Anatomic Pathology Services

The pediatric pathologists at Nationwide Children’s Hospital have extensive experience with evaluation and diagnosis of a broad range of neoplastic and non-neoplastic diseases. Many of these occur primarily in the pediatric population or have a unique presentation in the pediatric age group. Areas of expertise include:

• Pediatric renal tumors including Wilms tumor, renal cell carcinoma, and mesenchymal tumors
• Neuroblastoma and related neuroblastic tumors
• Sarcomas of bone, soft tissue and viscera
• Vascular malformations
• Transplant pathology of the heart, lung, kidney and liver
• Detailed dissection of the heart in children and adults with congenital heart disease

The pediatric pathologists at Nationwide Children’s Hospital have extensive experience with perinatal and pediatric autopsy pathology including congenital and metabolic diseases, as well as the examination of products of conception and the placenta. A complete report, including ancillary studies such as cytogenetics and molecular testing, where appropriate, is provided on each case. Areas of expertise include:

• Routine work up of fetal, neonatal and pediatric demise (generally up to age 18 years unless the patient is a longstanding Nationwide Children’s patient), including radiology, cytogenetics, microbiology and molecular testing where required 
• Detailed dissection of the heart in children and adults with congenital heart disease
• Complete gross and histologic examination of the placenta or products of conception, including immunohistochemistry, cytogenetics and molecular assays as required 

Autopsies are typically performed on fetuses >20 weeks of age and consent is required. An autopsy can be performed on a fetus <20 weeks, with consent and disposition attested to by the parent(s) and/or guardian(s).

The pediatric pathologists at Nationwide Children’s Hospital offer expertise in neoplastic and non-neoplastic diseases involving the gastrointestinal and hepatobiliary tracts. Electron microscopy with interpretation is available to assist in diagnosis.

Gastrointestinal Pathology:

• Endoscopic biopsies for the diagnosis of eosinophilic esophagitis, celiac disease, inflammatory bowel disease (Including very-early onset IBD), immunodeficiencies, and congenital enteropathies
• Graft-versus-host disease and conditions associated with the post bone marrow transplant period
• Polyps in hereditary polyposis syndromes
• Hirschsprung disease including diagnostic rectal biopsies and evaluation of resection specimens

Liver Pathology:

• Neonatal cholestasis including diagnosis of biliary atresia, paucity of bile ducts, and progressive familial cholestasis
• Metabolic liver disease
• Noninfectious hepatitis including non-alcoholic steatohepatitis and autoimmune hepatitis
• Liver transplant evaluation for graft injury and rejection
• Liver neoplasms including hepatoblastoma, mesenchymal tumors, and vascular lesions

The Renal Pathology Service provides comprehensive diagnostic services relating to the pathology of medical disorders of the kidney with specific training and focus in the pediatric population. The service provides exceptional expertise and a comprehensive work up on every biopsy including:

• Immunofluorescence microscopy and electron microscopy on every case
• Additional specialized immunofluorescence and immunohistochemistry tests as necessary
• Rapid preliminary results and clinicopathologic correlation directly from the renal pathologist on every patient
• The option to schedule renal biopsy video conferences with your institution

The neuropathologists at Nationwide Children’s Hospital offer extensive expertise in pediatric neoplastic and non-neoplastic conditions of the central and peripheral nervous system. Comprehensive diagnostic evaluation is available for a variety of conditions including:

• Diagnostic workup of biopsies and excision from benign and malignant conditions
• Evaluation of complex epilepsy resection specimens including an extensive panel of available immunostains and application of the most recent classification system by the International League Against Epilepsy (ILAE)
• Muscle disorders of children and adults including specimen processing, histochemical stains, and electron microscopy (performed if indicated)

Nationwide Children’s Laboratory Services provides consultations and reference laboratory testing on all hematologic disorders in children and young adults. Our staff of experienced pediatric and adult hematopathologists provides comprehensive services to cover all necessary diagnostic procedures on referred specimens and is available for case discussions with referring pathologists and clinicians as necessary. Our services include the following general categories.

• Bone Marrow Biopsies- Our bone marrow biopsy services provide morphologic examination of a full complement of bone marrow specimens, including aspirates, clots, core biopsies and touch imprints. As needed, flow cytometry studies and immunohistochemical/histochemical stains are performed in our laboratory and incorporated into the final diagnosis. DNA ploidy studies as well as molecular and cytogenetics/FISH studies are coordinated through the laboratory and integrated into the final diagnosis as necessary.
• Lymph Node Biopsies- We provide consultation on difficult cases of reactive and neoplastic causes of lymphadenopathy, including evaluation of glass slides, paraffin blocks, immunophenotyping by flow cytometry and molecular testing as necessary. Our marker panels are tailored for hemapoietic disorders in children and young adults.
• Peripheral Blood Specimens- Services include the pathologic examination of peripheral blood smears tailored for the pediatric anemia, cytopenias, red blood cell abnormalities, and malignancies, all of which follow an instrument-based CBC analysis. We also offer immunophenotyping of white blood cells by flow cytometry to evaluate for suspected neoplastic processes Hemoglobin electrophoresis with written interpretive consultation is offered in order to evaluate for hemoglobinopathies. Coagulation testing with consultation as well as thrombotic tendency testing is also available.
• Flow Cytometry- Flow cytometry is available for bone marrow aspirates, peripheral blood, fresh tissue specimens, and body fluids using a panel of markers tailored for the work-up of pediatric leukemias, lymphomas and other hematopoietic disorders. Children’s Oncology Group (COG) approved minimal residual disease (MRD) testing is available for B-lymphoblastic leukemia (B-ALL) patients on bone marrow aspirates (day 29 method) and peripheral blood (day 8 method). An initial panel performed at diagnosis may also be performed for future comparison post-treatment. Please note that MRD testing is not available for B-ALL patients who have received anti-CD19 therapies such as CAR-T and blinatumomab.
• Platelet Electron Microscopy- Platelet electron microscopy is a gold standard in the investigation of many bleeding disorders such as dense granule deficiency. There are time and transportation constraints to consider prior to collecting the ACD blood sample. Therefore, we will gladly connect with your team to discuss the basic preparation necessary to ensure optimal specimen handling and evaluation of platelets by electron microscopy.

The Nationwide Children's Cytopathology service provides diagnostic services on a broad range of non-gynecologic specimens and assists clinicians with performing fine needle aspirations on accessible lesions.

• Preparation of smears, cytospin slides, and cell blocks based on specimen type to provide a diagnosis
• Ancillary studies such as special stains, immunohistochemical stains and referral for molecular studies as necessary

Our team has extensive experience and expertise in the evaluation of congenital and acquired heart disease in children and adults. Dissection techniques are specifically tailored to preserve specimen integrity, and very small and macerated specimens are dissected using fine instruments and a dissecting microscope. The laboratory includes equipment for obtaining high quality digital images to document the gross and microscopic findings. Special areas of expertise include latex injection for complex vascular anatomy, conduction system dissection and histopathologic evaluation.

The range of services offered includes primary dissection of specimens, secondary evaluation of previously dissected specimens, histopathologic consultations and electron microscopy. The following specimen types are commonly accepted for consultation, and additional services may be provided upon request.

• Fresh or formalin-fixed heart specimens including autopsy materials
• Endomyocardial biopsies for evaluation of cardiomyopathy, neoplasms or transplant rejection Heart valves
• Glutaraldehyde fixed biopsies for ultrastructural evaluation with or without an interpretive report
• Second opinion with a consultation report on previously prepared histological sections and/or electron microscopic preparations

Educational Experience in Congenital Heart Disease

In addition to diagnostic services, the Department of Pathology offers a 1-to-2-week educational experience in congenital heart disease pathology. The course includes access to an extensive congenital heart disease registry, systematic independent study, instructor-led educational sessions and recommended reading materials. Please contact the laboratory for additional information and scheduling.

Accurate interpretation of biopsies from transplanted organs is critical for optimizing long-term graft survival. Our pathologists have experience in the evaluation of heart, lung, liver, small bowel and kidney transplant biopsies.

• Standard procedures for heart biopsies include specific microtomy protocols, examination of H+E stains taken at several levels in the block and C3d and C4d immunohistochemical stains on paraffin sections for evidence of antibody mediated rejection with CD68 immunostaining. Heart biopsies are classified based on International Society for Heart and Lung Transplantation (ISHLT) grading system and standardized nomenclature for heart biopsies.
• We perform PAS, trichrome and Jones stains on every kidney biopsy and use the Banff classification and recommendations for evaluation of these biopsies. Electron microscopy is available on glutaraldehyde-fixed portions of kidney biopsies to identify additional features of chronic antibody mediated rejection including chronic transplant glomerulopathy and peritubular capillary basement membrane multi-layering. When recurrent or de novo glomerular disease is suspected, we perform a full panel of immunofluorescence stains along with electron microscopy. Immunohistochemical stains are available for BK virus (SV40) and other viral pathogens.
• Transplant lung biopsy evaluation includes trichrome and elastic stains to assess for obliterative bronchiolitis and chronic transplant vasculopathy. Routine stains for pathogenic organisms include Gram, acid fast and GMS stains. Results are reported according to ISHLT grading system and consensus criteria for lung biopsies.
• Whole organs obtained at explant surgery or autopsy are also accepted for consultation. In addition to evaluation of acute rejection, explanted hearts are examined thoroughly for chronic coronary transplant vasculopathy. Lungs are examined for obliterative bronchiolitis and chronic vasculopathy.

Our laboratory offers comprehensive consultation services for primary diagnosis or a second opinion. Our pathologists have a breadth of expertise in pediatric neoplastic and non-neoplastic pathology, including GI/liver Pathology, Renal pathology, Neuropathology, Hematopathology, Cytopathology, Autopsy, Perinatal and Placental Pathology. Challenging cases are scrutinized by intra and inter-departmental consultations, and our pathology reports often represent the consensus opinion of several subject matter experts. We routinely keep our clients informed of the progress in their cases and are available for case discussions as necessary.

Click here to access the anatomic pathology consultation request form.

Technical-only services (without interpretation) are offered in the areas listed below:

• Immunohistochemical and Special Stains: Click here to access current test menu.
• Immunofluorescence: Direct immunofluorescence (IF) is offered for renal and skin biopsies. Please contact us prior to shipment regarding specimen and transportation requirements.
• Electron Microscopy: Transmission electron microscopy (TEM) is available for the evaluation of cilia, renal tissue, skeletal muscle, lymphocytes, platelets and tumors.