Frozen Section Pathological Examination Research Articles

Prognostic Significance of the Proximal Margin for Esophagogastric Junction Adenocarcinoma with Type II and III Tumors after Surgery

Background: The incidence of Esophagogastric Junction Adenocarcinoma (EJA) has increased in recent years, with surgical resection the main choice of treatment. The optimal length of the proximal margin for EJA is still under debate, and the impact of EJA survival and recurrence remains unclear. The aim of the present study was to investigate the influence of the optimal length of the proximal margin on EJA. Methods: From January 2011 to December 2015, 131 patients who had EJA with type II tumors were included and retrospectively analyzed. All patients underwent radical R0 resection. The proximal margin was measured promptly after resection, and the frozen-section pathological examination was negative for the margin. Results: There were 3 cases of Siewert type I EJA (2.9%), 75 cases of Siewert type II EJA (57.9%), and 53 cases (40.1%) of Siewert type III EJA. The median number of lymph nodes examined was 19 (range: 1-41), and the median number of positive lymph nodes was 2 (range: 0–18). Sixty-three patients underwent total gastrectomy (48.1%), and 68 underwent proximal gastrectomy (51.9%). The median follow-up time was 57.3 months: (range 1.9–174.1); 34 patients (26%) relapsed and 74 (56.5%) died. The 5-year overall survival rate of type II tumor patients was 68.2%, and that of type III tumor patients was 38.5% (P=0.02). For patients with a proximal margin <2cm, the median recurrence time was 41.6 months, whereas it was for 42.8 months for patients with proximal margin >2cm (log–rank: 0.496). Our data analysis found that a proximal margin length of 2cm was a prognostic variable for type II and type III tumors. Conclusions: There are a number of factors associated with recurrence and overall survival at 5 years for patients who have EJA with type II and type III tumors, and a proximal margin >2cm may indicate better prognosis.

Cystectomy of Ovarian Borderline and Malignant Tumors for Fertility Sparing: Outcome of Seventeen Cases

Background: Here we present a retrospective study of 17 cases in which the ovary on the affected side was spared in fertility-sparing surgery (FSS) during treatment for ovarian borderline malignant or malignant tumor. We determine that cystectomy is a suitable treatment for ovarian borderline tumors. Methods: A retrospective observation study was conducted at Saiseikai Fukuoka General Hospital in Japan between April 2009 and September 2020. Our hospital experienced 89 cases of FSS during treatment for ovarian borderline or malignant tumor. Of those, there were 17 cases in which the ovary on the affected side was spared. We examined recurrent and pregnant cases by stage, preoperative diagnosis, intraoperative pathological diagnosis, postoperative pathological diagnosis, and adjuvant therapy. Result: Of the 17, 12 cases were borderline malignant tumor, 4 were immature teratoma grade 1 (G1), and 1 case was endometrioid adenocarcinoma G1. Rapid intraoperative pathological diagnosis was conducted in 9 of the cases, and there were 6 in which surgical method was chosen based on the aforementioned results. Laparoscopic surgery was performed in 2 cases in which tumors were deemed benign via preoperative diagnosis, 2 cases of mature teratoma, and 2 in which borderline ovarian tumor was suspected. One (1) case of paraovarian cystecomy in a patient with history of multiple cesarean sections turned out to be serous borderline tumor. Postoperative treatment took place in only 1 case: endometrioid adenocarcinoma. There were 2 cases of recurrence, and 4 cases were eventually able to become pregnant naturally post-surgery. These pregnant cases included 1 in which serous borderline tumor recurred and we performed both cystectomy and lymphadenectomy, and one in which chemotherapy was performed after cyst enucleation for endometrioid adenocarcinoma G1. Conclusion: At present, there is no clear policy for FSS in cases such as stage Ib in which there are bilateral tumors. Accordingly, in the current study a radiologist was consulted for preoperative diagnosis, and surgical method was chosen with a view towards possible borderline malignancy or malignancy. In cases where fertility preservation of the affected ovary is a high priority, it is crucial to clearly explain the possibility of recurrence to the patient. We also stress the importance of detailed consultation among the surgical team during rapid intraoperal frozen section pathological examination for making the appropriate decision to ensure fertility preservation mid-surgery.

Diagnostic value of frozen section examination of sentinel lymph nodes in early-stage cervical cancer at the time of ultrastaging

ObjectivesWe aimed to assess the diagnostic value of frozen-section pathologic examination (FSE) of sentinel lymph nodes (SLN) in patients with early-stage cervical cancer. MethodsTwo French prospective multicentric database on SLN biopsy for cervical cancer (SENTICOL I and II) were analysed. Patients with IA to IIA1 2018 FIGO stage, who underwent SLN biopsy with both FSE and ultrastaging examination were included. Results and discussionBetween 2005 and 2012, 313 patients from 25 centers fulfilled the inclusion criteria. Metastatic involvement of SLN was diagnosed in 52 patients (16.6%). Macrometastases, micrometastases and isolated tumor cells (ITCs) were found in 27, 12 and 13 patients respectively. Among the 928 SLNs analysed, FSE identified 23 SLNs with macrometastases in 20 patients and 5 SLNs with micrometastases in 2 patients whereas no ITCs were identified. Ultrastaging of negative SLNs by FSE found macrometastases, micrometastases and ITCs in additional 7, 11 and 17 SLNs. Ultrastaging increased significantly the rate of patients with positive SLN from 7% to 16.6% (p < 0.0001).The sensitivity and the negative predictive value of FSE were 42.3% and 89.7% respectively or 56.4% and 94.1% if ITCs were excluded. False-negative cases were more frequent with tumor size ≥ 20 mm (OR = 4.46, 95%IC = [1.45–13.66], p = 0.01) and preoperative brachytherapy (OR = 4.47, 95%IC = [1.37–14.63], p = 0.01) and less frequent with patients included in higher volume center (>5 patients/year) (OR = 0.09, 95%IC = [0.02–0.51], p = 0.01). ConclusionsFSE of SLN had a low sensitivity for detecting micrometastases and ITCs and a high negative predictive value for SLN status. Clinical impact of false-negative cases has to be assessed by further studies.

Pathological features and survival analysis of gastric cancer patients with positive surgical margins: A large multicenter cohort study

ObjectiveTo investigate the factors related to positive surgical margins of gastric cancer and their correlation with the prognosis of these patients. MethodsThe clinicopathological data of gastric cancer patients undergoing gastrectomy were collected, and the relationship between surgical margins status and patient outcome was analyzed. ResultsA total of 10080 patients were included, among which 311 (3.1%) had positive surgical margins. pT3-4, pN+ and M1 were independent risk factors for positive margins, and a tumor in the middle of the stomach was a protective factor (p < 0.05). The 5-year overall survival (OS) rates of the patients with positive and negative margins after propensity score matching (PSM) were 24.2% and 36.8%, respectively (p < 0.001). For M0 patients, the 5-year OS of the margin-positive patients was lower than that of the margin-negative patients, and was higher than that of patients with M1. For the M1 patients, no statistically significant difference in 5-year OS was noted between patients with positive and negative margins. Age, positive margins, tumor location, pN+, and M1 were independent prognostic factors for OS in patients undergoing gastrectomy, and pN2-3 and M1 stages were independent prognostic factors for patients with positive surgical margins. Postoperative chemotherapy could improve the 5-year OS in pN2-3 and M1 margin-positive patients (p < 0.05). ConclusionThe prognosis of M0 gastric cancer patients with positive surgical margins is poor, and it is recommended that these patients should undergo routine intraoperative frozen-section pathological examination to reduce the risk of positive surgical margins.

Surgical method choice and coincidence rate of pathological diagnoses in transduodenal ampullectomy: A retrospective case series study and review of the literature.

BACKGROUNDTransduodenal ampullectomy (TDA) is not in wide clinical use due to its low radical effect and a high recurrence rate of tumors. However, TDA is still an effective treatment method; it has great clinical value in cases of duodenal benign tumors, precancerous lesions, and benign and malignant borderline tumors, and can avoid the risks associated with pancreaticoduodenectomy with larger resection range and greater thoroughness than endoscopic papillectomy.AIMTo investigate the surgical method choice and the coincidence rate of pathological diagnoses in TDA for ampullary neoplasms.METHODSTen patients with ampullary neoplasms underwent TDA based on the fact that their endoscopic biopsy results suggested benign lesions, and the endoscopic ultrasound (EUS)-assessed tumors were resectable. All cases underwent duodenal ampullary lesion endoscopic biopsy, intraoperative frozen-section pathological examination, and postoperative pathological examination.RESULTSThis study included seven patients with benign tumors and three with malignant tumors (1 pTis, 2 pT1), according to the postoperative pathology results. The coincidence rate of the postoperative pathology results with the intraoperative frozen-section biopsy results was 100% (10/10), and the coincidence rate with the endoscopic biopsy results was 70% (7/10) based on pathological characteristics. The endoscopic biopsy false-negative rate was 30% (3/10). All patients were followed for 6 to 70 mo without tumor recurrence or metastasis.CONCLUSIONThe coincidence rate of postoperative pathology results, intraoperative frozen-section pathology results, and endoscopic biopsy results is the restraining factor of TDA clinical application. Endoscopic biopsy results and EUS have importance relevance to surgical planning. Intraoperative frozen-section pathology results have a significant influence on the choice of surgical procedure.

Anatomy and Surgical Approach of the Ear and Temporal Bone.

The temporal bone is one of the more complex structures at the skull base that houses the hearing and vestibular organs, numerous nerves, and vessels. A host of inflammatory and neoplastic processes can occur within the temporal bone that often necessitate permanent and frozen section pathologic examination. A number of simple to complex surgical procedures are used to manage temporal bone pathology. This chapter will provide a brief overview of normal temporal bone anatomy, common surgical approaches, normal histology, and indications for pathologic examination.

悪性腫瘍を疑った上顎骨放線菌症の1例

Actinomycosis is an uncommon specific inflammation in the maxillofacial region, particularly arising in soft tissue around the mandible. In this paper, we report a case of maxillary actinomycosis with severe bone destruction and suspected malignant tumor. A 37-year-old man was referred to our hospital because of pain in the left molar region of the maxilla. Radiographic examination showed progressive bony destruction at the left maxillary sinus and alveolar process that were well enhanced by Gadolinium on the MRI. The clinical diagnosis was malignant tumor of the left maxillary sinus. Biopsy was performed under general anesthesia. Intraoperative frozen-section pathological examination revealed that it was inflammatory granulation tissue without malignancy. Accordingly, the operation was subsequently changed to sequestrectomy. Histological diagnosis of the permanent specimens was actinomycosis. No further signs or symptoms have been noted as of 48 months after surgery.

Diagnosis and treatment of the neurofibroma of the common bile duct

Neurofibroma is an autosomal dominant genetic disease which is originated from the abnormal differentiation of neural crest cells and would cause system damage.NF can occur at most organs in the body,while it is rarely seen in the common bile duct.In February 2007,1 old patients with NF was admitted to the Lishui Central Hospital of Zhejiang Province.The results of preoperative magnetic resonance cholangiopancreatography (MRCP) revealed that the common bile duct was slightly dilated,and the diameter of the common bile duct was 1.2 cm.A nodular short T2 signal lesion was detected at the middle part of the common bile duct with the size of 1.4 cm × 1.6 cm.The results of intraoperative rapid frozen section pathological examination showed that the lesion was cholangiocarcinoma,then cholangiocarcinoma resection + biliojejunal Roux-en-Y anastomosis was applied to the patient.Postoperative pathological examination confirmed that the lesion was neurofibroma.The patient was followed up for 7 years and died of pulmonary infection in June 2014.The clinical presentation of neurofibroma of the common bile duct is untypical.Space-occupying lesions detected in the patients with history of bile duct injury or operation should be considered to be diagnosed as neurofibroma.Special attention should be paid to the accuracy of the results of rapid frozen section pathological examination in order to avoid missdiagnosis. Key words: Neurofibromatosis; Common bile duct

Accuracy of intraoperative pathological examination of SLN in cervical cancer

ObjectiveEarly cervical cancer patients with pelvic lymph node metastasis do not benefit from radical hysterectomy. Assessment of the SLN status is thus crucial before deciding to perform a radical hysterectomy as opposed to aortic dissection only followed by definitive radiation therapy. Accuracy of frozen section of SLN has been questioned and deserves further investigation. MethodsStage IA–IB1 cervical cancer patients who underwent SLN then full pelvic dissection at the Claudius Regaud Cancer Center in Toulouse, France, were included. ResultsAt least one SLN was identified in all 94 patients. Bilateral detection rate was 80.8%. Ectopic drainage area was found in 19 patients (20.2%). Sentinel lymph node involvement was found in 11 patients (11.7%).Sensitivity and NPV of frozen section pathological examination for the detection of macrometastatic disease was 100%, sensitivity for the detection of macro and micrometastatic disease, excluding ITC, was 88.9%, and NPV was 98.8%. Micrometastasis and isolated tumor cells (ITC) undetected at frozen section examination were found in 1 patient (1.06%) and 2 lymph nodes (1.24%), and in 2 patients (2.13%) and 2 lymph nodes (1.24%), respectively. Final pathology sensitivity of SLN was 100% for both macro and micrometastatic disease, including ITC. ConclusionIn our institution, intraoperative frozen examination of SLN accurately predicts the status of pelvic lymph nodes and is effective for selecting intraoperatively the group of patients who benefit from radical hysterectomy. In addition, our results suggest that patients with small tumors and bilateral detection of SLN can be spared full pelvic lymphadenectomy.

The role of preoperative serum thyroglobulin and thyroid auto-antibody levels before histopathological diagnosis of thyroid cancers

If a frozen section pathological examination is not performed in unilateral thyroid nodule surgery and the postoperative pathological diagnosis is cancer, a second operation may be required. Therefore, it was studied whether serum thyroid auto-antibody levels are useful or not in determining preoperative malignancy in patients with thyroid disorders. Materials and methods: It was investigated retrospectively whether there was a correlation between preoperative serum thyroglobulin (Tg), anti-thyroglobulin antibody (anti-Tg), and anti-thyroid peroxidase antibody (anti-TPO) levels and thyroid cancer in patients who had undergone thyroidectomy. Results: Two hundred and eighty-seven patients who had undergone thyroid surgery and whose preoperative serum levels of Tg, anti-Tg, and anti-TPO had been recorded were included in this study. Only 54 (18.8%) of the patients had a malignant diagnosis in the postoperative histopathological examination. Sixteen of the patients who had a postoperative malignant thyroid disease diagnosis (29.6%) had high serum Tg, anti-TPO, and/or anti-Tg levels. The rate of high serum Tg levels was significant in patients with a benign pathology (49.4% vs. 31.5%, P = 0.018). Conclusion: It appears that preoperative measurement of serum Tg, anti-TPO, and anti-Tg levels is not a useful method to predict malign thyroid diseases.

Clinical Analysis of Plasma Cell Mastitis in 76 cases

Objective To summarize the features, diagnosis and treatment of plasma cell mastitis.Methods The clinical data of 76 patients with plasma cell mastitis proved by operation and pathology from 2004 to 2009 in our hospital were retrospectively analyzed. Results In 76 cases, there were 47 cases of mammary papilla invagination and foliatepapilla(61.8% ) ,53 cases of inflammatory lump( 69.7% ), 13 cases of chronic fistula cannulas( 17.1% ) ,5 cases misdiagnosed as breast cancer before operation(6.6% ). Conclusions Plasma cell mastitis could be occasionally misdiagnosed as breast cancer,final diagnosis was made by frozen section pathological examination, operation was the effective method to cure the disease, some patients were usually recured, mammary papilla dysplasia could be one of the major etiological factors. Key words: Mastitis; Plasma cells; Diagnostic errors; Retrospective studies

Retrospective analysis of diagnosis by intraoperative frozen section and routine paraffin embedded tissue in 638 thyroid disease patients

OBJECTIVE To summarize a common pathogenetic condition, the pathologic characteristics shown in frozen section and our experience utilizing 2 different diagnostic methods in cases of common thyroid diseases (TD). METHODS Data from 638 cases with frozen sections from thyroid tissue were retrospectively analyzed. The intraoperative frozen sections of the patients and postoperative diagnostic results of routine paraffin sections were compared. RESULTS In the 683 patients, the gender ratio of females to males was 2.64 : 1, and the ratio between the patients with nodular goiter (NG) and the patients with thyroid adenoma was 1.5 : 1. The oldest age group of patients with thyroid cancer (TC) ranged from 40 to 49 years. Frozen section pathologic examination has been employed more and more in the diagnosis of thyroid diseases, and the detection rate of TC has increased year by year, i.e., the rate increased to 6.45%, 7.58%, 14.55% and 16.57%, respectively, in 2005, 2006, 2007 and 2008. Thyroid papillary carcinoma (TPC) was the most commonly seen malignant tumor of the thyroid(MTT), which accounted for approximately 94.8% of MTTs and 11.44% of the total TDs. Micropapillary carcinoma accounted for 27.4% of TPC, and multifocal carcinomas accounted for 15.58% of TCs. Many of the TCs (19.48%) were complicated by benign diseases such as adenoma, NG and thyroiditis. The coincidence rate of diagnoses made by frozen section and paraffin embedding for thyroid disease was 98.59%. Calcification was rather common in NG and TPC, and there were signifi cant di ff erences in psammoma bodies (PMB) between the calcifications of TPC and NG ( P < 0.01). CONCLUSION TPC ranks first in the incidence of MTTs and accounts for 94.8% of all MTTs. About 1/4 of TPCs are micropapillary carcinoma, while 1/5 are accompanied by benign disease, such as adenoma, NG and thyroiditis. PMB are of importance and of signi fi cance in the diagnosis of TPC.