For cancer and some rare diseases, a second opinion may require review of the actual tissue material rather than only the written pathology report. Requirements vary by diagnosis and laboratory. Heidelberg Neuropathology, for example, accepts submissions from Germany and abroad and describes representative paraffin blocks or unstained sections, the original pathology report and relevant clinical information as part of its reference-diagnostics workflow.
The pathology report and the tissue material are different things
A report summarizes the original laboratory's interpretation. A reference pathologist may need the original tissue material to repeat histology, immunohistochemistry or molecular testing and to integrate the diagnosis according to current classification systems.
The receiving laboratory should define what to send
Do not request blocks or slides blindly. Contact the German department first because the required material depends on the diagnostic question and planned testing.
- Representative paraffin block(s)
- Unstained sections when specified
- Existing stained slides when requested
- Complete original pathology report
- Molecular/genetic pathology results already performed
- Operative report and relevant clinical history
Heidelberg gives a concrete example of reference-pathology requirements
Its Neuropathology second-opinion service states that representative paraffin blocks or 10–15 unstained sections may be required depending on the scope of analysis, together with the complete original neuropathology report, relevant clinical information and a submission form. That is an example for this specific service, not a universal requirement for every German pathology department.
Coordinate release of material with the original pathology laboratory
Patients may need their treating physician or original pathology institute to arrange release or loan of blocks/slides. Confirm who is responsible for packaging, shipping, return of material and any local administrative requirements before dispatch.
Safe shipment matters
Tissue material can be irreplaceable. Use the shipping instructions supplied by the receiving pathology service and do not improvise packaging or customs documentation. Heidelberg notes that specific safe-shipment instructions are available in its referrer information.
Pathology review can change the treatment question
Reference review may confirm the diagnosis, refine tumor classification or identify molecular features relevant to further treatment. That is why oncology travel planning should ideally follow confirmation of the diagnosis and treatment plan rather than precede it.
Official sources
Last source-reviewed 2026-08-29. Administrative, insurance, reimbursement, billing and visa rules can change. Follow current official instructions before acting.