well as lupus erythematosus and erythema multiforme. Because only minimal cellular detail is visible through the fluorescence microscope, immunofluorescence specimens must be accompanied by a routine specimen if a recently obtained specimen of the same disease process is not available for concurrent microscopic examination. Although fresh or frozen tissue is ideal for this study, specimens may be submitted in fresh (unexpired) immunologic transport medium (Michel’s solution or Zeus fixative). Since specimens lose about 10% of their immunoreactivity per day in transport medium, overnight courier service is recommended for optimal results. Because of the expense and limited shelf life of the transport medium, it should be ordered from the lab by telephone about a week before a patient’s biopsy appointment. (See separate Obtaining Maximally Diagnostic Oral Tissue Specimens).
3. Fungal Smear Examination
This test is used to evaluate for the presence of superficial fungal infection—primarily oral candidiasis. (See separate Oral Fungal Smear—indications and technique)
4. Radiographic Consultation
This service is provided to clinicians desiring a diagnostic report regarding radiographic lesions. In addition to listing a radiographic impression or differential diagnosis, recommendations for patient management may also be offered.
5. Microslide Review/Second Opinion
This service is being requested with increasing frequency because of increased utilization of managed healthcare plans. The high volume of cases processed by the contracted pathology labs and the usual lack of an oral pathologist on their staff often results in more general/nonspecific diagnoses of oral, head and neck specimens than clinicians and patients desire. However, our expertise with the mouth and surrounding tissues usually allows us to provide much more specific histopathologic diagnoses which facilitates more precise care.