Final Histopathology Research Articles

The long-term outcome following thoraco-amniotic shunting for congenital lung malformations

Aim of the StudyInsertion of a thoraco amniotic shunt (TAS) during fetal life is a therapeutic option where there is a high risk of death secondary to large congenital lung malformations (CLM). The aim of this study is to present our center's long-term experience. MethodsRetrospective single center review of the period (Jan 2000–Dec 2020). We included all fetuses that underwent TAS insertion for CLM with detailed analysis of those live newborns managed in our center. Data are quoted as median (range). Main resultsThirty one fetuses underwent 37 TAS insertions at a 25 (20–30) weeks gestational age. This was successful on 1st attempt in 30 (97%) fetuses. In 6 cases a 2nd shunt was required at 6.5 (2–10) weeks following the 1st insertion. Twenty-eight survived to be born.Sixteen (9 male) infants were delivered in our center at 39 (36–41) weeks gestational age and birth weight of 3.1 (2.6–4.2) kg. All infants underwent surgery at 2 (0–535) days (emergency surgery, n = 9; expedited n = 4; elective surgery, n = 3). Final histopathology findings were CPAM Type 1 (n = 14, n.b. associated with mucinous adenocarcinoma, n = 1), CPAM Type 2 (n = 1) and an extralobar sequestration (n = 1). Postoperative stay was 16 (1–70) days with survival in 15/16 (94%). One infant died at 1 day of life secondary to a combination of pulmonary hypoplasia and hypertension. Median follow up period was 10.7 (0.4–20.4) years. Nine (60%) children developed a degree of chest wall deformity though none have required surgical intervention. Clinically, 14/15 (93%) have otherwise normal lung function without limitations of activity, sporting or otherwise. One child has a modest exercise limitation (FVC – 70% predicted). ConclusionsTAS insertion is associated with high perinatal survival and should be considered in fetuses at risk of hydrops secondary to large cystic lung malformation. Their long term outcome is excellent although most have a mild degree of chest wall deformity.

Does the use of a "wrap" in three-dimensional surgical planning influence the bony margin status of benign and malignant neoplasms of the oral, head, and neck region? An initial investigation.

Three-dimensional surgical planning (3-DSP) is becoming commonplace in the management of benign and malignant disease for oral and maxillofacial surgery practice within the last decade. Surgeons utilize a virtual "wrap" to preoperatively delineate and define maxillofacial tumor resection margins. The investigators hypothesized that the use of a wrap is a predictable method to obtain negative bony margins. The investigators implemented a retrospective chart review. The sample was composed of patients over the age of 18 treated at John Peter Smith Health Network and Parkland/UT Southwestern Medical Center who obtained 3-DSP for the pathology of the head and neck, involving the bone, with a virtual wrap utilized for bony margins. The proportion of cases was calculated, descriptive statistics were reported, and binomial exact calculation was performed for confidence intervals. The primary variable analyzed was bony margin status on final histopathology, involved or uninvolved, based on the pathology report. The sample was composed of 39 cases, one of which was excluded due to aborting the preplanned 3-DSP. Of the 38 included cases, one had involved bony margin on final histopathology (2.6%; 95% confidence limits, 0.1%, 13.8%). There were 16 malignant cases (42%) and 22 benign cases (58%). When stratified by pathology, 1 out of the 16 malignant cases (6.3%; 95% confidence interval, 0.2%, 30%) and 0 out of the 22 benign cases (95% confidence interval, 0%, 15.4%) had an involved bony margin on final histopathology. The results of this preliminary study suggest three-dimensional surgical planning with wrap margins is a predictable method to obtain negative bony margins in benign and malignant disease of the maxillofacial complex. Further studies will focus on compiling prospective data to solidify the accuracy and predictability of using a wrap to obtain negative bony margins.

Minimally invasive esophagectomy/ gastroesophagectomy for cancer - Long term results from a single institution

Background: Esophagectomy is a complex operation. Minimally invasive esophagectomy (MIE) may decrease the morbidity and mortality of resection. The aim of this study was to produce long term outcome of MIE from a single center in Nepal. Methods: Patients with squamous cell carcinoma and adenocarcinoma of esophagus/ gastroesophageal junction who underwent MIE between 2001-2018 were analyzed. Results: 215 patients were taken for MIE during 2001-2018. There was 11.2% conversion rate. Totally MIE approach was performed in 43% cases and hybrid MIE in 57% cases. Mean operative time, intra operative blood loss, anastomotic leak, pulmonary infection, recurrent laryngeal nerve injury and in-hospital mortality were 246 min, 286 ml, 13.1%, 9%, 6.8% and 3%, respectively. Final histopathology revealed most common Stages III and IV in 51.2% and 36.1%, respectively. The median survival was 34 months and 5-OS was 27%. 5-OS was 27% and o% for R0 and R+ resection (p<.001). Median survival after radical and non-radical lymphadenectomy was 36 months and 25 months (p=.003), respectively. Responders to neoadjuvant treatment had the best survival. Conclusion: MIE has got acceptable post operative morbidities. R0 resection, early stage of disease, radical lymphadenectomy and responders to neoadjuvant treatment had got the best survival results

Utility of percentage signal recovery derived from dynamic susceptibility contrast perfusion magnetic resonance imaging for differentiating glioblastoma, lymphoma, metastasis and meningioma: An observational prospective study

Abstract Background: Pre-operative differentiation of brain neoplasm (gliomas, metastasis, lymphoma and meningiomas) is important for staging, intra-operative management and post-operative treatment. Dynamic susceptibility contrast (DSC)-enhanced perfusion magnetic resonance imaging (MRI) based on microvasculature assessment can aid in differentiating these intracranial mass lesions. Methods: Thirty three patients referred to the radiology department for MRI with a presumptive diagnosis of primary intracranial tumour were included in the study. DSC imaging was performed by using a gradient-recalled T2*-weighted echo-planar imaging sequence. These data were used to calculate mean and maximum relative cerebral blood volume (rCBVmean and rCBVmax) and also percentage signal recovery (PSR) and relative PSR (rPSR) values. Results: The final histopathology was glioblastoma multiforme (GBM, n = 10, 30.3%), followed by metastasis in 9 (27.3%), lymphoma in 8 (24.2%) and meningioma in 6 cases (18.2%). All PSR parameters (maximum PSR, mean PSR, minimum PSR [minPSR] and rPSR) and rCBVmean were observed to be helpful (P < 0.05) in differentiating GBM (glioblastoma) from lymphoma; of these, the rCBVmean and rPSR (P = 0.0001) were most useful. Only rCBVmean could differentiate GBM from metastasis (P < 0.05); rCBVmean (P < 0.05) and minPSR (P <0.05) could differentiate GBM from meningioma. Conclusions: DSC-enhanced perfusion MRI based on microvasculature assessment can aid in differentiating intracranial mass lesions.

Heterotopic Pancreas Mimicking Metastases From Renal Carcinoma: A Rare Differential.

Heterotopic pancreas, also known as ectopic or aberrant pancreas, is described as the deposits of normal pancreatic tissue "dropped" into the developing gastrointestinal system. Here we present an operated case of renal clear cell carcinoma, which on 6-month follow-up presented with eccentric mass in the gastric body suspicious for malignancy. Endoscopic biopsy was inconclusive and showed isometabolism on 18F-FDG PET/CT. It was subsequently resected laparoscopically, and final histopathology revealed heterotopic pancreas.

Digital real-time microscopy of ex-vivo tissues: A novel strategy to control surgical accuracy.

Ex-vivo FCM is a novel digital optical technique that provides images of fresh tissues in a real-time fashion with magnification to subcellular details of a flattened unprocessed sample. Digital images are hematoxylin-eosin-like and can be shared and interpreted remotely. In urology, FCM has been successfully applied for prostate tissue interpretation, either during biopsy and radical prostatectomy. Possible applications of FCM may reflect those of frozen section analysis and can be extended to all fields in which the intra-operative microscopical control is advisable. This is an investigative prospective case series that aims to explore FCM feasibility in novel surgical settings and provide a depiction of FCM digital images in those fields. The definite purpose is to check the accuracy of surgical specimen during the following interventions: (a) trans-urethral resection of bladder tumors, to confirm the presence of muscular layer; (b) biopsy of a retroperitoneal mass, to check for the location and quality of cores; (c) training in robotic radical prostatectomy, to control surgical margins after a nerve sparing performed by a trainee. To this aim, we collected FCM images during seven surgical procedures. FCM findings were compared to those from the final histopathological analysis and the agreement was assessed. In all cases, FCM digital images were obtained in the OR. FCM was able to confirm the presence of muscular layer in TURB specimen, the presence of lymphomatous tissue, surgical margins at prostate specimen. FCM intra-operative interpretation was consistent with final histopathology in all cases. Ex vivo FCM may represent a novel approach to control the quality of specimens, likely to tailor surgical strategy in a real-time fashion. Moreover, digitalization represents a step toward the implementation of telepathology in clinical practice.

American Thyroid Association guidelines for evaluation of thyroid nodule: Our experience of patients presenting to AKUH

Thyroid nodules are one of the frequently seen presentations in the clinic. Thyroid nodules are present in almost 5% of females and 1% males in iodine-sufficient regions [1]. On the other hand it can incidentally be found in as high as 67% of the patients on ultrasound neck. Among all the thyroid nodules, 5-15% come out to be malignant on final histopathology [1]. Thyroid carcinomas can be divided into Differentiated Thyroid Carcinomas (DTC) and undifferentiated carcinomas. The differentiated thyroid carcinomas include papillary, follicular and hurthle cell carcinomas [1]. Among all the thyroid carcinomas reported, 90% tend to be DTC. The undifferentiated group includes anaplastic thyroid cancers [1,2]. Over last 3 decades, the incidence of thyroid cancer is increasing worldwide [1,3]. An increase of almost 4 folds have been seen between 1988 and 2002 in incidence of papillary thyroid carcinoma [1].

Cecal Perforation: Gastrointestinal Menifestation of Acute Lymphoblastic Leukemia

Background: Hematological malignancies present with gastrointestinal manifestations in the form of typhlitis, colitis and bowel perforation. Prompt diagnosis and appropriate treatment of these entities is essential because they are associated with high morbidity and mortality. Case report: We present a case report of a young female patient who was diagnosed with acute lymphoblastic leukemia and while being on induction chemotherapy started having fever, pneumonia, positive blood culture and was started for that on broad spectrum antibiotics after which she developed abdominal pain and loose motion and was found to have clostridial difficile a toxin positive in blood. Surgical consult was taken for non-settling abdominal pain. It was a challenging diagnosis as patient was having loose motion with positive clostridial difficile further more ct scan abdomen done with contrast showed only bowel thickening which was in favor of colitis along with ascites. She was initially managed conservatively and ascitic diagnostic tap also was done which showed serous fluid. However, her persistent abdominal pain which was not settling led her to go another ct scan abdomen after 3 days of initial ct scan and showed specks of free air around cecum based on which she was taken to operation theatre and was found to have big cecal perforation with fecal peritonitis, she ended up having right hemicolectomy and ileo transverse stoma formation. She had prolonged Intensive Care Unit (ICU) stay but eventually recovered fully and was shifted to general ward where after wound healing was taken over by hematology department for continuation of her chemotherapy. Final histopathology of right hemicolectomy specimen showed focal marked mucosal ulcerations/erosions with patchy submucosal neutrophilic abscesses with fibrinosuppurative necrosis, and marked serositis with dense acute (fibrinopurulent) inflammation, all bowel layers mucosa, sub mucosa, muscularis and serosa showed neutrophilic infiltrates, there was no evidence of pseudomembranous colitis, granuloma or malignancy. Conclusion: Patients on chemotherapy for hematological malignancies are neutropenic and are at high risk of bowel ischemia and perforation emanating to there primary disease, immunocompromised status and direct and indirect side effects of chemotherapeutic agents. A high index of suspicion is needed to diagnose these cases accurately and treat accordingly to prevent mortality.

A Prediction Model Based on the Risk Factors Associated with Pathological Upgrading in Patients with Early-Stage Gastric Neoplasms Diagnosed by Endoscopic Forceps Biopsy.

The discrepancies between the diagnosis of preoperative endoscopic forceps biopsy (EFB) and endoscopic submucosal dissection (ESD) in patients with early gastric neoplasm (EGN) exist objectively. Among them, pathological upgrading directly influences the accuracy and appropriateness of clinical decisions. The aims of this study were to investigate the risk factors for the discrepancies, with a particular focus on pathological upgrading and to establish a prediction model for estimating the risk of pathological upgrading after EFB. We retrospectively collected the records of 978 patients who underwent ESD from December 1, 2017 to July 31, 2021 and who had a final histopathology determination of EGN. A nomogram to predict the risk of pathological upgrading was constructed after analyzing subgroup differences among the 901 lesions enrolled. The ratio of pathological upgrading was 510 of 953 (53.5%). Clinical, laboratorial and endoscopic characteristics were analyzed using univariable and binary multivariable logistic regression analyses. A nomogram was constructed by including age, history of chronic atrophic gastritis, symptoms of digestive system, blood high density lipoprotein concentration, macroscopic type, pathological diagnosis of EFB, uneven surface, remarkable redness, and lesion size. The C-statistics were 0.804 (95% confidence interval, 0.774 to 0.834) and 0.748 (95% confidence interval, 0.664 to 0.832) in the training and validation set, respectively. We also built an online webserver based on the proposed nomogram for convenient clinical use. The clinical value of identifying the preoperative diagnosis of EGN lesions is limited when using EFB separately. We have developed a nomogram that can predict the probability of pathological upgrading with good calibration and discrimination value.

Effect of Chronic Urinary Retention over Serum Prostate-Specific Antigen and Its Role in Histopathological Diagnosis

Background: Prostate-specific antigen (PSA) rises in all types of retentions and also in carcinoma prostate. The raised levels of PSA levels due to urinary retention may raise a false suspicion of carcinoma prostate in these patients. Unlike chronic urinary retention (CUR), the effect of acute urinary retention (AUR) on serum PSA levels had been studied in detail as evident from the past literature. Objectives: The objectives of the study were first to estimate and interpret serum PSA levels in adult males with CUR due to prostatic pathology, second to assess the need of taking prostatic biopsy based on the studied PSA trends, and finally to assess the prostatic histopathology in cases of persistently high PSA levels after 6 weeks. Materials and Methods: This was an observational follow-up study including 41 patients diagnosed with CUR due to prostatic etiology, matching the inclusion and exclusion criteria. On presentation, serum PSA levels were recorded. Retention was relieved by either per urethral catheterization or suprapubic catheterization. PSA levels were recorded after 24 hours, 1 week, 3 weeks, and 6 weeks and PSA trends were noted. Prostatic biopsy was advised for only those subjects in whom PSA did not attain the baseline value of 4 ng/mL within 6 weeks. The histopathological report of the biopsy was followed in each patient for studying its association with PSA trends. Results: Mean PSA at the time of presentation was 17.92 ng/mL. PSA trends showed that in the majority of the patients “Suspected benign group” (80.49%, n = 33), PSA returned to <4 ng/mL within 6 weeks of catheterization. Six patients, the “Borderline group” (14.63%), showed a downtrend in their PSA trends but could not attain baseline value. PSA trends in only two patients, the “Suspected malignant group” (4.87%), showed a comparative constant or an uptrend. All patients in the “Suspected benign group” and a majority of the “Borderline group” patients (83.33%) had a histopathologically confirmed benign prostatic pathology. Out of the two highly suspected malignant cases, only one patient (50%) had carcinoma prostate on final histopathology. Conclusion: PSA rises mainly in carcinoma prostate, but it falsely rises in all urinary retentions. The relationship between AUR and PSA had been studied in detail as evident from the past literature but needs to be established in patients with CUR. A period of 4 to 6 weeks can be safely employed for waiting for PSA to fall back to normal in CUR. A biopsy is required only for patients in which PSA is constantly high to rule out carcinoma prostate.

Primary Bilateral Ovarian Lymphoma: A Rare Case Report

Primary ovarian lymphomas constitute 0.5% of all ovarian malignancies. We report one such case in a middle-aged woman who presented with a bilateral ovarian tumor. Bilateral oophorectomy with salpingectomy was sent for frozen section analysis that revealed a round cell tumor. Final histopathology showed a mitotically active small round blue cell tumor arranged in diffuse sheets and chords with an evident starry-sky pattern. Extensive immunohistochemistry (IHC) panel was performed. Histopathology along with IHC did not classify the tumor into diffuse-large-B cell-lymphoma or Burkitt lymphoma and a final diagnosis of high-grade B cell lymphoma (HGBL) was made. This case is presented for its rarity and to discuss the challenges on IHC to subclassify a lymphoma as HGBL. Although rare, the possibility of primary ovarian non-Hodgkin lymphoma should be kept in mind when dealing with bilateral ovarian tumors as a timely and accurate diagnosis can save unnecessary surgeries and improve outcome.

A study of total mesorectal excision for rectal cancer-upfront and after neoadjuvant chemotherapy or chemoradiation

Background: Colorectal cancer is a major cause of morbidity and mortality throughout the world. The incidence of rectal carcinoma is increasing in developing countries. Challenge in preoperative evaluation remains to identify patients who might benefit from neoadjuvant chemotherapy or chemoradiation (NACT/RT). The aim of this study was to study the correlation of final histopathology specimen (pathological tumor regression grade) with preoperative MRI (magnetic resonance tumor regression grade) (mrTRG).Method: This was a prospective observational analysis with operable rectal cancer of mid or distal rectum who underwent total mesorectal excision either upfront or following CT/RT. Preoperative MRI was done for local staging and also to assess response to neo-adjuvant CT/RT. Histo-pathological specimen was assessed for pathological tumor regression and correlation between mrTRG and pathological tumor regression grading (pTRG) analysed.Results: Out of 79 patients, 69 patients received NACRT and 10 patients underwent upfront surgery. On bivariate analysis mrTRG and pTRG corresponded in 47 patients whereas in 22 patients it didn’t correspond. There was a statistically significant agreement between mrTRG and pTRG (p=0.0491).Conclusions: mrTRG grading was identified as a reliable predictor of pathological response after neoadjuvant chemoradiotherapy and thus a predictor of completeness of resection. So, efforts should be routinely done to do a mrTRG grading as it not only provides oncological safety but also reduces post operative mortality.

Assessing the Agreement Between Preoperative Fine-Needle Aspiration Cytology (FNAC) Done for Major Salivary Gland Neoplasm When Reported by Head and Neck Pathologists and Non-head and Neck Pathologists with Its Final Histopathology.

The preoperative FNA is an important investigation in the workup of a salivary gland pathology. A preoperative diagnosis is important to plan management and counsel patients accordingly. In this study, we aimed to assess the agreement between the preoperative FNA and the final histopathology report when reported by a head and neck and a non-head and neck pathologist. All patients with major salivary gland neoplasm having undergone a preoperative FNA before surgery from January 2012 to December 2019 at our hospital were included in the study. Analysis was done to check for concordance between head and neck and non-head and neck pathologists of the preoperative FNA and final histopathology. Three hundred and twenty-five patients were included in the study. The preoperative FNA could identify the tumour as benign or malignant in the majority (n = 228, 70.1%). The agreement between the preoperative FNA, frozen section diagnosis and the reporting of grade in the frozen section and the final HPR was slightly better with the head and neck pathologist (kappa = 0.429, kappa = 0.698 and kappa = 0.257), respectively, than with the non-head and neck pathologist (kappa = 0.387, kappa = 0.519 and kappa = 0.158), all of which was statistically significant (p < 0.001). The diagnosis made with the preoperative FNA and reporting in the frozen section had a fair agreement with the final histopathology when reported by a head and neck pathologist in comparison to a non-head and neck pathologist.

254 Driving Improvement for Testicular Cancer Patients within a Urology Unit at a District General Hospital

Abstract Aim Assess the proportion of patients undergoing: (1) Preoperative assessment of the testicle, including serum tumour markers (STM) and testicular ultrasound (US), (2) Orchidectomy within 3 weeks of US diagnosis, and (3) Radiological staging (CT) within 3 weeks of surgery. Method Patients who had a radical inguinal orchidectomy for probable testicular malignancy were identified, between January and October 2021, via the electronic theatre system. Clinical data, including blood results, imaging, and histopathology, were obtained via the ICE reporting system. Results 21 patients underwent orchidectomy during the 10-month period. The median age was 37 (26–89) with the majority (81%) presenting with a painless testicular lump. On final histopathology, 11 (52.3%) demonstrated classical seminoma and 6 (28.6%) a mixed germ cell tumour. Testicular US was performed on all patients prior to surgery and 95.2% had the full complement of STM taken. Unfortunately, the Lactate Dehydrogenase (LDH) in 65% of these patients had haemolysed. The mean time from US diagnosis to orchidectomy was 20.1 days (4–29), with 66.6% of patients operated on within 3 weeks. A staging CT was performed on 84.6% of patients within 3 weeks of surgery. Conclusions Delays from testicular cancer diagnosis to surgery can impact on both disease stage and ultimately outcome. Following local presentation of our results, whilst liaising with biochemistry, various factors have been addressed to help mitigate the risk of STM sample haemolysis (including sample drawing, transport, and processing). In addition, a more formal pathway has since been instigated to ensure patients are undergoing orchidectomy in a timely fashion.

Role of MRI in pre-operative staging of endometrial cancer: A diagnostic accuracy study

Endometrial cancer (EC) is a commonly occurring cancer among post-menopausal women. Pre-treatment imaging of the extent of disease can influence the decisions in the management of EC. MRI with its diffusion weighted (DW) images can help in better depiction of the primary tumour, its local extension and extrauterine spread to the peritoneum and lymph nodes. This study was conducted to know the role of MRI for pre-operative staging of endometrial cancer and as a guide for pelvic lymph nodal dissection.It was a descriptive cross-sectional study conducted at a tertiary care hospital patients diagnosed with primary endometrial adenocarcinoma on biopsy. Patients with advanced disease requiring chemotherapy prior to surgery were excluded. Fifty consecutive patients were subjected to MRI Pelvis with abdominal screening in the week preceding definitive surgery, Findings from imaging were compared with final histopathology for concurrence on tumour size, depth of myometrial invasion, presence of adnexal, nodal and cervical stromal involvement.Majority of the patients in this study were post-menopausal women. Sensitivity of MRI for staging of Endometrial Carcinoma in this study was 91.84% and Accuracy was 90%. When compared to HPE for lymph node positivity, MRI had sensitivity of 100%, specificity of 97.87%, PPV of 75%, NPV of 100% and accuracy of 98%.Pre-operative MRI in the week prior to the planned surgery can help in accurately staging the endometrial carcinoma in terms of myometrial infiltration, cervical stromal infiltration as well as pelvic lymph nodal involvement.

Identification of women with high grade histopathology results after conisation by artificial neural networks.

BackgroundThe aim of the study was to evaluate if artificial neural networks can predict high-grade histopathology results after conisation from risk factors and their combinations in patients undergoing conisation because of pathological changes on uterine cervix.Patients and methodsWe analysed 1475 patients who had conisation surgery at the University Clinic for Gynaecology and Obstetrics of University Clinical Centre Maribor from 1993–2005. The database in different datasets was arranged to deal with unbalance data and enhance classification performance. Weka open-source software was used for analysis with artificial neural networks. Last Papanicolaou smear (PAP) and risk factors for development of cervical dysplasia and carcinoma were used as input and high-grade dysplasia Yes/No as output result. 10-fold cross validation was used for defining training and holdout set for analysis.ResultsBas eline classification and multiple runs of artificial neural network on various risk factors settings were performed. We achieved 84.19% correct classifications, area under the curve 0.87, kappa 0.64, F-measure 0.884 and Matthews correlation coefficient (MCC) 0.640 in model, where baseline prediction was 69.79%.ConclusionsWith artificial neural networks we were able to identify more patients who developed high-grade squamous intraepithelial lesion on final histopathology result of conisation as with baseline prediction. But, characteristics of 1475 patients who had conisation in years 1993–2005 at the University Clinical Centre Maribor did not allow reliable prediction with artificial neural networks for every-day clinical practice.

Point-of-care ultrasound scan as the primary modality for evaluating parotid tumors.

ObjectivesThis study aimed to explore ultrasonography as a single imaging modality for the initial assessment of parotid lesions compared to computed tomography (CT) and magnetic resonance imaging (MRI).MethodsA retrospective cross‐sectional study was performed on 264 parotid gland lesions evaluated in a dedicated point‐of‐care ultrasound (POCUS) clinic with concurrent fine needle biopsy (FNB). Two hundred and nine of these lesions also underwent CT or MRI imaging. Histopathology results, when available, were recorded and compared to imaging impressions.ResultsSurgeon‐performed POCUS classified parotid masses accurately when compared to final histopathology (90/96, 94%). Using predefined criteria, POCUS determined the nature of parotid lesions more definitively than the descriptive CT or MRI radiology reports (p <.001). Sub‐analysis showed that ultrasonography was able to distinguish between benign pathologies with high degree of accuracy (Warthin tumor—82%, pleomorphic adenoma—64%).ConclusionsPOCUS can accurately distinguish between benign and malignant parotid lesions. POCUS may suffice as the only imaging study for benign lesions, obviating the need for additional cross‐sectional imaging. This can be combined with fine needle or core biopsy in the same visit, resulting in expedient diagnosis, low cost, and lack of radiation exposure.Level of Evidence2b, individual cross‐sectional cohort study.

EP-631 Left Ovarian Teratoma Containing Follicular Thyroid Carcinoma: A case Report

Abstract Introduction A mature cystic teratoma of the ovary is composed of well-differentiated derivatives of the three germ layers, the ectoderm, the mesoderm and the endoderm. About 20% of ovarian teratomas contain thyroid tissues. When thyroid tissue comprises more than 50% of the ovarian teratoma, it is termed; struma ovarii. Patients are usually asymptomatic or predominantly presented with a pelvic mass in 45% of cases or abdominal pain. We represent a rare case of stuma ovarii containing follicular thyroid carcinoma. Case presentation A 56 years old patient presented with a left ovarian mass. The patient had no history of any thyroid abnormalities and no family history of thyroid malignancy. The patient underwent total hysterectomy (TH) and bilateral salpingo-oophrectomy (BSO). Mature cystic teratoma of the left ovary containing highly differentiated follicular carcinoma with omental deposits was discovered. The case was referred for thyroid MDT for discussion of further management. Thyroid US and CT scans showed slightly small thyroid containing multiple hypoechoic nodules with no evidence of distant metastasis. Management The patient had total thyroidectomy and the final histopathology reported incidental multifocal papillary microcarcinomas of follicular variant; stage pT1a. Post-operatively the patient had Radio-iodine ablation. TSH suppression with thyroxin was initiated. The patient had regular radiological and thyroglobulin checks and no recurrence was detected on 5 years of follow-up. Conclusion The treatment for malignant struma ovarii depends on the tumor stage. The initial surgery includes TH and BSO with omentectomy. The adjuvant treatment includes thyroxine, total thyroidectomy with RAI ablation. Long-term follow-up is recommended.

Use of Intraoperative Frozen Section to Assess Final Tumor Margin Status in Patients Undergoing Surgery for Oral Cavity Squamous Cell Carcinoma

Methods of assessing final margin status in patients undergoing surgery for oral cavity squamous cell carcinoma, such as intraoperative frozen section histopathology (IFSH) taken from the tumor bed, may have limitations in accuracy. To evaluate the accuracy and implications of using IFSH samples to assess tumor bed margins in patients undergoing surgery for oral cavity squamous cell carcinoma (SCC). This cross-sectional study included 1257 patients who underwent surgery for oral cavity SCC between January 1, 2000, and December 31, 2015, at an academic cancer center. A total of 4821 IFSH samples were examined from 1104 patients (87.8%) who had at least 1 IFSH sample. Institutional practice is to harvest margins for IFSH from the tumor bed. Statistical analysis was performed from August 1, 2021, to April 4, 2022. Sensitivity and specificity were calculated for IFSH samples of margins compared with the permanent pathology samples of the same tissue and for IFSH compared with the final tumor specimen histopathology (FTSH). Results were classified using a binary method, with histopathologic reports interpreted as either negative (including negative or atypia or dysplasia) or positive (including carcinoma in situ, suspicious, or positive). A total of 1257 patients met the inclusion criteria, including 709 men (56.4%), with a median age of 62 years (IQR, 52-73 years); 1104 patients (627 men [56.8%]; median age, 62 years [IQR, 52-72 years]) had IFHS samples. For IFSH relative to permanent sections of the IFSH tissue, sensitivity and specificity of IFSH were high (sensitivity, 76.5% [95% CI, 67.5%-85.5%]; specificity, 99.9% [95% CI, 99.8%-100%]), with discordant results in 24 of 4821 total specimens (0.5%). Final specimen margins were positive in 11.7% of patients (147 of 1257). Compared with FTSH, the sensitivity of IFSH for defining margin status was 10.8% (95% CI, 5.8%-15.8%), and the specificity was 99.1% (95% CI, 98.8%-99.4%). The rate of discordance was 4.0% (171 of 4284 specimens) between IFSH and FTSH. The findings of this cross-sectional study suggest that IFSH is accurate compared with permanent pathologic characteristics of the same tissue, but less reliable at assessing final margin status on the tumor specimen. Despite a high specificity, the sensitivity of IFSH compared with FTSH is low, which may be associated with the inherent inability of tumor bed IFSH margin analysis to accurately account for the 3-dimensional association of tumor margins with the periphery of the specimen and the overall low rate of positive final tumor margins. Although tumor bed IFSH is widely used in the management of oral cavity cancer, this study suggests that there are limitations of this modality in assessing the final surgical margin status.

Malignant Adenomyoepithelial Tumour of the Breast - a Rare Diagnosis - Case Report.

Breast adenomyoepithelioma is an unusual tumour characterized by a biphasic proliferation of epithelial and myoepithelial cells. Most of the breast adenomyoepitheliomas are considered to be benign and characterized by propensity for local recurrence. Malignant change can occur rarely in one or both cellular components. We here present a case of a 70-year-old previously healthy female who initially presented with a painless breast lump. The patient underwent wide local excision in view of suspicion of malignancy and sent for frozen section regarding the diagnosis and margins which surprisingly came as adenomyoepithelioma. Final histopathology came as low-grade malignant adenomyoepithelioma. The patient shows no sign of tumour recurrence in the follow up.