ANATOMIC PATHOLOGY

NB (!): Detailed clinical information is required e.g. 1. Indication (e.g., suspected tumor, nephrotic syndrome, nephritic syndrome, CKD etc.), relevant diagnostic findings [e.g. imaging, serum creatinine, urinalysis (protein, RBCs, casts), serum albumin, complement (C3, C4), autoantibodies (ANA, dsDNA, ANCA, anti-GBM), HBV/ HCV/ HIV status etc.]. For NON-TUMOR (MEDICAL KIDNEY) indications, RENAL BIOPSY COMPREHENSIVE EVALUATION (LIGHT MICROSCOPY + IMMUNOFLUORESCENCE) is advised instead. 2. Transplant status i.e. native (no transplant) vs. transplant kidney. 3. Relevant medications within last 3-6 months. SAMPLE TYPE: Renal (kidney) core biopsy in 10% NEUTRAL BUFFERED FORMALIN. SPECIMEN PROCESSING & PRESERVATION (SPECIMEN ALLOCATION IS CRITICAL): Core in 10% NEUTRAL BUFFERED FORMALIN (volume at least 10x the tissue volume) for LIGHT MICROSCOPY (LM). STORAGE & SHIPPING: • Storage: Specimens should be kept at room temperature. Do NOT freeze or refrigerate, as freezing lyses cells and ice crystal formation destroys architecture. • Shipping temperature: ship at ambient temperature (15-25°C) via overnight courier to ensure delivery within 24 hours of biopsy. STABILITY: Tissue stability is indefinite in 10% neutral buffered formalin once adequate fixation has occurred.

NB (!): Notify lab prior for guidance. Detailed clinical information is required e.g. 1. Indication (e.g., nephrotic syndrome, nephritic syndrome, AKI, CKD, suspected transplant rejection etc.), relevant lab findings [e.g. serum creatinine, eGFR, urinalysis (protein, RBCs, casts), serum albumin, complement (C3, C4), autoantibodies (ANA, dsDNA, ANCA, anti-GBM), HBV/ HCV/ HIV status etc.]. 2. Transplant status i.e. native (no transplant) vs. transplant kidney. 3. Relevant medications within last 3-6 months. SAMPLE TYPE: Core biopsies PROMPTLY DELIVERED. Two to three separate cores with glomeruli are required for adequate diagnosis. AVOID PLACING ALL CORES IN FORMALIN (samples in formalin will be rejected for immunofluorescence studies). Label specimen adequately (minimum: two patient identifiers, anatomic site). Indicate the TIME/ DATE of biopsy. SPECIMEN PROCESSING & PRESERVATION (SPECIMEN ALLOCATION IS CRITICAL): • Immersed core in 10% NEUTRAL BUFFERED FORMALIN for LIGHT MICROSCOPY (LM). • Immersed core in MICHEL'S TRANSPORT MEDIUM (=ZEUS MEDIUM) for IMMUNOFLUORESCENCE (IF). Note: Formalin fixes tissue but destroys the antigenicity required for IF; therefore, separate samples in separate containers are mandatory. • ELECTRON MICROSCOPY (EM): Not included in this profile. If required, an additional core should be placed in GLUTARALDEHYDE (separate registration and additional charges apply). STORAGE & SHIPPING: • Storage: Specimens should be kept at cool to room temperature. Do NOT freeze as freezing lyses cells and ice crystal formation destroys architecture. Insulated packaging should be considered to avoid excessive heat (extreme ambient temperatures) during transportation. • Shipping temperature: ship at cool to ambient temperature (4-25°C) via overnight courier to ensure deliver within 24 hours of biopsy. STABILITY: Tissue in Michel’s media is stable for 3-5 days (optimal ≤72 hours). Tissue stability is indefinite in formalin.

Provide clinical history, imaging findings, and prior therapy. Acceptable specimens: 1. Fresh breast tissue in 10% neutral buffered formalin (NBF); place in fixative immediately after excision OR 2. FFPE blocks OR 3. Unstained slides (3–5 µm). For IHC positively charged slides. Fixation requirements: 6–72 hours in 10% NBF; avoid over-fixation or under-fixation. Tissue quality: Representative tumor tissue with minimal crush or thermal artifact. Test components: Histology with ER, PR, Ki 67 and HER 2 IHC.

Formalin Fixed, Paraffin -Embedded Blocks. Residual tissue must be available on the block. Routinely, staining & reporting service is offered; however, stain & return service (IHC staining only without interpretation) is available for pathologists for interpretation & reporting at their end. Test may not be performed if no indication is found as determined by the reviewing pathologist. Ancillary tests may be indicated at additional cost as determined by the reviewing pathologist. NB: Cost depends on the number of IHC markers (resident pathologist available to give advice).

Formalin Fixed, Paraffin -Embedded Blocks. Residual tissue must be available on the block. Routinely, staining & reporting service is offered; however, stain & return service (IHC staining only without interpretation) is available for pathologists for interpretation & reporting at their end. Test may not be performed if no indication is found as determined by the reviewing pathologist. Ancillary tests may be indicated at additional cost as determined by the reviewing pathologist. NB: Cost depends on the number of IHC markers (resident pathologist available to give advice).

Formalin Fixed, Paraffin -Embedded Blocks. Residual tissue must be available on the block. Routinely, staining & reporting service is offered; however, stain & return service (IHC staining only without interpretation) is available for pathologists for interpretation & reporting at their end. Test may not be performed if no indication is found as determined by the reviewing pathologist. Ancillary tests may be indicated at additional cost as determined by the reviewing pathologist. NB: Cost depends on the number of IHC markers (resident pathologist available to give advice).

Formalin Fixed, Paraffin -Embedded Blocks. Residual tissue must be available on the block. Routinely, staining & reporting service is offered; however, stain & return service (IHC staining only without interpretation) is available for pathologists for interpretation & reporting at their end. Test may not be performed if no indication is found as determined by the reviewing pathologist. Ancillary tests may be indicated at additional cost as determined by the reviewing pathologist. NB: Cost depends on the number of IHC markers (resident pathologist available to give advice).

Formalin Fixed, Paraffin -Embedded Blocks. Residual tissue must be available on the block. Routinely, staining & reporting service is offered; however, stain & return service (IHC staining only without interpretation) is available for pathologists for interpretation & reporting at their end. Test may not be performed if no indication is found as determined by the reviewing pathologist. Ancillary tests may be indicated at additional cost as determined by the reviewing pathologist. NB: Cost depends on the number of IHC markers (resident pathologist available to give advice).

Provide clinical history, imaging findings, and prior therapy. Acceptable specimens: 1. Fresh breast tissue in 10% neutral buffered formalin (NBF); place in fixative immediately after excision OR 2. FFPE blocks OR 3. Unstained positively charged slides (3–5 µm). Fixation requirements: 6–72 hours in 10% NBF; avoid over-fixation or under-fixation. Tissue quality: Representative tumor tissue with minimal crush or thermal artifact.

Formalin fixed, paraffin embedded blocks. Residual tissue with tumor must be available on the block. Transport at room temperature (20-25 degrees C); protect from excessive heat. Clinical history and original H&E report are mandatory. PD-L1 IHC shall ONLY be performed when a confirmed histopathologic diagnosis and intended immunotherapy context are documented, ensuring correct clone selection, scoring methodology, and clinically valid interpretation. PD-L1 IMMUNOHISTOCHEMISTRY ORDER MUST NOT BE REGISTERED BEFORE VERIFYING TUMOR TYPE (E.G. NSCLC, HNSCC, GASTRIC ADENOCARCINOMA, UROTHELIAL CARCINOMA, TNBC) AND THERAPEUTIC INTENT (SPECIFIC TARGETED TREATMENT AGENT E.G. PEMBROLUZIMAB, NIVOLUMAB ETC.