Final Histopathological Diagnosis Research Articles

Work-Up and Outcome of Hepatic Resection for Peri-Hilar Cholangiocarcinoma (PH-CCA) without Staging Laparoscopy.

Simple SummaryThis is a single centre cohort of patients undergoing surgery for PH-CCA suggests that routine staging laparoscopy may not be necessary in the pre-operative work-up.Background: This study reports the outcome of a work-up programme for resection of peri-hilar cholangiocarcinoma (PH-CCA) without the use of staging laparoscopy. Methods: This is a clinical case cohort series of patients undergoing surgical resection of PH-CCA without the use of staging laparoscopy in the work-up algorithm. During the 13 years from 1 January 2009 to 1 January 2022, 32 patients underwent laparotomy for planned surgical resection of PH-CCA. Data were collected on demographic profile, admission biochemistry, radiology, pre-operative intervention, operation and outcome, together with post-operative complications and disease-free and overall survival. Results: All patients underwent pre-operative contrast-enhanced CT. Twenty-four (75%) underwent pre-operative MR. Twenty-three (72%) underwent pre-operative biliary drainage. Twenty-nine patients (91%) had either type III or IV peri-hilar cholangiocarcinoma. One patient (3%) in this series underwent a non-resectional laparotomy. Twenty-nine (91%) had a final histopathological diagnosis of PH-CCA. One further patient had a final diagnosis of an intraductal papillary neoplasm of the biliary tree (IPNB) with high-grade dysplasia but no invasive cancer. Eleven patients (36%) received chemotherapy after surgery. The median (95% CI) time to recurrence was 14 (7–31) months. The median survival was 25 (18-upper limit not reached) months. Conclusion: This cohort of 32 patients undergoing attempted resection for PH-CCA without the use of staging laparoscopy in the work-up algorithm indicates that with careful attention to patient fitness and cross-sectional and interventional radiologic/endoscopic imaging, a very low non-therapeutic laparotomy rate of 3% can be achieved and sustained.

The waiting time for prostate cancer treatment in Italy: analysis from the PROS-IT CNR Study.

Prostate cancer (PCa) is the second most common neoplasm in male patients. To date, there's no certain indication about the maximum waiting time (WT) acceptable for treatment beginning and the impact on oncological and functional outcomes has not been well established. Data from the National Research Council PCa monitoring multicenter project in Italy (Pros-IT CNR) were prospectively collected and analyzed. WT was defined as the time from the bioptical diagnosis of PCa to the first treatment received. Patients were divided in two groups, using a time frame of 90 days. Quality of life was measured through the Italian version of the University of California Los Angeles-Prostate Cancer Index (UCLA-PCI) and of the Short-Form Health Survey (SF-12). The occurrence of upgrading, upstaging, presence of lymph node metastasis and positive surgical margins at the final histopathological diagnosis, and PSA at 12 months follow-up were evaluated. The overall median WT was 93 days. The logistic multivariable model confirmed that age, being resident in Southern regions of Italy and T staging at diagnosis were significantly associated with a WT>90 days. At 6 months from diagnosis the mean SF-12 score for the emotional-psychological component was significantly lower in WT≥90 days group (P=0.0428). Among patients treated with surgical approach, no significant differences in oncological outcomes were found in the two groups. In our study age, clinical T stage and provenance from Southern regions of Italy are associated with a WT>90 days. WT might have no impact on functional and oncological outcome.

143 An audit of indications, complication and justification of hysterectomies at prince charles hospital, merthyr tydfil

Objective-Aim: of this audit was to analyse indications, complications, correlation of preoperative diagnosis with final histopathology report and justification of all hysterectomies at Prince Charles hospital. Method: It is a retrospective study of 57 cases who had hysterectomies in 2019. The data regarding patients age, indication for hysterectomy, type of hysterectomy, complications during and after surgery and final histopathological diagnosis were collected from the patient case records. Results: A total of 57 cases of hysterectomies were included in the study.

Robotic-assisted surgery for esophageal submucosal tumors: a single-center case series

Esophageal submucosal tumors (SMTs) are rare heterogenous clinical entities. The surgical resection can be performed in different surgical approaches. However, the robotic surgical strategy is poorly documented in the treatment of SMTs. We present our series of operated esophageal SMTs approached via robotic-assisted surgery. Six patients with symptomatic esophageal submucosal tumors underwent robotic surgery within a 3-year period. The performed procedures were robotic-assisted enucleation, robotic esophagectomy (RAMIE) and reverse hybrid robotic esophagectomy. Patients’ clinical data, intra/postoperative outcomes, and histopathological features were retrieved from the institution’s prospective database. Five of six patients were scheduled for upfront surgery: four underwent robotic enucleation (three leiomyoma and one suspected GIST) and one underwent reverse hybrid robotic esophagectomy (suspected GIST). One patient, diagnosed with GIST, was treated with neoadjuvant Imatinib therapy, before undergoing a RAMIE. No major intra-operative complications were recorded. Median length of stay was 7 days (6–50), with a longer post-operative course in patients who underwent esophagectomy. Clavien–Dindo > 3a complications occurred in two patients, aspiration pneumonia and delayed gastric emptying. The final histopathological and immuno-histochemical diagnosis were leiomyoma, well-differentiated GIST, low-grade fibromyxoid sarcoma and Schwannoma. Robotic-assisted surgery seems to be a promising option for surgical treatment strategies of benign or borderline esophageal submucosal tumors.

Impact of timing and precision of histopathological diagnosis on outcomes of patients with Burkitt lymphoma and high-grade B-cell lymphoma.

Burkitt lymphoma (BL) and diffuse large B-cell lymphoma (DLBCL) are aggressive B-cell non-Hodgkin lymphomas (B-NHL) with a generally favorable prognosis after immunochemotherapy. The outcome of BL is superior to DLBCL. In 2016, a distinct group of lymphomas displaying characteristics of both BL and DLBCL (high grade B-cell lymphoma, HGBL) was introduced into the WHO classification. Histopathological discrimination of BL, DLBCL, and HGBL may be challenging. Data on the frequency of histopathological difficulties resulting in revision of the final diagnosis of BL/DLBCL/HGBL and its impact on the prognosis are limited. We assessed histopathological features and clinical outcomes of 66 patients with suspected diagnosis of BL at the reporting institution between 2010 and 2020. The median age was 51 years (range 19-82) and final histopathological diagnosis revealed BL (n=40), DLBCL (n=12), or HGBL (n=14). Patients with DLBCL and HGBL were either treated with DLBCL-directed (83.3% and 35.7%) or BL-directed (16.7% and 64.3%) protocols. Patients in whom diagnosis was revised from DLBCL to BL after initiation of DLBCL-directed treatment had a significantly inferior progression-free survival (PFS) than patients initially diagnosed with BL (p=0.045), thus resembling rather the prognosis of DLBCL/HGBL. There was no difference between patients with DLBCL and HGBL, respectively, regarding PFS and OS (p=0.38 and p=0.27). These results suggest that timely and precise histopathological diagnosis as well as reference histopathological review of the underlying lymphoma is critical to determine up-front treatment strategies. Consequently, selection of more aggressive treatment protocols in case of difficulties with discrimination between DLBCL/HGBL/BL may be a reasonable approach.

Idiopathic granulomatous mastitis: diagnostic dilemma

We report a case of Idiopathic granulomatous mastitis in a 21 years old female who came to our hospital with complaints of painful lump in her left breast because the results of initial excision of fibroadenoma, when re-exploration was done to rule out any foreign body – excision biopsy was done. However, the final histopathological diagnosis was granulomatous mastitis with suture granuloma, no evidence of malignancy. A review of literature revealed that idiopathic granulomatous mastitis has a tendency to affect young women. Clinical diagnosis and imaging has often been difficult. Complete resection or corticosteroid therapy can be recommended as appropriate treatment. Since recurrence rate is as high as 50%, long term follow up is indicated in such patients.

The predictive value of hematologic parameters in the risk of thyroid malignancy in cases with atypia/follicular lesion of undetermined significance.

Atypia/follicular lesion of undetermined significance (AUS/FLUS) is still the most challenging category in the Bethesda System for Reporting Thyroid Cytopathology. Therefore, the aim of the current study was to investigate the value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) in predicting malignancy in cases with AUS/FLUS nodules. A total of 200 patients with AUS/FLUS nodules who underwent thyroidectomy were included in this study. Preoperative hemogram parameters, ultrasonographic findings, fine-needle aspiration results, and postoperative final histopathological diagnoses of the patients were recorded retrospectively. Thyroid malignancies were detected in 122 of the patients (61.0%). Patients in the benign group (BG) were older than those in the malignancy group (MG) (52.0 ± 11.3 vs. 45.9 ± 12.3years, p < 0.001). The median TSH values of the two groups were comparable. Statistically significant differences were obtained between the two groups in respect of mean WBC of 7.53 ± 1.44 in MG and 6.87 ± 1.35 (103/mm3) in BG, mean neutrophil of 4.65 ± 1.12 in MG and 3.95 ± 0.99 (103/mm3) in BG, and median NLR of 2.18 (0.71-4.57) in MG and 1.75 (0.80-3.42) in BG (p < 0.001). The median PLR and MPV values of the two groups were similar. When NLR cut-off point was designated as 2.24, the accuracy of NLR in distinguishing malignancy from the benign condition was 0.65 in ROC analysis (area under the curve, 0.665; specificity, 0.808; sensitivity, 0.492). High NLR values may provide limited help in predicting thyroid malignancy in the AUS/FLUS nodule population, while PLR and MPV are not reliable parameters.

Role of Intraoperative Frozen Section in the Diagnosis of Ovarian Neoplasms- A Retrospective Study in an Oncology Centre

Introduction: Ovarian malignancy is the sixth most common cancer in women and the seventh most common cause of cancer death. Intraoperative frozen section evaluation plays a critical role in guiding the type and extent of surgery. The overall accuracy of the intraoperative frozen section diagnosis for ovarian tumours was reported to be ranging from 85 to 95%. Aim: To determine frozen section accuracy in the diagnosis of ovarian neoplasms. Materials and Methods: The present study was a retrospective study taken up in the Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, from January 2011 to December 2018 during which all the ovarian masses which were sent for frozen section and later for regular Histopathological Examination (HPE) were included in the study. All the slides of these cases were reviewed by two senior pathologists in a double blind study. The frozen section and the permanent section reports of each patient were compared. The overall accuracy, sensitivity, specificity, positive and negative predictive values of the frozen section diagnoses were studied for benign, borderline and malignant cases by using 2 × 2 tables. The final histopathological diagnosis was considered as gold standard. Results: The study included 289 cases and the overall accuracy of frozen section was 87.89%. Thirty five cases were incorrectly diagnosed, of which 24 cases were under diagnosed and 11 were over diagnosed. With respect to malignant potential, the sensitivity for malignant tumours was 81.4% with specificity of 96.8%. For benign tumours, the sensitivity and specificity were 93% and 91.4%, respectively. Borderline tumours had the lowest sensitivity of 68.7% with specificity of 91.8%. Conclusion: Gross examination is to be done carefully for tumour tissue selection for frozen section diagnosis intraoperatively. The results help to decide the type and extent of surgical management.

Diagnostic accuracy of qualitative MRI in 550 paediatric brain tumours: evaluating current practice in the computational era.

To investigate the accuracy of qualitative reporting of conventional magnetic resonance imaging (MRI) in the classification of paediatric brain tumours. Preoperative MRI reports of 608 children prior to resection or biopsy of an intracranial lesion were retrospectively reviewed. A total of 550 children had complete radiological and histopathological notes, thereby reaching our inclusion criteria. Concordance between MRI report and final histopathological diagnosis was assessed using an established lexicon derived from the WHO 2016 classification of CNS tumours. Levels of agreement based on cellular origin, tumour type, and tumour grade were evaluated. Diagnostic accuracy, sensitivity, specificity, confidence intervals, and positive and negative predictive values were calculated. Diagnostic accuracy differed significantly between tumour types and tumour grades. Sensitivities were highest for ependymomas and sellar, pituitary, pineal, and cranial and/or paraspinal nerve tumours (range 80.65-100%). Sensitivity was slightly lower for astrocytic gliomas, oligodendrogliomas, and choroid plexus, neuronal, mixed neuronal-glial, embryonal, and histiocytic tumours (range 63.33-79.59%). Low sensitivities were noted for meningiomas and mesenchymal non-meningothelial, melanocytic, and germ cell tumours (range 0-56.25%). The most correct tumour type predictions were made in the posterior fossa whilst the most incorrect predictions were made in the lobar regions, pineal/tectal plate area, and the supratentorial ventricles. This is the largest published series investigating the predictive accuracy of MRI in paediatric brain tumours. We show that diagnostic accuracy varies greatly by tumour type and location. Looking forward, we should develop and leverage computational methods to improve accuracy in the tumour types and anatomical locations where qualitative diagnostic accuracy is lower.

A Clinico-pathological Study of Papulonodular Lesions of Skin in a Rural Hospital Setup

Introduction: Skin disorders are a common cause of morbidity in our country, High prevelance of dermatological lesions is seen in tropical countries. The spectrum of lesions varies significantly depending on the geographical region, so accurate diagnosis is of utmost importance as treatment is varied for different skin disorders presenting with similar clinical findings. Aim: To study the spectrum of papulonodular lesions of skin and to evaluate concordance between the clinical and histopathological diagnosis of papulonodular skin lesions. Materials and Methods: This prospective cross-sectional study was conducted in Department of Pathology at MVJ Medical College and Research Hospital, Hoskote, Karnataka, India, from October 2017 to September 2019. The study included 100 skin biopsies that had clinically presented as papules, nodules and as papulonodular lesions. Based on the histopathological findings the lesions were grouped according to aetiology and the final histopathological diagnosis was compared with the clinical diagnosis offered. The slides were stained with Haematoxylin and Eosin, examined under a microscope and findings were noted. Special stains on the tissue sections like Zeihl-Neelson and Fite Faraco were used when required. The qualitative characteristics presented using frequency and percentages, quantitative variables presented using Mean±SD. Results: In the 100 biopsies studied 77 cases were papular, 20 cases were nodular and 3 cases were both papular and nodular. The lesions were common in males (54%) with 67% being in the 21-50 years age group. Lesions were categorised into five aetiological groups based on histology i.e, non infectious papulosquamous (25%), eczematous (23%, Inflammatory (20%), Infectious (11%) and lastly neoplastic (21%). A clinico- pathological association of 79% was observed with differences mainly observed in the eczematous group and tumours. Conclusion: This study highlights the various common skin disorders that can present as papulonodular lesions and the significance of histopathological examination and clinico- pathological association for early diagnosis and management of skin lesions.

Accuracy of Bronchial Cytological Diagnosis in Lung Lesions in Comparison with Histopathology.

i. To study the cytological features of lung lesions. ii. To assess the sensitivity, specificity, and diagnostic accuracy of bronchial cytology of lung lesions in comparison with histopathology. Prospective study at the tertiary care hospital. It included 63 cases of lung lesions, evaluated using the PSC system for reporting respiratory cytology. The cytological diagnosis was correlated with the final histopathological diagnosis. The study was conducted between January 2019 and June 2020. SPSS 20.0 software. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of bronchial cytology was 60%, 89%, 90%, 58.62%, and 71.42%, respectively. Bronchial cytology including bronchial wash, bronchial brush, endobronchial ultrasound/transbronchial needle aspiration, and computerized tomography-guided fine needle aspiration cytology can be used to increase the sensitivity and specificity for definitive diagnosis and better management.

Endoscopic Resection of Upper Gastrointestinal Subepithelial Tumours: Our Clinical Experience and Results

Upper gastrointestinal subepithelial tumours (SETs) are generally asymptomatic and clinically insignificant and have malign, borderline and benign variants. In advanced endoscopic procedures, histopathological diagnosis and endoscopic resection are possible and feasible. In this study, we examined our approach to upper gastrointestinal subepithelial tumours and our clinical results. Adult patients who applied to Surgical Endoscopy unit between January 2014 and January 2015 were included in the study. The patients' files and final histopathological diagnoses were recorded and analysed retrospectively for this single-center study. SET lesion lower than 30 mm and the lesion whose endoscopic submucosal dissection attemption was included in the study. The total of 8 patients were four female (50%) and four male (50%), aged 31-66 years (median, 53 years). The tumoral lesions were located 4 (50%) patients in esophagus, 3 (37.5%) patients in stomach and one (12.5%) patient in duodenum and their diameter ranged from 5 to 30 mm (median, 14 mm). Post-interventional no complications or abdominal symptoms were encountered. Also, in early follow-ups for six months, no recurrence was observed. Our experiences together with literature reported here, indicated endoscopic resection is a safe and effective method of treatment for most patients with upper gastrointestinal SETs.

Evolving Trends in Pancreatic Cystic Tumors: A 3-Decade Single-Center Experience with 1290 Resections

Introduction: Incidental-discovery of pancreatic cystic lesions has increased and has led to a rise in pancreatic resections. It is important to analyze surgical outcomes from these procedures, and the prevalence of malignancy, pre-malignancy, and resections for purely benign lesions, some of which may be unintended. We aim to describe our institutional experience with resected cystic lesions over a 30-year period, with emphasis on the changes in clinical presentation over time. Methods: From prospectively maintained databases, 1290 patients who underwent pancreatic resection between 1990 and 2020 for a pancreatic cystic lesion were identified. In addition to demographics and diagnosis, presence of symptoms, incidental discovery, diagnostic studies, type of surgery, postoperative outcomes, and concordance between presumptive diagnosis and final histopathology were recorded. Results: 1290 patients were identified, 62% female with mean age of 60 y. 57% of tumors were incidentally-discovered. 90-day operative mortality was 0.9% and major morbidity 14.4%. There were 23 different diagnoses, but IPMN, MCN, and serous cystadenoma comprised 80% of cases. Concordance between preoperative and final histopathological diagnosis increased over time and is currently 80%, rising in parallel with the use of EUS, cytological and molecular analysis. Conclusion: Indications and diagnostic work-up of cystic tumors of the pancreas have changed over time. Surgical resection can be performed with very low mortality and acceptable morbidity and diagnostic accuracy is currently 80%. About 10% of patients are still undergoing surgery for purely benign lesions that were presumed to be malignant or premalignant. Further refinements in diagnostic tests are required.

Survival analyses of patients with non-endometrioid endometrial carcinoma

Non-endometrioid endometrial carcinoma seems to be less common with a poor prognosis. Due to the lack of standard treatment options and worse survival rates of non-endometrioid endometrial carcinoma, we aimed to investigate these patients inclusively. In total, 492 women with endometrial cancer who were treated in a gynecologic oncology center were examined. Patients with a final histopathologic diagnosis of non-endometrioid endometrial carcinoma were evaluated in respect of demographic characteristics, prognostic aspects, and survival outcomes. We identified 94 patients with the histopathologic results of non-endometrioid endometrial carcinoma. The performance of the systematic lymphadenectomy and adjuvant treatment rate were 96.9% and 92.6%, respectively. Recurrence of the disease was detected in 32 (34%) women and disease-related mortality occurred in 28 (29.8%) women. Multivariate Cox proportional regression analyses determined tumor size, adnexal involvement, and lymphovascular space invasion as independent predictors of overall survival. Larger tumor size, adnexal, and lymphovascular space invasion are important factors in determining prognosis in non-endometrioid endometrial carcinoma patients according to our findings. Besides, high rates of surgical staging and adjuvant chemotherapy and radiation therapy may contribute to improved survival outcomes; in addition to having potential advantages of providing prognostic information. Therefore, a multidisciplinary therapeutic approach should be planned from the early stages for all patients in this group. Nevertheless, comprehensive prospective studies are necessary to optimize the treatment strategies and support successful treatment modalities.

Association between lesion enhancement and breast cancer in contrast-enhanced spectral mammography.

Contrast-enhanced spectral mammography (CESM) may help to determine the malignancy potential of lesions according to the degree of enhancement. To investigate the correlation between the degree of contrast enhancement of the lesions in contrast-enhanced spectral mammography (CESM) and the final histopathological diagnosis in patients with BI-RADS 4 and 5 lesions. CESM was performed in 128 patients who had BI-RADS 4 and 5 lesions on mammography and underwent histopathological examination. A total of 128 index lesions were scored using a 4-point scale regarding the degree of contrast enhancement (0 = no contrast enhancement, 1 = minimal, 2 = moderate, 3 = marked), a score of 2 and 3 was accepted as suggestive of malignancy. The study was approved in our institutional scientific committee. In total, 76 (59.4%) of the lesions had benign histopathological results, whereas 52 of them had malignant results. Contrast enhancement was not observed in 22.7% of the lesions while 24.2% had minimal enhancement, 18.8% had moderate enhancement, and 34.4% had marked enhancement in CESM. The sensitivity of the degree of contrast enhancement in CESM was 98.1%, when the specificity was 77.6%, positive predictive value was 75%, negative predictive value was 98.3%, and accuracy was 85.9%. This study demonstrated that the degree of contrast enhancement of the lesions in CESM may be used in daily practice with easily performing a visual scale in predicting the malignancy potential of the lesions.

Magnetic resonance-guided repeat biopsy of suspicious malignant lung lesions after an initial negative computed tomography-guided Biopsy.

This study sought to establish the diagnostic utility of performing a second biopsy using an magnetic resonance (MR)-guided percutaneous transthoracic needle biopsy (PTNB) approach in patients with suspicious malignant lung lesions that had already undergone an initial negative computed tomography (CT)-guided biopsy. This study evaluated 31 patients with suspicious lung lesions (18 males, 13 females; mean age: 62.1 ± 11.3 years) that had previously undergone CT-guided PTNB with negative pathological findings January 2015-November 2020. A final histopathological diagnosis was made based on resected lung lesion specimens or, when resection was not conducted, on clinical diagnosis following a ≥6-month follow-up. The diagnostic accuracy of MR-guided secondary lung biopsy was determined by comparing the lung biopsy results for each patient to their final diagnosis. 1.0T open MR-guided secondary lung biopsy was performed for 31 lesions (20 central, 11 peripheral; mean size, 5.3 ± 2.0 cm). The pathological results revealed 20/31 (64.5%) lesions to be malignant (14 adenocarcinoma, 4 squamous cell carcinoma, and 2 small-cell lung cancer) as detected by 1.0T open MR-guided PTNB and confirmed by surgical pathology and clinical follow-up. There were three instances of biopsy-induced complications including hemorrhage in 6.5% of the patients (2/31) and pneumothorax in 3.2% of the patients (1/31). No patients experienced severe complications. For individuals with clinically suspicious lung lesions that initially received negative CT-guided PTNB findings, 1.0T open MR-guided secondary lung biopsy is a safe and effective secondary diagnostic approach.

Conjunctival Lesions: A 5-Year Basic Demographic Data and Clinicopathological Review in a Tertiary Eye Care Hospital

BackgroundConjunctival lesions are common with a wide spectrum of benign, premalignant, and malignant lesions. Few histopathological studies have been conducted on conjunctival lesions with variable designs and results. Our aim in this study is to provide information on common conjunctival lesions seen in an ophthalmology tertiary care center in Saudi Arabia.MethodsA retrospective, observational study of all consecutive conjunctival tissue specimens sent for histopathological assessment to the pathology department from 2015 to 2019 were analyzed. Clinical data were collected from medical records, and the histopathological slides were reviewed by a single pathologist.ResultsA total of 110 conjunctival specimens from 108 patients were included (mean age: 53 years, 67 males and 43 females). Bilateral involvement was mostly found in inflammatory lesions (40%). Most lesions were benign (91%), with a significantly longer duration of symptoms in malignant lesions (p = 0.036*). The clinical diagnosis matched the final histopathological diagnosis in 75.5% of the total specimens. The most frequent category of benign lesions was fibrodegenerative and proliferative lesions (53.6%), with a significantly higher prevalence among adult males (p < 0.001). Melanocytic lesions were more common in children (33.3%) than adults (9.8%), and the mean age of children was significantly lower (p = 0.013). The most frequent malignant lesion was ocular surface squamous neoplasia (50%), with equal prevalence among males and females. The overall outcome was favorable in 89.4% and unfavorable in 10.6%, mostly due to surgical complications, further progression of the lesion, or recurrence.ConclusionThis study shows variability in the frequency of conjunctival lesions based on gender, age, geographical, racial, and environmental factors. There has been a shift in the gender-based prevalence of ocular squamous neoplasia over the last three decades, probably due to a change in lifestyle.

Hepatic adrenal rest tumor in a patient with multifactorial liver cirrhosis: a case report with CT and MRI findings and pathologic correlation

BackgroundAdrenal rest tumor is an ectopic collection of adrenocortical cells in an extra-adrenal site, more frequently located around the kidney, retroperitoneum, spermatic cord, para-testicular region and broad ligament, but very rarely occurring also in the liver. Hepatic adrenal rest tumor poses a diagnostic challenge in differentiating it from hepatocellular carcinoma, particularly in a cirrhotic liver.Case presentationAn 83-years-old male was referred to our hospital by his family doctor for hepatological evaluation due to multifactorial liver cirrhosis. Ultrasound revealed a centimetric hypoechoic nodule in the VI hepatic segment in the context of a liver with signs of cirrhosis and steatosis. The patient first underwent MRI and then CT, which showed a fat containing focal liver lesion in the subcapsular location of the right lobe, strictly adjacent to the homolateral adrenal gland. The nodule was hypervascular in the arterial phase, washed out in the portal-venous and transitional phases, resulting hypointense in the hepato-biliary phase at MR imaging. In the suspicion of a hepatocellular carcinoma, the nodule was surgically removed, and the patient’s postoperative course was unremarkable. The final histopathological diagnosis was of adrenal rest tumor of the liver.ConclusionsHepatic adrenal rest tumor is an extremely rare hepatic tumor, often without any clinical manifestation, that can also occur in the cirrhotic liver as in our case. Although there are not specific imaging findings, the possible diagnosis of HART should be considered when we observe a well-defined lesion in the subcapsular location of the right lobe, with fat containing, hypervascularity after contrast medium injection and vascular supply from the right hepatic artery.

Role of Intraoperative Pathology Consultation by Imprint and Scrape Cytology in Soft Tissue Tumors and Tumor-Like Lesions.

Intraoperative pathologic consultation plays an essential role in therapeutic decision making, possibly avoiding under or overtreatment of the patient. Common indications for intraoperative consultation include obtaining a diagnosis in an unknown pathology, ruling out malignancy, confirming a provisional diagnosis, and assessing margin status. Fifty patients undergoing surgery for soft tissue tumors or tumor-like lesions were included in the present prospective study to evaluate the role of intraoperative pathologic consultation by imprint and scrape cytology. Careful and quick gross examination of the specimen was performed, followed by processing for imprint and scrape smears. The prepared smears were evaluated by three pathologists and the cytological diagnosis compared subsequently with final histopathological diagnosis. Intraoperative consultation was primarily requested to make or confirm preoperative diagnosis. In 44.0% cases, no previous tissue/cytological diagnosis was available. In 56.0% cases, previous pathological diagnosis was available, but the reports were inconclusive or were reported from outside our institute. The diagnostic yield of imprint smears was 24% (5 malignant, 6 benign, and 1 inconclusive), and scrape smears was 100% (10 malignant, 38 benign, and 2 inconclusive). Paraffin-embedded sections yielded diagnosis in 100% cases (11 malignant, 38 benign, and 1 nonneoplastic). Imprint smears alone were not of much help in intraoperative diagnosis. Scrape smears were found to be superior to imprint smears in terms of diagnostic yield and accuracy. Combined imprint and scrape smear cytology did not provide any advantage in intraoperative provisional tissue diagnosis in soft tissue tumors.

Borderline ovarian tumor frozen section diagnoses with features suspicious of invasive cancer: a retrospective study

BackgroundA frozen section diagnosis of a borderline ovarian tumor with suspicious features of invasive carcinoma (“at least borderline” or synonymous descriptions) presents us with the dilemma of whether or not to perform a full ovarian cancer staging procedure. Quantification of this dilemma may help us with the issue of this clinical decision. The present study assessed and compared both the prevalence of straightforward borderline and “at least borderline” frozen section diagnoses and the proportion of these women with a final histopathological diagnosis of invasive carcinoma, with a special interest in histologic subtypes.MethodsA retrospective cohort study was performed in three hospitals in The Netherlands. All women that underwent ovarian surgery with perioperative frozen section evaluation in one of these hospitals between January 2007 and July 2018 were identified and included in case of a borderline or “at least borderline” frozen section diagnosis and a borderline ovarian tumor or invasive carcinoma as a final diagnosis.ResultsA total of 223 women were included, of which 41 women (18.4%) were diagnosed with “at least borderline” at frozen section. Thirteen of forty-one women (31.7%) following “at least borderline” frozen section diagnosis and 14 of 182 women (7.7%) following a straightforward borderline frozen section diagnosis were diagnosed with invasive carcinoma at paraffin section evaluation (p < 0.001). When compared to straightforward borderline frozen section diagnoses, the proportion of women diagnosed with invasive carcinoma increased from 3.1 to 35.7% for serous tumors (p = 0.001), 10.0 to 21.7% for mucinous tumors (p = 0.129) and 50.0 to 75.0% (p = 0.452) in case of other histologic subtypes following an “at least borderline” frozen section diagnosis.ConclusionsOverall, when compared to women with a decisive borderline frozen section diagnosis, women diagnosed with “at least borderline” frozen section diagnoses were found to have a higher chance of carcinoma upon final diagnosis (7.7% vs 31.7%). Especially in the serous subtype, full staging during initial surgery might be considered after preoperative consent to prevent a second surgical procedure or chemotherapy in unstaged women. Further studies are needed to evaluate whether additional sampling in case of an “at least borderline” diagnosis may decrease the risk of surgical over-treatment.