a. Civilian cases will not be accepted or accessioned at the Institute if legal action concerning the case has been or is about to be filed. The civilian contributor certifies by his/her signature on the civilian Contributor's Consultation request that "to the best of his/her knowledge and belief, no litigation or claim of professional negligence involving the medical care and diagnosis of the patient has been or is about to be filed." In addition, non-federal asbestos-related disease cases are no longer being accepted or accessioned at the Institute. Cases will not be accepted if the contributor requests the return of the original slides.
b. The following basic items are required for each consultation case submitted to the Institute, regardless of whether the case is from a civilian or federal contributor:
(1) Completed AFIP Form 288-R, Military and Civilian Contributor's Consultation Request (Encl 1). There may be several versions of this form in use at any one time and all are acceptable. However, it is extremely important that the following demographic data be completed in its entirety:
(a) Contributor's name and address - Give your name, the name of your laboratory and a complete address with zip code. Include your telephone number and extension, including area code, and your facsimile number. Please identify yourself in the same manner for all cases submitted.
(b) Laboratory Specimen Number - Label each pathologic specimen and all documentary material with the correct pathology number/surgical number. List all pathology numbers for which material is being sent (Discrepancies, which must be resolved prior to accessioning will cause delay in processing the case.)
(c) Complete Patient Name -- Print or type the patient's full name, including the middle name. (Without the patient's name, it is impossible to collate previous and subsequent submissions.) Each "No Name" case will be set aside and an effort will be made to contact the contributor for a name; if the contributor cannot be contacted or a name is not provided within 24 hours, the case will be returned unless an exception is granted by The Director of AFIP.
(d) Social Security Number (SSN) - The patient's social security number is exceedingly important because it is used to distinguish the patient from all others having the same or similar name. If the patient is the dependent of a service member (see (g) below) give the patient's SSN, NOT the military sponsor's.
(e) Date of Birth - This is another identifier used in the same manner as the SSN. If the date of birth is unavailable, please provide the patient's estimated age.
(f) Sex - This information is very important, especially if the patient has a unisex name.
(g) Race/Ethnicity - This information not only aids in the rendering of a diagnosis in some cases, it is extremely useful for future research.
(h) AFIP Accession Number - If previous material was submitted to the AFIP include the AFIP accession number with any follow-up material. The AFIP accession number is a unique number assigned to a patient's case material by AFIP when it is initially submitted for consultation. The AFIP accession number is the fastest and most certain way for our pathologists to correlate previous submissions on patients.
(2) A summary of the clinical history giving the symptoms and their duration; the location and size of lesion(s); laboratory data (if done); the clinical diagnosis; and the treatment. This can be attached to the AFIP Form 288-R as separate correspondence or can be indicated in the remarks section.
(3) A copy of the surgical pathology report with a gross description and your diagnosis. Include the exact anatomic location, the lesion(s) size, and the relationship of the lesion(s) to adjacent structures.
(4) Microscopic Slides - Most cases must include hematoxylin and eosin stained slides.
(5) Paraffin Blocks - While not absolutely required, blocks should be forwarded with the case so that special stains and studies can be expedited.
(6) Wet Tissue - Wet tissue may be required if paraffin blocks are unavailable or if special procedures are necessary.
(7) Gross specimens of museum quality.
c. The following additional items should also be sent if available and would be appreciated:
(1) Clinical and gross specimen photographs.
(2) Radiographs, ultrasound studies, CT scans, MRIs, etc. These add substantially to the diagnostic value of the case and are highly desired by the Departments of Gastrointestinal Pathology, Neuropathology and Pulmonary Pathology.
d. There are certain departments within the AFIP which, due to their particular missions, have additional mandatory requirements. These are detailed below:
(1) Department of Cardiovascular Pathology - Gross heart when available.
(2) Division of Nephropathology - Frozen tissue for immunofluorescence, properly fixed tissue for electron microscopy, and Renal Biopsy Consultation Request Form.
(3) Department of Orthopedic Pathology - Radiographs, including pre-and post-operative films, radionucleotide scans, MRI and CT scans and/or other imaging studies, and the operative report. In addition, frozen tissue for histochemistry in muscle biopsies and properly fixed tissue for electron microscopy in muscle and peripheral nerve biopsies.
(4) Department of Neuropathology - Whole brains, spinal cords, MRI and CT scans/and or other imaging studies, when available. In addition, frozen tissue for histochemistry in muscle biopsies and properly fixed tissue for electron microscopy in muscle and peripheral nerve biopsies.
(5) Department of Pediatric Pathology
(a) For Autopsies - Maternal history, photographs, full body radiographs (especially necessary for evaluation of infants with dysmorphic features or congenital anomalies), placenta and remainder of wet tissue (preferred over blocks).
(b) For Gestational Trophoblastic Diseases - Maternal history, gross examination (blocks or wet tissue), ultrasound findings, and beta-hCG levels.
(6) Department of Hematologic and Lymphatic Pathology - Bone marrow aspirate with at least two unstained aspirates and peripheral blood with at least two unstained peripheral blood slides. Spleen and lymph node cases require one representative block in addition to the hematoxylin and eosin stained slides.
(7) Department of Dermatopathology - Anatomic site of lesion, distribution of lesions (if multiple), duration, clinical appearance, clinical impression, pertinent medications and laboratory data.
(8) Division of Endocrine Pathology - Wet tissue for all cases.
(9) Department of Genitourinary Pathology - Information on family incidence and any applicable clinical tumor marker, e.g., HCG and AFP for testicular tumors and PSA and ultrasound for prostate biopsies. Information on any treatment given prior to bladder and prostate biopsies.
(10) Office of the Armed Forces Medical Examiner - Reports of autopsy investigation and toxicologic studies, photographs of death scene and autopsy; pathologic materials such as microscopic slides, paraffin blocks, formalin-fixed tissue; and, if available, radiographs.
e. If an incomplete case is received it will be placed on hold for review of a pathologist from the applicable pathology department. He/She may decide to accept the case as is, request the missing material or information be forwarded from the contributor prior to processing, or direct the return of the case to the contributor. Hold cases are resolved within 24 hours of being placed in hold status.
f. A case submission matrix is attached to each copy of AFIP Form 288-R, which lists the specific requirements of each department. This should be removed prior to submission of the completed form and kept as reference. AFIP Forms 288-R may be duplicated as required.
g. Contributor's forms for the Civilian Consultation Program can be obtained by contacting the American Registry of Pathology at the address listed in Chapter 2, paragraph 4. Military and other federal contributors may obtain AFIP Form 288-R from the following address:
Armed Forces Institute of Pathology
ATTN: Center for Advanced Pathology
6825 16th Street, N.W., Room 1098
Washington, D.C. 20306-6000
3-2. Additional Specific Submission Requirements and Policies
a. Bulk submission of cases by military facilities which contain ten or more cases must also be accompanied by a Standard Form 543, Contributor's List of Pathologic Material. This form must be completed in addition to the AFIP Form 288-R for each patient. Cases should not be referred to the Institute by federal contributors for the sole purpose of obtaining special stains if the contributors have the appropriate laboratory facilities.
b. Civilian contributors who are subject to a consultation fee who include a check or establish a prepaid account will receive lowered fees. Fees charged for those cases which must be invoiced will generally be slightly higher.
c. All cases submitted by the Department of Veterans Affairs under the SERS program should be clearly marked in order to be processed under the provisions of this program. Cases should be submitted in accordance with the Schedule for Examination as published in the Department of Medicine and Surgery Manual, M-2 as previously referenced. Each case will consist of an SF 515, a set of stained slides, and when feasible, blocks or wet tissue. Inclusion of other information such as photographs and x-rays is encouraged and appreciated.
d. All requests for the review of Department of Veterans' Affairs claims cases should also be clearly marked as a "VA Claims Case." Identification of these cases will insure that the case is tracked by the designated personnel and that all material is returned after the consultation is rendered.
3-3. Response Time
a. The staff of the AFIP will attempt to forward a completed consultation report to the contributor within 72 hours of receipt of the case at the Institute for routine cases involving the diagnosis of slides alone. An additional two to three days will be required if blocks are used for special stains or immunohistochemistry and for cases requiring interdepartmental consultations. A longer turn-around time will be required for specimens requiring special procedures, such as neuromuscular processing and metabolic bone analysis, or preparation of gross specimens, such as the heart, eye, brain, or total prostate.
b. Reports will ordinarily be sent to the laboratory facsimile number if it is noted on the consultation form. Written reports will be sent via first class mail at the same time as the facsimile report. For those civilian contributors requesting a telephonic report, there will be no additional charge. Telephonic reports may also be requested by federal contributors as required to expedite patient care.
c. When a case is accessioned at the Institute, a post card is sent to the contributor indicating the date the case was accessioned and the AFIP accession number assigned to the case. Having this number available when writing or telephoning the Institute regarding the status of a case will expedite our service. Chapter 6 describes how certain types of inquiries should be addressed.
