Frozen Section Report Research Articles

Nephrogenic Adenoma: A Pitfall on Frozen Section of Urethral Strictures.

Urethral strictures are a common cause of urinary obstruction which can be treated with surgical resection. Frozen sections are rare and pose a diagnostic challenge to pathologists due to the presence of benign lesions such as nephrogenic adenoma. We retrospectively examined all specimens of urethral stricture resections submitted to pathology at our institution from 2012 to 2022 (n = 258). Final pathology reports were searched to identify patients with dysplasia, carcinoma, or nephrogenic adenoma. When available, frozen section reports were also examined and compared to the final report, and additional clinical history and microscopic images were collected for patients with nephrogenic adenoma. Nephrogenic adenoma was identified in 3.8% (10/258) of urethral stricture resections. Dysplasia was identified in one patient who underwent two separate resections, and squamous cell carcinoma was found in one resection. Intraoperative frozen section was requested in 3.4% of resections (9/258). In two resections, an initial diagnosis of squamous cell carcinoma was initially favoured, however when reviewed with a genitourinary pathologist the diagnosis was changed to "reactive process" with a final diagnosis of nephrogenic adenoma. Nephrogenic adenoma can be challenging on frozen section due to variable architectural patterns, inflammation, and reactive changes. While urethral strictures are relatively common, their assessment by frozen section is rare and pathologists may lack familiarity with the variable morphology of benign entities that can be seen on frozen section resulting in their misinterpretation. We highlight this potential diagnostic pitfall and demonstrate the value of a second opinion prior to definitive frozen section diagnosis of malignancy.

Exploring the Clinicopathological Diversity in Sarcomatous Transformations in the Uterus.

Introduction Uterine sarcomas are a rare group of mesenchymal tumors.They originate either from the uterine smooth muscle or from the endometrial stroma. The spectrum of malignant uterine sarcomatous transformations includes leiomyosarcoma, low-grade endometrial stromal sarcoma (LG-ESS), high-grade endometrial stromal sarcoma (HG-ESS), undifferentiated uterine sarcoma, and carcinosarcoma. The purpose of this study is to determine the distribution of malignant uterine sarcomatous transformations, in relation to the patient's age, epidemiological aspects, and clinical features, and to analyze the different histological types of uterine sarcomas diagnosed at our institutionand thereby to quantify their frequency and determine the most common histopathological subtype occurring in the population. Materials and methods This was a retrospective descriptive study of 21 cases of malignant uterine sarcomatous transformations, diagnosed in Saveetha Medical College, Chennai, between January 2019 and December 2022. Data was collected from the archives of the department of pathologyand from the department of medical records in the hospital. The spectrum of uterine sarcomas was analyzed in relation to the patient's age, menopausal status, presenting symptoms, preoperative diagnosis, biopsy and frozen section reports wherever available, and histopathological reports with pathological staging. Results The most common age group in which uterine sarcoma was diagnosed was found to be 61-70 years. All 10 patients who were diagnosed with carcinosarcoma were aged 60 years, andall seven patients diagnosed with low-grade endometrial stromal sarcoma were less than 50 years of age. Most of the patients were postmenopausal females, except for one patient who was premenopausal. The most common histological variety found was carcinosarcoma, malignant mixed mullerian tumor (47.6%), followed by LG-ESS (33.3%), leiomyosarcoma (14.28%), and HG-ESS (4.7%). Conclusion Uterine sarcomas are anaggressive group of tumors having a very poor prognosis. Due to its rarity and histopathological diversity, there is a lack of consensus on the risk factors.

Intraoperative frozen section in gynaecology cancers with special reference to ovarian tumours: time to "unfreeze" the pitfalls in the path of the Derby horse of Oncology.

In an oncological set up the role of frozen section biopsy is undeniable. They serve as an important tool for surgeon's intraoperative decision making but the diagnostic reliability of intraoperative frozen section may vary from institute to institute. The surgeon should be well aware of the accuracy of the frozen section reports in their setup to enable them to take decisions based on the report. This is why we had conducted a retrospective study at Dr B. Borooah Cancer Institute, Guwahati, Assam, India to find out our institutional frozen section accuracy. The study was conducted from 1st January 2017 to 31st December 2022 (5years). All gynaecology oncology patients who were operated on during the study period and had an intraoperative frozen section done were included in the study. Patients who had incomplete final histopathological report (HPR) or no final HPR were excluded from the study. Frozen section and final histopathology report were compared and analysed and discordant cases were analysed based on the degree of discordancy. For benign ovarian disease, the IFS accuracy, sensitivity and specificity are 96.7%, 100% and 93%, respectively. For borderline ovarian disease the IFS accuracy, sensitivity and specificity are 96.7%, 80% and 97.6%, respectively. For malignant ovarian disease the IFS accuracy, sensitivity and specificity are 95.4%, 89.1% and 100%, respectively. Sampling error was the most common cause of discordancy. Intraoperative frozen section may not have 100% diagnostic accuracy but still it is the running horse of our oncological institute.

Are blood parameters assessed before taking frozen sections useful in gynecological oncology?

Background/Aim: Inflammatory processes are often implicated in oncology, and inflammatory markers and indices have been much studied in this context. In gynecological surgery, frozen sections have proven valuable in decision-making. Here we aim to identify laboratory parameters that correlate with frozen section results and thus develop new indices in neoplastic decision-making. Methods: In this retrospective cross-sectional study at Bursa Yüksek İhtisas Training and Research Hospital, we evaluated 139 patients diagnosed with adnexal mass and endometrial intraepithelial neoplasia. We divided the patients whose frozen sections were reported as malignant, borderline, or benign into three groups and compared the pre-operative complete blood parameters. Results: The mean age of our patients was 57.3 (11.5) years, and frozen section reports were benign in 33 (23.7%), borderline in 43 (30.9%), and malignant in 63 (45.3%) patients. The mean corpuscular volume and mean platelet volume values ​​were different, and this difference was significant between borderline and malignant groups in post-hoc analyses (P = 0.04 and P = 0.03, respectively). While the percentage of lymphocytes was lower in malignant groups, the percentage of neutrophils was higher (P = 0.01 and P = 0.03, respectively). According to post-hoc analysis, the percentage of neutrophils differs between benign and malignant groups (P = 0.05). The difference in lymphocyte percentage was significant between benign-borderline and benign-malignant groups (P = 0.02, P = 0.05; respectively). The blood neutrophil/lymphocyte ratio was higher in the malignant groups compared to the other two groups (P = 0.02). We used the Multi Linear Regression Analysis method to analyze the factors that play a role in predicting the frozen outcome as malignant. Accordingly, the model with the best performance used lymphocyte percentage, neutrophil/lymphocyte ratio, and Ca-125 parameters (P = 0.03). Conclusion: This study indicates that inflammatory markers may give a clue about the character of the neoplastic mass before oncology surgery. Thus, we can make new contributions to the surgical and clinical approach in the literature by developing new malignancy indices.

Frozen Section in Diagnosis of Thyroid Swelling: Does It Still Have Role?

Purpose The present study correlates the frozen section diagnosis of thyroid swelling with the histopathological diagnosis and assesses the expression of immunohistochemical markers in malignant thyroid tumours. Also, the study aims to analyse the accuracy and limitations of the frozen section as an intraoperative tool for the diagnosis of thyroid swellings. Method Fifty-three cases of thyroid swelling were included in the study. Frozen section reports were classified as benign, malignant and deferred. A correlation between frozen section and histopathology examination (HPE) reports has been evaluated. The malignant cases confirmed on HPE were subjected to Immunohistochemistry (IHC) with TTF-1, Thyroglobulin, and CK-7. Results Among the 53 patients, 45 (84.9%) were females, and the majority were younger than 40years (60.37%). On frozen section majority, 42 (79.25%) were benign, while a definitive diagnosis of malignancy was made in six cases (11.32%). On the frozen section, there were no false-positive cases, six true-positive cases, one false-negative case and 46 true-negative cases, with a sensitivity of 85.71%, specificity of 100%, the positive predictive value of 100%, the negative predictive value of 97.87% and diagnostic accuracy of 98.11% respectively. All the six papillary carcinomas and one follicular carcinoma showed immunoreactivity of tumor cells to TTF 1, CK 7 and Thyroglobulin. Conclusion There was a strong correlation between the frozen section and histopathological diagnosis. Still, it is not recommended in routine use for intraoperative diagnosis of thyroid swelling because of various limitations and the high diagnostic accuracy of FNAC. Adequate histopathologic diagnosis of thyroid disease is based on extensive subsampling of the specimen, which is not possible during an intraoperative frozen section procedure. If the frozen section is used, its limitations must be recognized, preferably based on first-hand data.

Sentinel node mapping using indocyanine green and near-infrared fluorescence imaging technology for endometrial cancer: A prospective study using a surgical algorithm in Indian patients.

Background:Indocyanine green (ICG) fluorescence with high-definition, three-dimensional imaging systems is emerging as the latest strategy to reduce trauma and improve surgical outcomes during oncosurgery.Materials and Methods:This is a prospective study involving 100 patients with carcinoma endometrium who underwent robotic-assisted Type 1 pan-hysterectomy, with ICG-directed sentinel lymph node (SLN) biopsy from November 2017 to December 2019. The aim was to assess the feasibility and diagnostic accuracy of SLN algorithm and to evaluate the location and distribution of SLN in pelvic, para-aortic and unusual areas and the role of frozen section.Results:The overall SLN detection rate was 98%. Bilateral detection was possible in 92% of the cases. Right side was detected in 98% of the cases and left side was visualised in 92% of the cases. Complete node dissection was done where SLN mapping failed. The most common location for SLN in our series was obturator on the right hemipelvis and internal iliac on the left hemipelvis. SLN in the para-aortic area was detected in 14% of cases. In six cases, SLN was found in atypical locations, that is pre-sacral area. Eight patients had SLN positivity for metastasis and underwent complete retroperitoneal lymphadenectomy. Comparison of final histopathological report with frozen section reports showed no false negatives.Conclusions:SLN mapping holds a great promise as a modern staging strategy for endometrial cancer. In our experience, cervical injection was an optimal method of mapping the pelvis. ICG showed a high overall detection rate, and bilateral mapping appears to be a feasible alternative to the more traditional methods of SLN mapping in patients with endometrial cancer. The ICG fluorescence imaging system is simple and safe and may become a standard in oncosurgery in view of its staging and anatomical imaging capabilities. This approach can reduce the morbidity, operative times and costs associated with complete lymphadenectomy while maintaining prognostic and predictive information.

Reverse masquerade

Sebaceous lesions encompass a spectrum from benign lesions to disfiguring malignant lesions. Eyelid sebaceomas are extremely rare and only two definite cases are described in the English literature, whereas sebaceous adenomas occur in the eyelids more commonly and can be distinguished easily from sebaceous gland carcinoma by its clinical and histological appearance. We describe two cases of eyelid lesions that clinically resembled a possible malignant eyelid tumor. In both the cases, frozen section report was suggestive of a well-differentiated sebaceous gland carcinoma. However, histopathology examination of the permanent section was consistent with the diagnosis of sebaceoma and sebaceous adenoma respectively.

A single-centre experience of the management of inguinal lymph nodes associated with penile squamous-cell carcinoma

Background: Twenty-two cases of penile carcinoma that were managed at our institution over a 5-year period were analysed on the basis of inguinal lymph node dissection (ILND), complications and follow-up. Methods: A total of 22 cases post penectomy were stratified into low risk (T1 G1 or G2 without lympho-vascular invasion and negative on fine-needle aspiration cytology (FNAC)) and high risk (T1 G3 and above and/or lympho-vascular invasion). Low-risk patients having palpable lymphadenopathy were given a course of antibiotics. If the lymph nodes were still palpable, FNAC was done, and patients then underwent superficial ILND (SILND) or even ILND in cases with positive frozen-section reports. In the high-risk group, all patients underwent SILND, and if required, underwent ILND. Two patients in the high-risk group were lost to follow-up after 9 months. Histopathology reports were noted, and patients were followed up for 2 years. Results: In the low-risk group, seven patients had palpable lymph nodes and underwent SILND. The remaining five patients were put on surveillance. Amongst the seven who underwent SILND, six were positive at frozen section, requiring ILND. Nine patients in the high-risk group underwent ILND. Four patients in the ILND group had a minor wound infection. Lymphoedema was seen in two patients which was managed conservatively, and lymphorrhoea was seen in one patient. Flap necrosis occurred in one patient. Recurrences were seen in three patients in the high-risk group. Two who had deep node involvement and who had early nodal recurrence underwent bilateral ILND. One patient in the high-risk group had late ipsilateral nodal recurrence and underwent ipsilateral ILND. There were no regional recurrences. Conclusion: Carcinoma of the penis has high morbidity because of delayed presentation, lack of awareness and poor compliance. This necessitates staging SILND in all high-risk cases for therapeutic and prognostic purposes.

“Harms” Associated with Breast Cancer Screening and Reliability of Frozen Section in Older Women: In the Case of an 80 Year Old Woman

The objective of this paper is to present a rare case with negative final histologic examination despite abnormal findings of all previous exams indicating breast cancer in an 80 year old woman. Mammographic and magnetic resonance imaging findings were concordant with the frozen section biopsy result of DCIS. However, the final histologic diagnosis was radial scar (benign breast lesion that can radiologically mimic malignancy). As a conclusion, abnormal mammographic and magnetic resonance imaging findings with positive for DCIS frozen section reports are not always confirmed in the final histologic examination. Furthermore, considering that screening does not seem to be associated with a reduction in mortality due to breast cancer after the age of 75, breast cancer screening could be individualized in this age group.

Diagnostic Accuracy of Frozen Section and Its Influence on Intraoperative Management of Indeterminate Epithelial Ovarian Tumors.

The objective of this study is to determine the diagnostic accuracy of frozen section in detecting epithelial ovarian tumor histological types and its effect on management. A retrospective review was done of all patients who had an intraoperative frozen section for an indeterminate ovarian tumor over a six-year period. The reference standard was final histology. The validity indices for frozen section in diagnosing benign, borderline, and malignant lesions were determined. One hundred thirty-five intraoperative frozen section-diagnosed epithelial ovarian tumors were reviewed. The mean age was 44.9 ± 14.2years, the median parity was 2, and 57% (77/135) of patients were post-menopausal. The commonest histological subtype was mucinous 48.1% (65/135) on frozen section and 46.7% (63/135) on final histology. The overall concordance rate of frozen section to final histology was 81.5% (ƙ = 0.719, p = 0.0001). The accuracy, sensitivity, specificity, and positive predictive value of frozen section to diagnose benign lesions were 86.7%, 85.7%, 97.2%, and 79.2% respectively. In borderline tumors, the diagnostic test characteristics were 88.1%, 81.2%, 90.3%, and 72.2%. For malignant lesions, these values were 88.1%, 77.8%, 95.1%, and 91.3% respectively. The odds ratios for frozen section being correct were 40.9 (95% CI 14.8-113.5) for benign lesions, 40.3 (95% CI 13.4-121.3) for borderline tumors, and 67.4 (95% CI 20.5-222.0) for malignancy. Over-treatment or under-treatment occurred in 19.3% of patients. Intraoperative frozen section is useful in situations where the nature of the ovarian tumor is uncertain. However, borderline ovarian tumors are more likely to be over-diagnosed. About a fifth of patients received inappropriate treatments based on the frozen section report.

Correlation of intraoperative frozen section report and histopathological diagnosis

Correlation of intraoperative frozen section report and histopathological diagnosis

Role of Intraoperative Frozen Section in the Diagnosis of Ovarian Tumors: Experience at Gujarat Cancer and Research Institute

The surgical management of ovarian tumors depends on their correct categorization as benign, borderline or malignant. Ovarian neoplasms are an important cause of morbidity and mortality in women. This study was undertaken to evaluate the accuracy of intraoperative frozen section in the diagnosis of various categories of ovarian neoplasms. Intraoperative frozen section diagnosis was retrospectively evaluated in 292 patients with suspected ovarian neoplasms who underwent surgery as primary line of therapy at our institution. This was compared with the final histopathology diagnosis on paraffin sections. In 292 patients frozen section report had a sensitivity of 100%, 65% and 96.67% for benign, borderline and malignant tumors, respectively. The corresponding specificities were 94.28%, 99.26%, and 99.42%, respectively. The overall accuracy of frozen section diagnosis was 96.2%. The majority of cases of disagreement were in the mucinous and borderline tumors. Intraoperative frozen section has high accuracy in the diagnosis of suspected ovarian neoplasms. It is a valuable tool to guide the surgical management of these patients and should be routinely used in all major oncology centers.

Accuracy of Intraoperative Frozen Section in Diagnosing Malignancy of Ovarian Neoplasm

Objective: To evaluate the accuracy of frozen section for ovarian neoplasm
 in our hospital.
 Method: A retrospective evaluation was conducted on medical records
 of patients with ovarian neoplasms who underwent a frozen
 section laparotomy between the years 2008 and 2013 at Dr. Cipto
 Mangunkusumo Hospital. Records with incomplete data on frozen
 section or paraffin block report were excluded. Criteria for frozen
 section laparotomy in our facility was based on a malignancy score of
 equal to or more than 6. Frozen section reports were compared to
 paraffin block report based on benign, borderline, or malignant cases.
 Result: From 139 patients with ovarian neoplasm, only 91 patients
 fulfilled the inclusion and exclusion criteria. Frozen section examination
 revealed benign cases was 15.4%, borderline cases was 15.4%,
 and malignant cases was 69.2%. Based on histopathological type, clear
 cell cystoadenocarcinoma was the most commonly observed histotype
 (19.8%). The sensitivity of frozen section for benign, borderline,
 and malignancy cases respectively was 81.8%, 76.9%, 91.0%. The
 specificity of frozen section for benign, borderline, and malignancy
 case respectively was 93.8%, 94.8%, 91.6%.
 Conclusion: We found that the accuracy of intraoperative frozen section
 in our facility is adequate to diagnose ovarian neoplasm and can
 be used to assist in determining the extent of surgical management.
 [Indones J Obstet Gynecol 2015; 3: 161-164]
 Keywords: frozen section, ovarian neoplasm, paraffin block, sensitivity,
 specitificity

Evaluating the Impact of Frozen Section Analysis in Surgery for Ovarian Neoplasms

Frozen section is a valuable diagnostic tool that can identify the nature of the ovarian lesions intra-operatively thus helping to select appropriate surgery for the patient. In the present study, we are analyzing the accuracy of frozen section in diagnosing benign, borderline, and malignant ovarian tumors and the impact of change which frozen section diagnosis made on planned surgery. Frozen section diagnosis and final histopathology reports of 178 patients operated between January 2010 and August 2014 were compared. Accuracy of the frozen section and sensitivity, specificity, positive predictive value, and negative predictive value in diagnosing benign, malignant, and borderline lesions were analyzed. The impact on surgery was calculated by assessing the percentage of patients in whom the surgical management deviated from the planned procedure based on frozen section results. Frozen section reports showed an overall diagnostic accuracy of 92.7 %. The sensitivity and specificity in predicting benign, borderline, and malignant tumors were 99, 72.7, and 89 %, and 86.8, 98.8, and 100 %, respectively. Accuracy in detecting mucinous tumors was 85.5 %. In 26.9 % of the patients, the surgical management was changed to better suit the patient based on the frozen section result. Intra-operative frozen section is an accurate diagnostic tool that helped change the planned surgeries in a quarter of patients in whom the examination was sought for.

The Role of Frozen-Section in the Surgical Management of Patients with Endometrial Intraepithelial Neoplasia.

Patients with endometrial intraepithelial neoplasia may have concurrent endometrial cancer if managed surgically or develop cancer in time if managed conservatively. Therefore, intraoperative assessment of the uterus may be helpful if a surgical approach is decided on. Our study aimed to investigate the role of frozen-section examination in patients with endometrial intraepithelial neoplasia. Patients with endometrial intraepithelial neoplasia who were subjected to hysterectomy with intraoperative frozen-section assessment were included. Main outcome measures were the rates of concurrent endometrial cancer and concurrent high-risk endometrial cancer as well as the efficacy of frozen-section in the detection of concurrent invasive disease and in the designation of low-risk and high-risk features. The study group consisted of seventy-three patients. Permanent pathology revealed endometrial adenocarcinoma in 19.2% whereas only one patient (1.4%) had high-risk disease necessitating surgical staging. Frozen-section diagnoses were consistent with final pathology in 93.2% of patients in terms of the presence or absence of co-existent carcinoma. When frozen-section reports were further evaluated in terms of the presence or absence of high-risk endometrial carcinoma, consistency with the final pathology was seen in 98.6% of patients. Co-existent endometrial cancer is not uncommon in endometrial intraepithelial neoplasia. Intraoperative frozen-section evaluation should therefore be considered whenever possible. Frozen-section is effective in the detection of coexistent invasive disease and in the designation of low-risk features. Although coexistent high-risk cancer is extremely rare, frozen-section assessment is not successful in determining high-risk features. Therefore, a re-staging surgery may be required on rare occasions.

Accuracy of intraoperative frozen section in the evaluation of patients with adnexal mass: retrospective analysis of 748 cases with multivariate regression analysis.

To evaluate the accuracy of intraoperative frozen section in the evaluation of patients with adnexal mass and to define the clinicopathological factors associated with misdiagnosis during frozen section evaluation. The clinicopathological data of patients who underwent exploratory laparotomy for adnexal mass were reviewed. Results of the intraoperative frozen section and permanent histology reports were compared. Univariate and multivariate analyses were performed to reveal factors associated with misdiagnosis. The study group consisted of 748 patients. Of these patients, 509 (68.0%) had benign, 43 (5.7%) had borderline, 196 (26.2%) had malignant histological diagnosis at permanent section. The overall agreement between intraoperative frozen section and permanent pathology was 96.8%. Twenty four out of 745 cases (3.8%) were misdiagnosed by frozen section. Univariate analysis showed that borderline histology (p < 0.0001) and tumor size larger than 10 cm (p = 0.012) were associated with misdiagnosis. According to multivariate analysis, borderline histology (OR: 22.6, p < 0.0001) was the only independent predictor for misdiagnosis during frozen examination. The frozen section evaluation of the adnexal mass is highly accurate. However, tumor size greater than 10 cm and borderline histology are the factors that adversely influence the accuracy of intraoperative frozen section. Clinicians must be aware of these pitfalls during intraoperative decision making following frozen section report.

The guidance of intraoperative frozen section for staging surgery in endometrial carcinoma: frozen section in endometrial carcinoma.

The objective of this study was to evaluate the reliability of an intraoperative frozen section during the endometrial carcinoma staging surgery procedure. The paraffin section reports of 291 cases with endometrial carcinoma were compared with intraoperative frozen section reports, which were diagnosed in the Pathology Department of Cukurova University, Medical Faculty between June 2006 and December 2012. The reports were reviewed for diagnostic accuracy of the frozen section in terms of histological subtype, grade, and myometrial invasion. Concordance values between frozen and paraffin section reports were 86, 84.3, and 91.6% for histological subtype, grade, and myometrial invasion, respectively. When collectively evaluated, two (0.7%) of 291 patients were inappropriately operated on due to frozen section reports. Intraoperative frozen section is a reliable guide for surgeons to evaluate the risk group of patients with endometrial cancer and prevent an unnecessary staging surgery operation.

Organ Preservation Technique Without Ischemia in Patients With Testicular Tumor

To determine the safety and efficacy of organ-sparing surgery (OSS) without ischemia in patients with testicular tumor. From January 2003 to October 2010, marker-negative clinical stage I testicular tumors ≤ 30 mm and marker-positive tumors in case of a tumor in a singular testis were managed by an organ-sparing approach. After localization of the tumor by ultrasound and accurate staging, OSS was performed without ischemia. Frozen section analyses of the tumor and tumor bed biopsies were obtained. In cases of malignant germ cell tumor with a normal contralateral testis, an orchiectomy of the tumor-bearing testis was performed. In all other cases, the organ-preserving procedure was completed. A total of 65 patients underwent this approach. In 35 patients with a germ cell tumor on frozen section report (mean tumor size 1.4 cm; standard deviation ± 8.54 mm) and presence of a normal contralateral testis, a radical orchiectomy of the tumor-bearing testis was performed. Thirty-three organ-preserving procedures were completed in 30 patients without any complications (mean tumor size 0.9 cm; range, 0.2-2.0). No local or systemic recurrence was observed in all the 65 patients, and serum testosterone levels remained within normal limits in all but 2 patients. All patients are currently free of disease at a median follow-up of 52.5 months (range, 3-107). Our findings suggest that a "no-clamping" OSS technique is safe and feasible in selected tumor patients.

Extra Uterine Postmenopausal Fibroid with Torsion

Extra uterine leiomyomas are rare and present greater diagnostic challenge. Here we present a case of a 65yr old postmenopausal woman with an adherent calcified pedunculated broad ligament fibroid with torsion who presented as pelvic pain. The case was successfully managed by adhesiolysis and excision of the broad ligament fibroid followed by pan hysterectomy. 2 , they are found in association with similar uterine tumours and their pathology and complications are the same as fibroids. Among the extrauterine fibroids, broad ligament fibroids are the most common to occur 3 although its overall incidence being rare. The incidence of broad ligament fibroid is <1%. II. Case report A 65yr old P2L2 post menopausal lady came with complaints of pain lower abdomen since 1month which was gradual in onset, intermittent and dull aching in nature, with no radiation. No history of bladder/bowel disturbance. No history of sudden weight loss/anorexia/fever. No history of bleeding per vaginum. No history of malignancy in the family. On physical examination, patient was afebrile and hemodynamically stable. On per abdomen examination no palpable masses felt and anterior abdominal wall is obese. Tubectomy scar seen. No engorged veins or visible pulsations. On per speculum examination cervix and vagina appear healthy and pushed towards left. no abnormal discharge. On bimanual examination cervix was firm and deviated to left. Uterus was bulky, anteverted, exact size could not be made out and no forniceal fullness or forniceal tenderness. Patient was investigated thoroughly. Ultrasound revealed retroverted bulky uterus. Multiple intramural altered echo pattern noted in fundal, anterior and posterior myometrium with the largest measuring 1.6×1.0 cm in the anterior myometrium which is calcified. Both the ovaries are not visualized. As in our case diagnostic reports were conclusive of multiple degenerated fibroids causing pelvic pain, we went on with elective laparotomy where we were surprised to find a large irregular mass of size 10×6 cm, hard in consistency, nodular with calcifications found behind the uterus probably arising from the right adnexae. Bulky uterus with multiple small seedling sub serosal fibroids is seen anterior and to the left of the mass. The mass was densely adhered posteriorly to the intestines. The adhesions were gently released and the mass intoto was removed along with the uterus and the ovaries. The mass along with omental bits were sent for frozen section. As the frozen section report was given as benign leiomyoma, patient underwent panhysterectomy. Intra operative findings: An irregular calcified mass of size 10×6cm seen arising from the right adnexae, densely adhered posteriorly to the intestines. The pedicle of the tumor was twisted 3times. Uterus was bulky with 1×1cm fibroid in the anterior myometrium and multiple seedling fibroids seen. Bilateral ovaries appeared healthy. Post operative period was uneventful and patient was discharged on day 8

743 ULTRASOUND DETECTED NON-PALPABLE TESTICULAR LESIONS WHAT DO YOU DO?

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease II1 Apr 2012743 ULTRASOUND DETECTED NON-PALPABLE TESTICULAR LESIONS WHAT DO YOU DO? Claudio Valotto, Fabio Zattoni, Andrea Guttilla, Paolo Beltrami, and Filiberto Zattoni Claudio ValottoClaudio Valotto Padova, Italy More articles by this author , Fabio ZattoniFabio Zattoni Padova, Italy More articles by this author , Andrea GuttillaAndrea Guttilla Padova, Italy More articles by this author , Paolo BeltramiPaolo Beltrami Padova, Italy More articles by this author , and Filiberto ZattoniFiliberto Zattoni Padova, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.829AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES With the increased use of trans-scrotal ultrasonography, the unexpected detection of non-palpable testicular lesions has become more frequent. The suggested therapeutical approaches vary from radical orchiectomy to simple ultrasound follow-up, but an univocal behavior was not suggested. Herein, we report our experience with non-palpable testicular lesions, incidentally discovered, who underwent surgical exploration. METHODS From April 2008 to October 2011, a total of 25 patients with negative testicular cancer markers, were considered for surgical exploration because of a testicular lesion incidentally detected through an ultrasound exam. Ultrasound findings as well as operative reports (including frozen section evaluations) were retrospectively reviewed. RESULTS The suspected lesion was located in the left testis in 10 cases; in the right one in 12 and they were bilateral in the remaining 3 patients. The mean diameter of the ecogenic area was 16.1 mm (range 4-89 mm). All patients were approached through an inguinal incision; the involved testis was initially exposed; the spermatic cord clamped and an intraoperative ultrasound was performed. All lesions were identified and successfully removed. The intraoperative frozen section revealed a benign lesion in 21cases (84 %) (Group 1); a malignant tumor in 4 (16 %) (Group 2). In Group 1, the final histological findings confirmed the frozen section reports in 18/21 cases (85 %) and they were positive for cancer (seminoma) in 3/21 cases (14%). These patients immediately after underwent a radical orchiectomy; the pathological report was negative in one case, while the seminoma was confirmed in 2 cases. In Group 2, the definitive histological exam confirmed the tumor in 3/4 cases (75 %), while it was negative in 1/4 (25 %). All patients underwent a following radical orchiectomy and the pathological reports were negative in 2 patients and positive in the 2 others. The postoperative period was uneventful in all cases. None of our cases had a relapse at a median follow-up of 18 months. CONCLUSIONS According to our experience, ultrasound detected non-palpable lesions of the testis are lesions with a benign prognosis in 80 % of the cases. Among the malignant ones, only the seminoma histotype was detected. In the light of that, a surgical conservative approach may be recommended in all patients with such lesions. A negative frozen section does not exclude the presence of a seminoma, but, in our experience, the deferred treatment did not compromise the oncological control of the disease. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e304-e305 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Claudio Valotto Padova, Italy More articles by this author Fabio Zattoni Padova, Italy More articles by this author Andrea Guttilla Padova, Italy More articles by this author Paolo Beltrami Padova, Italy More articles by this author Filiberto Zattoni Padova, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...