What Is Histopathology?

Expertise, specialities, and training

Histology is the study of tissues, and pathology is the study of disease. Histopathology means the study of tissues related to disease.

A histopathology report describes the tissue that the pathologist examined. It can identify features of what cancer looks like under the microscope. A histopathology report is also sometimes called a biopsy report or a pathology report.

This article explains what is in a histopathology report and how to interpret results.

female doctor looking in microscope
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How Is Histopathology Performed?

A specialist doctor who examines tissue under a microscope is called a pathologist. Pathologists study samples of tissue in a lab.

Pathologists process and cut tissue into very thin layers, called sections. Then, they stain and examine it with a microscope. Using a microscope, they can observe and document the tissue's details.

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This video has been medically reviewed by Anju Goel, MD, MPH.

Identifying Disease

Samples of tissue can be obtained with procedures such as endoscopy, colonoscopy, and colposcopy, or with surgical procedures such as a breast biopsy.

A variety of diseases can be identified with a histopathology examination, including ulcerative colitis, Crohn's disease, uterine fibroids, cancer, and even infections.

Frozen Section

For some diseases, a sample of the tissue can be interpreted very quickly using frozen sections (also called a cryosection) that are obtained during surgery. Frozen sections are examined immediately in the lab to provide a result within about 20 minutes.

This type of pathology is most commonly used to evaluate tumor margins during surgery so that a surgeon can decide if more tissue should be removed for full removal of cancer.

The use of frozen sections during surgery depends on the type of cancer being removed and other factors.

Lymph and Blood Cancers

Lymph nodes are often biopsied to evaluate for certain types of blood cancer and to identify metastases of solid tumors (such as breast cancer and lung cancer). A bone marrow biopsy may also be required for a definitive diagnosis for many types of blood cancers.​

Components of a Histopathology Report

Histopathology reports on surgical cancer specimens can be complex.

They may include:

  • A description of the appearance of the involved tissue
  • A diagnosis
  • A synoptic report detailing the findings of the case
  • Pathologist's comments

Histopathology reports can be challenging to understand, so it's essential to go over them with a healthcare provider. Knowing which components are going to be included in your report may help you prepare for your appointment.

Interpreting the Results

Many of the pathologist's findings are used to help determine prognosis, especially in cases of cancer.

Prognosis

Prognosis is the prediction or estimate of survival or recovery from a disease.

Prognostic indicators may include:

  • Size and severity of the disease
  • Tumor grade
  • Indications that cancer has spread and extent of spread

Grading systems differ depending on the kind of cancer. In general, the cells are scored based on how abnormal they appear under the microscope.

For example, Grade 1 tumors appear nearly normal, whereas Grade 4 tumors reflect more abnormalities. The more abnormal the cells look, the higher the grade.

Grading is not the same as staging. Staging is based on where the cancer is found in the body and how far it has spread.

Other Sampling Techniques

In addition to histopathology, pathologists may use other techniques to assess the presence of cancer in the tissues.

Molecular Techniques

Molecular techniques refer to the ability to analyze cells and tissues at the molecular level, which is at the level of proteins, receptors, and genes.

Pathologists diagnose cancer, such as leukemia, through a combination of techniques, including:

  • Cytochemistry: How the sampled cells take up certain stains
  • Immunophenotype: Looks for unique surface proteins
  • Karyotype: Chromosomal changes
  • Morphology: How the cells look

Immunohistochemistry

Often in lymphomas and other cancers, doctors use immunohistochemistry to help assess the tumor type, prognosis, and treatment.

What Is Immunohistochemistry?

Immunohistochemistry involves using antibodies to stick to particular tags or markers outside the cancer cells. These markers that the antibodies attach to often have "CD" in their name, which stands for "cluster of differentiation." CDs identify cell phenotypes, which identify different cancers.

For example, if CD23 and CD5 are present in the cancer cells, it might support the notion that chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) is a possible diagnosis.

However, these same markers are also present in other malignancies. So doctors use this method in combination with other identifying features.

Chromosomal Studies

Pathologists may perform molecular and chromosomal studies to look at gene rearrangements and specific changes to the chromosomes. Sometimes inserted or deleted genes correlate to prognosis. Genetic changes present in a cancer tissue sample may be hereditary or acquired.

For instance, in CLL, a specific piece of a chromosome (17p) is lost. Along with the missing chromosome, a gene that helps suppress cancer is often lost. The 17p deletion is found in about 5-10% of people with CLL overall. The 17p deletion CLL is a form of CLL that is harder to treat with conventional chemotherapy.

Recap

Doctors may use additional pathology techniques to diagnose cancer. For example, molecular techniques look at proteins, receptors, and genes, which help identify cancer subtypes. Immunohistochemistry looks for markers on cancer cells to narrow down what type of cancer a person has and chromosomal studies look at gene differences to develop a prognosis.

Summary

Histopathology studies tissue to look for disease. Pathologists perform histopathology in a lab. They examine tissue under a microscope and develop a report of their findings. Histopathology reports can include descriptions of the tissue, diagnosis, and prognosis. In addition to evaluating the shape and structure of cells, pathologists may also use other techniques to assess and diagnose cancer.

A Word From Verywell

Histopathology reports can be confusing. That's why it's best not to jump to conclusions before going over them with a healthcare provider. Your report will contain information about your tissue sample, offer a diagnosis or suggestions for further testing, and a prognosis if enough information is available. These details will help a doctor manage your treatment in the future.

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7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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