Anatomy and Pathological Histology

The Simple Department Structure (SSD) of Anatomy and Pathological Histology conducts the following activities:

  • Histological diagnoses on pathologies of the muscular-skeletal system;
  • Consulting on prepared and unprepared samples (here the indications on how to request an anatomic-pathologic consulting - in Italian);
  • Clinical research with retrospective and prospective study on the clinical records of the Rizzoli Orthopaedic Institute;
  • Meetings with the colleagues from the oncologic units of the Rizzoli Orthopaedic Institute;
  • Practical-professional internships for students of the degree course in Laboratory Techniques; internships for Italian and foreign students and doctors.

In the muscular-skeletal field, the diagnostic activity regards tumoral or tumor-like lesions of the bone and soft tissues, non-neoplastic diseases of the bone and diseases of the synovium and the joints.
The SSD of Anatomy and Pathological Histology is acknowledged as national reference center by A.E.I.O.P. (Italian Association for Hematology and Pediatric Oncology) regarding pediatric bone tumors, and as regional HUB reference center for the diagnosing of bone tumors and of tumors of soft tissues and extremities.

Histological diagnostics

The service of Pathologic Anatomy provides histopathological diagnoses on bioptic material and surgical pieces. The aim of such histologic exams is to establish the presence of a pathological process and to define its nature.
In detail, the examination of surgical pieces includes:

  • Macroscopic description with examination of surgical margins;
  • Execution of macroscopic photos in digital format;
  • Radiographic study of macroscopic sections;
  • Sampling of neoplasias;
  • Study of microsections;
  • Mapping of the surgical piece for the evaluation of chemiotherapy-induced necroses, where provided by international protocols.

Hematoxylin-eosin coloration in a high grade malignant osteosarcoma

Intraoperative histological diagnostics

The Laboratory provides extemporaneous exams on fresh samples sent to the laboratory during a surgical operation. The result is phoned through and faxed to the clinician who requested it, within 15 minutes.

Immunohistochemistry

In the immunohistochemistry branch, a search for specific tissue antigens is performed in order to fully characterize the pathologies of the muscular-skeletal system. Such exams are conducted on paraffin-embedded tissue, using automated instruments, mono- or polyclonal antibodies and highly sensitive revelation systems.
The main diagnostic applications of immunohistochemistry involve differential diagnosing of diverse neoplasias of the muscular-skeletal system, the identification of metastases origins in cases of unknown primitive tumors, and the qualitative evaluation of prognostic-therapeutic markers, with the aim to set up targeted therapies.

Nuclear immunohistochemical positivity for the SATB2 antigen in an osteosarcoma

Molecular biology

The molecular biology branch performs searches for genetic alterations, characterizing specific sarcomas, by applying techniques such as the Real-Time RT-PCR (Reverse Transcriptase-Polymerase Chain Reaction) and the FISH (Fluorescence In Situ Hybridization).

Electrophoretic graph in an Ewing sarcoma

New technologies such as the Digital PCR, which have led to refine always more sophisticated methodologies of molecular investigation, contribute to the development of the sector.
Such investigations are conducted on both on fresh tissue and on paraffin-embedded tissue fixed in formalin.
Here the list of the translocations investigated at the SSD of Anatomy and Pathological Histology (in Italian).

N.B. In case of need of molecular investigations (ALK, EGFR, HER…) on the metastases of epithelial tumors, the patient can request histological sections as a sample of the tumor (see the indications to request the histological material).

FISH analysis for the rearrangement of the EWSR1 gene

Specialist consultation

The SSD offers specialist consultations, with histological revision of solutions inherent to the pathologies of bone and soft tissues. The SSD of Anatomy and Pathological Histology routinely receives national and international cases for consultation (in red on the map, the countries which have so far sent cases for consultation).

Maps of the requests for a specialist consultation

Educational activity

The SSD organizes anatomic-clinical meetings, discussing particularly interesting cases from the clinical-diagnostic-therapeutic perspective, through video projection of radiological images and examination of histological solutions at the multihead microscope.
The Laboratory offers practical-professional internships for students of the degree course in Laboratory Techniques, as well as pre-degree internships for students of Biology and Biotechnology.
The ward is also an internship destination for Italian and foreign doctors who follow the routine activity of the ward, have access to the histological archive of bone and soft tissues tumors, and participate to the publication of scientific works.

Research activity

The laboratory performs research activity on pathologies of the musculoskeletal system, in particular:

  • collaborations with the Research Laboratories and other wards of the Rizzoli Orthopaedic Institute, through the provision of archive material, preparation of solutions, reviewing of cases, and immunohistochemical and molecular investigations;
  • identification of prognostic and predictive markers for their utilization in new targeted therapies, in collaboration with the Chemotherapy Department;
  • refinement of new therapeutic protocols, in collaboration with the Laboratory of Experimental Oncology;
  • studies on bones resected from bone tumors in the juvenile age, in collaboration with the Laboratory of Medical Technology;
  • participation to European projects concerning bone and soft tissue tumors.  

The developments and the results of the research activity are monitored yearly by the Scientific Direction of the Institute, in accordance with the guidelines set by the Ministry of Health.

The Tissue Bank of musculoskeletal tumors

Fresh pathological tissue is routinely collected at the Laboratory for the Musculoskeletal Tumors Bio-bank. The collected tissues can be utilized both for possible in-depth diagnostic analyses and for research purposes, also at the international level.
Currently, the biobank has collected:

  • over 10.000 neoplastic tissue samples from musculoskeletal tumors, from both bones and soft tissues, including metastases formed from these tumors and bone metastases of different origins;
  • about 5.000 samples of healthy tissue adjacent to the neoplasias.

The management of this biobank is entrusted to Dr. Giovanna Magagnoli (biologist at the Laboratory of Experimental Oncology), working at the Anatomy and Pathological Histology Department. This involves the cryopreservation and archiving of tissues and the registration of the data concerning the samples on a specific data base.
The Bio-Bank of musculoskeletal tumors of the Rizzoli Orthopaedic Institute results to be the world's largest collection of tissues deriving from tumors of the musculoskeletal system, and is member of the network of bio-banks acknowledged by the BBMRI (Biobanking and Biomolecular Resources Research Infrastructure) and the RIBBO (Italian network of Oncologic Bio-Banks).

The Service Quality System for Anatomy and Pathological Histology

The SSD of Anatomy and Pathological Histology is an Organization provided with a Management System certified by KIWA CERMET in compliance to the UNI EN ISO 9001:2008 standard.

Content updated 15/11/2016 - 16:08
Content edited by: Dr.ssa Stefania Benini - Dott. Marco Gambarotti
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