Frozen Section Specimens Research Articles

Uranium micro localization in the femur of rats exposed to uranium acetate

Uranium is a radionuclide that causes internal exposure, with the bone being one of its primary sites of retention. However, the precise localization of uranium within the bone is not well known. In this study, we analyzed the distribution of uranium in the femur of rats exposed to uranium. For our analysis, we used synchrotron radiation X-ray fluorescence analysis with high-energy excitation X-rays with microbeam (high-energy SR-µXRF). To quantify uranium in bone tissues, we modified our previously developed thin-section standards. Additionally, we prepared droplet standards for quantifying bone calcium. Our findings showed that uranium concentration at bone sites was estimated to be 20% lower than at bone marrow sites of the same intensity, likely owing to matrix effects. The elemental mapping of the femur’s frozen section specimens showed that uranium was distributed in a very limited surface layer bordering the bone marrow, one day post-administration.

Development and validation of a deep learning model for improving detection of nonmelanoma skin cancers treated with Mohs micrographic surgery

BackgroundReal-time review of frozen sections underpins the quality of Mohs surgery. There is an unmet need for low-cost techniques that can improve Mohs surgery by reliably corroborating cancerous regions of interest and surgical margin proximity. ObjectiveTo test that deep learning models can identify non-melanoma skin cancer (NMSC) regions in Mohs frozen section specimens. MethodsDeep learning models were developed on archival images of focused-microscopic views (FMV) containing regions of annotated, invasive NMSC between 2015 and 2018, then validated on prospectively collected images in a temporal cohort (2019-2021). ResultsThe tile-based classification models were derived using 1,423 FMV images from 154 patients and tested on 374 images from 66 patients. The best models detected basal cell carcinomas with a median average precision of 0.966 and median area under the receiver operating curve of 0.889 at 100x magnification (0.943 and 0.922 at 40x magnification). For invasive squamous cell carcinomas, high median average precision of 0.904 was achieved at 100x magnification. LimitationsSingle institution study with limited cases of SCC and rare NMSC. ConclusionDeep learning appears highly accurate for detecting skin cancers in Mohs frozen sections, supporting its potential for enhancing surgical margin control and increasing operational efficiency.

Accuracy of frozen section remote subspecialty consultation using real-time telepathology and whole-slide imaging in gynecologic cases.

Intrapathology consultation is recommended for complex cases during frozen section (FS) as routine practice. In our institution, solicited second opinions were traditionally provided by in-person consultation (IPC). Whole-slide imaging (WSI) was implemented in 2018 as an alternative but replaced by videoconferencing in 2020. Here, we assess the accuracy of remote FS consultation using these digital modalities vs IPC. Gynecologic FS cases over a 4-year period overseen by 2 intraoperative consultants were grouped by consultation method: (1) IPC, (2) WSI, and (3) videoconferencing. Accuracy was determined by concordance between the FS and final report diagnoses. Turnaround time between the 3 groups was analyzed using SPSS statistical software (IBM). Using WSI and videoconferencing, 100% concordance was observed, while the IPC group had a 98.5% concordance rate. Videoconferencing, however, showed longer turnaround times (mean, 45.59 minutes) than IPC (mean, 33.36 minutes). Although turnaround time positively correlated with the number of FS specimens, blocks, and H&E slides per case, no statistically significant differences in the number of specimens, blocks, and H&E slides generated were found among the consultation methods. Even though turnaround time using videoconferencing is longer, the accuracy of WSI and videoconferencing for remote FS consultation is equivalent to IPC. It is therefore a safe method for conducting intrapathology FS consultation in challenging surgical cases.

Diagnostic value of intraoperative fine-needle aspiration cytologic diagnosis versus frozen section-based histopathologic diagnosis in thoracic malignancies: A single institution's experience.

Primary lung cancer is the leading cause of cancer death in the United States. Most lung cancers are diagnosed in an outpatient setting, but a subset requires intraoperative diagnosis. Two intraoperative diagnostic methods are available, frozen section (FS) and fine needle aspiration (FNA) cytology. This study compares intraoperative FNA cytology and FS based diagnosis in thoracic malignancies within the same clinical practice. Pathology reports from thoracic intraoperative FNA cytology or FS (January 2017-December 2019) were reviewed. Resection diagnosis was the gold standard. If unavailable, concurrent biopsy and final FNA cytology diagnosis were the gold standard. Of 300 FNA specimens (155 patients), 142 (47%) cases were benign, and 158 (53%) were malignant. Adenocarcinoma was the most common malignant diagnosis (40%), followed by squamous cell carcinoma (26%), neuroendocrine tumors (18%), and other (16%). Intraoperative FNA yielded 88% sensitivity, 99% specificity, and 92% accuracy (p < .001). Of 298 FS specimens (252 patients), 215 (72%) cases were malignant and 83 (28%) were benign. Adenocarcinomas was the most common malignant diagnosis (48%), followed by squamous cell carcinoma (25%), metastatic carcinomas (13%), and other (14%). FS yielded 97% sensitivity, 99% specificity, and 97% accuracy (p < .001). Our findings confirm FS is the gold standard for intraoperative diagnosis. FNA cytology may be useful as a non-invasive, inexpensive initial diagnostic tool intraoperatively, given the similar specificity (99% FNA, 99% FS) and accuracy (92% FNA, 97% FS). Negative FNA could be followed by the costlier and invasive FS. We encourage surgeons to utilize intraoperative FNA first.

Maxillectomy and Flap Reconstruction of Maxillary Defects After Cancer Ablation Through the Lip-Split Parasymphyseal Mandibulotomy Approach in Patients With Advanced-Stage Maxillary Malignant Tumors.

The conventional approach for maxillectomy has some common and serious complications. The present study evaluated the outcomes of maxillectomy and flap reconstruction after cancer ablation using the lip-split parasymphyseal mandibulotomy (LPM) approach. Twenty-eight patients with malignant tumors, including squamous cell carcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma, underwent maxillectomy through the LPM approach. Brown classes II and III were reconstructed with the facial-submental artery submental island flap, an extensive segmental pectoralis major myocutaneous flap, and a free anterolateral thigh flap with the use of a titanium mesh, respectively. All proximal margin frozen section specimens showed negative surgical margins. Anterolateral thigh flap failure occurred in 1 patient, whereas ophthalmic and mandibulotomy complications developed in 4 and 7 patients, respectively. In all, 84.6% of the patients had satisfactory or excellent lip esthetic results. Of the patients, 57.1% were alive with no evidence of disease, whereas 28.6% were alive with disease and 14.3% died of local recurrence or distant metastasis. No significant survival difference was evident among the squamous cell carcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma groups. The LPM approach can provide good surgical access, facilitating maxillectomy in advanced-stage malignant tumors with minimal morbidity. Facial-submental artery submental island flap and anterolateral thigh flap or extensive segmental pectoralis major myocutaneous flap with a titanium mesh are ideal techniques for reconstructing Brown classes II and III defects, respectively.

Single-stage Transanal Endorectal Pull-Through for Hirschsprung’s Disease: A Retrospective Study of Surgico-pathological Correlations and Technical Considerations

Abstract Background: Transanal endorectal pull-through (TEPT) is a well-established operation for the management of rectosigmoid and short-segment Hirschsprung’s disease (HD). A well-performed contrast enema (CE) is an essential road map for the surgeon when attempting the TEPT. We looked at the surgicopathological–radiological correlations and technical considerations of this procedure and discussed our experience over a decade. TEPT essentially relies on radiological mapping of the disease correlating with intraoperative and pathological findings. Some investigators opine that the radiological correlation of the transition zone (rTZ) with the pathological transition zone (pTZ) is accurate whereas others disagree. We review our experience in managing HD patients with TEPT, in terms of pre-operative workup and operative and pathological considerations. Materials and Methods: A retrospective study was done in a single unit, from January 2010 to January 2020. Forty-seven patients who met the inclusion criteria such as short-segment HD and uncomplicated HD underwent CE before surgery. The patients included in the review underwent a primary TEPT. For each patient, we identified the radiological transition zone (rTZ) on the contrast enema, the gross transition zone (gTZ) on intraoperatively visual examination, the frozen section transition zone (fTZ) on intraoperative analysis of the frozen section specimens (fTZ), and the pathological transition zone (pTZ) on permanent paraffin blocks of the specimens. We determined the strength of correlation of the rTZ, the gTZ and the fTZ with reference to the pTZ. Results: Forty-seven patients underwent single-stage transanal pull-through. There were 40 males. There were 8 neonates, 20 infants and 19 children (&gt;12 months of age). The mean age at diagnosis was 8.7 days (3–20 days) for the neonates, 5.11 months (2–12 months) for the infants and 4.3 years (1.5–9 years) for children. In our study, 85% correlation was noted between the rTZ and the pTZ (tb = 0.362, P = 0.006). There was an excellent correlation between the intraoperative gTZ, fTZ and the pTZ in all patients except one (97.8%, tb = 0.942, P &lt; 0.001). Conclusions: The TEPT is a feasible option to manage carefully selected patients with rectosigmoid HD. The presence of robust support from pathology and a properly carried out CE are essential parameters to be considered before successfully undertaking these operations. The functional outcomes of TEPT are comparable with other procedures for HD with the added advantage of it being a scar-less and a stoma-less approach.

Pathologist-Verified Billing: Correction Rates of Miscoded Frozen Section Cases.

With the adoption of Epic/Beaker at our institution, surgical pathology specimens are assigned a Current Procedural Terminology (CPT) charge code at the time of accessioning, and pathologists have been made responsible for verifying the accuracy of the code before signing out the case. To determine with what frequency attending pathologists reassigned the correct charge code to a specimen when the code assigned at accessioning was incorrect, as well as to estimate the potential financial impact of missed changes. We reviewed all specimens received for frozen section during a 7-month period, identified specimens where the default charge code that our departmental protocol assigns at frozen section (88305) was incorrect, and assessed the rate of successful code change by pathologists and the potential financial cost of each missed change. Three hundred fifty-two of 2191 frozen section specimens (16%) required a change in the 88305 charge code. The codes for 195 specimens (55%) were correctly changed by the attending pathologist, while 157 (45%) were not changed (149) or were changed to an incorrect charge code (8). Individual pathologist change rates ranged from 0% to 100%, with a mean and median change rate of 43% and 24%, respectively. Using average code reimbursements at our institution, the loss in revenue from the 157 missed and incorrect frozen section changes was estimated at $13 788 ($1970 per month). Pathologists showed highly variable rates of correcting CPT charge codes when the incorrect code had been previously assigned to a case, with associated loss of revenue from missed and incorrect code changes.

Acetylcholinesterase histochemistry: A very useful technique in the diagnosis of Hirschsprung’s disease

Hirschsprung’s disease (HD) is a common congenital paediatric disorder. The gold standard for its diagnosis is the demonstration of the absence of ganglion cells on H&amp;E stained sections from a spastic segment of the bowel, still at times; conclusive diagnosis of HD is difficult. This study was done to assess the accuracy of rapid Hematoxylin &amp; Eosin (H&amp;E) staining and AChE histochemistry in combination for the diagnosis of HD, especially in frozen section specimens. Samples from 36 clinically suspected HD cases were evaluated for the presence or absence of ganglion cells on H&amp;E staining on both fresh-frozen and paraffin-embedded sections, whereas AChE staining was done on frozen sections only. Of the 36 cases of frozen section specimens from the spastic region of the colon, GCs were absent in 28 cases on H&amp;E staining while positive staining patterns on AChE histochemistry were observed in 29 cases. Formalin-fixed paraffin-embedded sections showed the absence of GC on H&amp;E staining in 28 cases. The sensitivity and specificity of frozen sections with rapid H&amp;E were 77.78% and 81.82% while the sensitivity and specificity of AChE histochemistry were 80.56% and 81.82% respectively in the diagnosis of HD. Application of AChE histochemistry as an ancillary technique on frozen sections specimens of HD in combination with rapid H&amp;E staining is very useful for definitive diagnosis of HD.

Frozen section telepathology service: Efficiency and benefits of an e-health policy in South Tyrol.

Objective/BackgroundTelepathology has been widely adopted to allow intraoperative pathology examinations to be performed remotely and for obtaining second opinion teleconsultation. In the Italian northern region of South Tyrol, the widespread geographical distances and consequent cost for the health system of having a travelling pathologist cover intraoperative consultations in peripheral hospitals was a key driver for the implementation of a telepathology system.MethodsIn 2010, four Menarini D-Sight whole slide scanners to digitize entire pathology slides were placed in the peripheral hospitals of Merano, Bressanone, Brunico, and in the hub hospital of Bolzano. Digital workstations were also installed to allow pathologists to remotely perform intraoperative consultations with digital slides. This study reviews the outcome after 12 years of telepathology for this intended clinical use.ResultsAfter an initial validation phase with 100 cases which yielded a sensitivity of 65% (CI 43–84%) and specificity of 100% (CI 95–100%), there were 2058 intraoperative consultations handled by telepathology. The cases evaluated were mainly breast sentinel lymph nodes, followed by urological, gynecological and general surgical pathology frozen section specimens. There were no false-positive cases and 165 (8%) false-negative cases, yielding an overall sensitivity and specificity of 65% (CI 61–69%) and 100% (CI 99–100%), respectively.ConclusionTelepathology is reliable for remote intraoperative diagnosis and, despite technical issues and initial acquaintance issues, proved beneficial for patient care in satellite hospitals, improved standardization, promoted innovation, and resulted in cost savings for the health system.

The accuracy of detecting melanoma on frozen section melanoma antigen recognized by T cells 1 (MART-1) stains and on permanent sections of previously frozen tissue: A prospective cohort study

To the Editor: Mohs micrographic surgery (MMS) for melanoma is controversial because of concerns about the accuracy of detecting melanoma on frozen sections. This study's primary analysis examined the sensitivity and specificity of detecting melanoma using hematoxylin and eosin (H&E) and melanoma-associated antigen recognized by T cells (MART-1) frozen sections compared with permanent sections. The secondary analysis evaluated whether frozen section specimens can be subsequently processed for permanent sections without diminishing diagnostic accuracy.

Risk‐stratifying clinicopathologic criteria for ovarian preservation in premenopausal women with early stage low‐risk endometrial cancer

To establish the rate of occult ovarian micro-metastases in early stage disease and to provide an eligibility framework for providers to consider ovarian preservation in a patient population with presumed early stage disease. A retrospective review from January 2005 to December 2010 identified women with presumed early stage endometrial cancer from a single institutional database. Inclusion criteria included: (1) FIGO grade 1 endometrioid endometrial cancer on endometrial biopsy; or (2) the same pathology as (1) on frozen section specimen with less than 50% myometrial biopsy; and (3) no evidence of metastatic disease on preoperative imaging or visible metastatic disease in the peritoneal cavity. Of the 52 patients, 86.5% were diagnosed with stage IA and 11.5% were diagnosed with stage II disease. One patient (1.9%) had microscopic adnexal involvement in a fallopian tube, which upstaged her to stage IIA disease. None of the patients had ovarian involvement. Preservation of the ovaries appears to be a safe and viable option for premenopausal women who are diagnosed with presumed early stage endometrioid endometrial cancer. It is believed that ovarian preservation in this select population will provide them with significant health benefits and improve their quality of life.

Fluorescein dye as a novel cost-effective approach for staining raw specimens in ophthalmic pathology

Purpose:To study the usefulness of sodium fluorescein dye for staining raw specimens in ophthalmic pathology.Methods:Laboratory-based observational study. Eye specimens received in the ocular pathology department of a tertiary eye care center in northeast India were included in the study after obtaining the informed consent. The study period was from 2016 to 2019. Specimens received were a corneal button, lid, orbital tissues, enucleated eyeballs, eviscerated eye, explanted intraocular lens (IOLs), optic nerve and ocular parasites. Sections of the gross specimens were stained with sodium fluorescein (C20H12O5NA) dye. The average duration of tissue-stain contact time was 45 s. The sections were analyzed under the compound microscope. The intensity of illumination of the microscope was modulated to obtain high contrast digital photographs.Results:26 corneal buttons with or without limbal tissue specimens were analyzed with fluorescein staining procedure; limbus with its pigmented cells were seen in the enucleated eyeballs. 33 enucleated eyes (retinoblastoma [RB] (n = 24), phthisical eyes (n = 4), choroidal melanomas (n = 2), and others (n = 3) were included in the study cohort. In these 33 enucleated eyes, vitreous were also examined for the presence of hyalocytes and other pathological cells. Retinal pigment epithelial cells were also seen (n = 11). RB seeds were seen with fluorescein stain and documented in 14 specimens. The RB seeds were mostly in vitreous (n = 9) and subretinal space (n = 5). Fat cells (n = 8) from orbital tissues and sebaceous cells (n = 5) from frozen section specimens were also observed and documented.Conclusion:This study highlights a novel method of rapid staining of gross ophthalmic pathology specimens.

The incidence of microscopic adnexal metastatic disease in women with presumed early stage endometrial cancer.

e17128 Background: The standard surgical staging for endometrial cancer has been established as a total laparoscopic hysterectomy,bilateral salpingo-oopherectomy and lymphadenectomies. However, ovarian removal can have significant consequences in pre- and peri-menopausal women, which comprise 25% newly diagnosed endometrial cancer. The potential ramifications of premature surgical menopause are clinically important. The goal of this study is to determine the incidence of microscopic adnexal metastatic disease in younger patients with presumed early stage endometrial cancer. Methods: From January 2005 through December 2010, 57 women who were 52 years old or younger with presumed early stage endometrial cancer were identified from our institutional database. Inclusion criteria included (1) FIGO grade 1 endometrioid endometrial cancer on endometrial biopsy, or (2) FIGO grade 1 endometrioid endometrial cancer on frozen section specimen with &lt; 50% myometrial invasion, no evidence of metastatic disease on pre-operative imaging, and no grossly visible metastatic disease in the peritoneal cavity during the staging surgery. Results: Of these 57 patients, four (7%) had lymphovascular space invasion, 20 (35%) had lower uterine segment involvement, 26 (45%) had superficial myometrial invasion or no residual carcinoma, while three (5%) unexpectedly had 50% or greater myometrial invasion on final pathology. Half of our patient population (50%) received vaginal brachytherapy. Of the 57 patients, one (1.8%) had microscopic adnexal involvement in a fallopian tube which upstaged her to stage IIIA disease. Pathological risk factors for advanced stage included LVI, lower uterine segment disease, and 50% myometrial invasion. Conclusions: After a thorough pre-operative evaluation and intra-operative exploration, preservation of the ovaries appears to be a safe and viable option for younger women who are diagnosed with presumed early stage disease. We suggest that ovarian preservation should be discussed on an individual basis in pre- peri-menopausal patients who meet the above-mentioned strict eligibility criteria.

Digital pathology is a practical alternative to on-site intraoperative frozen section diagnosis in thoracic surgery.

Telepathology uses digitised image transfer to allow off-site reporting of histopathology slides. This technology could facilitate the centralisation of pathology services, which may improve their quality and cost-effectiveness. The benefits may be most apparent in frozen section reporting, in which turnaround times (TATs) are vital. We moved from on-site to off-site telepathology reporting of thoracic surgery frozen section specimens in 2016. The aim of this study was to compare TATs before and after this service change. All thoracic frozen section specimens analysed 4months prior and 4months following the service change were included. Demographics, operation, sample type, time taken from theatre, time received by laboratory, time reported by laboratory, TAT, frozen section diagnosis, final histopathological diagnosis and final TNM staging were recorded. The results were analysed with spss statistical software version 24. In total, there were 65 samples from 59 patients; 34 before the change and 31 after the change. Specimens included 51 lung, six lymph node, three bronchial, three chest wall and two pleural biopsies. Before the change, the median TAT was 25min [interquartile range (IQR) 20-33min]. No diagnoses were deferred. No diagnoses were changed on subsequent paraffin analysis. After the change, with the use of digital pathology, the median TAT was 27.5min (IQR 21.75-38.5min). This difference was not significant (P=0.581). Diagnosis was deferred in one case (3.23%). There was one (3.23%) mid-case technical failure resulting in the sample having to be transported by courier, resulting in a TAT of 106min. No diagnoses were changed on subsequent paraffin analysis. There was no significant difference in reporting times between digital technology and an on-site service, although one sample was affected by a technical failure requiring physical transportation of the specimen for analysis. Our study was underpowered to detect differences in accuracy.

SIU-ICUD on bladder cancer: pathology.

Many changes have been made during these last years and concepts for understanding bladder cancer have evolved. We make an update with the latest findings of the WHO (World Health Organistaion) 2016, ICCR (International Collaboration on Cancer Reporting) and other official organisms and try to show the latest developments. In this document we provide new consensus guidelines and insights. We kept this document short and concise providing consensus guidelines to clinicians for the best patient care, it should be easy to understand for a non pathologists. We focussed on several burning issues, such as the anatomical and histological understanding of the bladder wall, the prognostic significance of grading and the most challenging problems in staging, we underline our needs from the clinicians such as clinical information, we further discuss the histological subtypes of bladder cancer, which is an extremely important issue in the light of molecular classifications and give prognostic insights. Furthermore, we discuss the ICCR worldwide consensus reporting, urinary cytology with the Paris system and several issues such as frozen section specimen.

A Pediatric Case of Sigmoid Colon Malignancy Presented with Krukenberg Tumor

Colorectal cancers are mostly encountered at adults and are rare in pediatric and adolescent age group individuals. In this presentation; it was aimed to demonstrate the radiologic findings of a female pediatric patient with the complaint of abdominal pain, in whom a left ovary mass was incidentally determined and the diagnosis of recto-sigmoid cancer wassubsequently made. Case report and literature review. 15-year old female patient with recently started abdominal pain and abdominal distention was referred to our clinic. No additional grouses that could give rise to thought of malignancy, such as loss in weight, blood in stool or change in defecation habits, were existed. Her previously performed ultrasound examination at a private hospital had documented a right ovarian mass. Mild abdominal distention was noted at physical examination. No suggestive finding was determined in laboratory tests. A left adnexal mass including milimetriccystic components and increased vascularity, with size of 13 × 8 cm and well-demarked margins was determined in repeated B-Mode / Doppler sonography. In pelvic magnetic resonance MR imaging, this mass lesion was with signal intensity properties of hypointense at T1-weigthed, hyperintense at T2-weighted sequences, and with homogenous contrast enhancement afteriv. contrastagent administration. Additionally, a diffuse thickening in the wall of the sigmoid colon segment that came in the view of the pelvic MRI sequences was noted.Finally, the diagnosis of metastatic Krukenberg tumor at right ovary secondary to the sigmoid colonic mass was made depending upon the frozen section specimens following the surgery. Pediatric colorectal carcinomas are rare entities generally with a poor prognosis. Metastasis of colorectal carcinomas, as in the unlikely event of occurrence, should be kept in minds in pediatric cases with vascular ovarian masses

The Diagnostic Accuracy of Frozen Section Compared to Permanent Section: A Single Center Study in Iran.

The diagnostic accuracy of frozen section as an important source of information in surgical pathology is important not only in the management of surgical patients but also as a measure of quality control in surgical pathology. In this study, we evaluated the diagnostic accuracy of frozen sections over a 6-year period in a teaching hospital in Iran. We retrospectively reviewed frozen sections performed in the Pathology Department of Taleghani Hospital (Shahid Beheshti University of Medical Sciences), Tehran, Iran from 2007 to 2013. The results were compared to the permanent sections to evaluate diagnostic accuracy, sensitivity and specificity, of frozen section test. Discordant cases were reassessed to find the reasons for discrepancy. A total of 306 frozen section specimens from 176 surgical cases were evaluated. In eleven specimens (3.59%) the diagnoses were deferred. Of the remaining 295 specimens, 6 (2.03%) were discordant and 289 (97.96%) were concordant to permanent diagnoses. Specimens were primarily from the head & neck, thyroid, ovary, parathyroid and lymph nodes. The overall sensitivity, specificity, positive predictive value and negative predictive value of the frozen section compared to permanent section (as gold standard) were 92.95%, 99.55%, 98.50% and 97.80% respectively. Of the 6 discordant diagnoses, two (33.3%) were due to sampling error and four (66.6%) were due to interpretative errors. Frozen section is an accurate and valuable test and can be relied on in surgical managements. The results of this study also confirm that the accuracy of frozen section diagnosis in our institution compares well with internationally published rates.

A case of Genital Tuberculosis

Background: genital tuberculosis is a misleading health problem. Methods: Laparascopic surgery of a multiparous woman revealed a complex mass adhering to the pelvic floor. Collected samples were cultured for microbial infection. Polymerase Chain Reaction test was done for presence of Mycobacterium tuberculosis. Results: Mantoux test and Polymerase Chain Reaction test were negative. Caseous necrosis on frozen section specimens were seen. Granulomatous inflammation composed of epithelial cells and multinucleated giant cells were found. Patient was cured with anti-tuberculosis treatment. Conclusions: In the present case only histopathological investigation of the smear could detect the genital tuberculosis.

Pathology and telepathology in Myanmar

Myanmar is an ASEAN country, standing with its own resources in health care of people. There are 5 medical universities currently in Myanmar, namely, University of Medicine-1, University of Medicine-2, and Defence Services Medical Academy in Yangon, and University of Medicine, Mandalay, and University of Medicine, Magway. The first medical college was founded in Yangon in 1930. The MBBS course (Bachelor degree) work extends over seven years in which general pathology in 3rd MBBS and systemic pathology with Haematology are in the curriculum of Final part I. Postgraduate Pathology courses of Diploma, Master degree and PhD have been conducted since 1970. Currently, pathologists are working in the all health sectors. Most of the tissue diagnoses are made by routine H&E staining and immunohistochemistry techniques are in lesser extent. Frozen section specimens were done around 1980 but not in date. Myanmar has very little experience and knowledge in telepathology. Here is a practice of taking second opinion while rendering of histopathology tissue diagnoses by consulting with seniors who are clever in the particular subjects. Therefore, encouragement and enforcement in the areas of telepathology for education, diagnosis and research purposes for young generation of pathologist are crucial.

Frozen section analysis of margins for head and neck tumor resections: reduction of sampling errors with a third histologic level

Frozen section analysis is an essential tool for assessing margins intra-operatively to assure complete resection. Many institutions evaluate surgical defect edge tissue provided by the surgeon after the main lesion has been removed. With the increasing use of transoral laser microsurgery, this method is becoming even more prevalent. We sought to evaluate error rates at our large academic institution and to see if sampling errors could be reduced by the simple method change of taking an additional third section on these specimens. All head and neck tumor resection cases from January 2005 through August 2008 with margins evaluated by frozen section were identified by database search. These cases were analyzed by cutting two levels during frozen section and a third permanent section later. All resection cases from August 2008 through July 2009 were identified as well. These were analyzed by cutting three levels during frozen section (the third a ‘much deeper’ level) and a fourth permanent section later. Error rates for both of these periods were determined. Errors were separated into sampling and interpretation types. There were 4976 total frozen section specimens from 848 patients. The overall error rate was 2.4% for all frozen sections where just two levels were evaluated and was 2.5% when three levels were evaluated (P=0.67). The sampling error rate was 1.6% for two-level sectioning and 1.2% for three-level sectioning (P=0.42). However, when considering only the frozen section cases where tumor was ultimately identified (either at the time of frozen section or on permanent sections) the sampling error rate for two-level sectioning was 15.3 versus 7.4% for three-level sectioning. This difference was statistically significant (P=0.006). Cutting a single additional ‘deeper’ level at the time of frozen section identifies more tumor-bearing specimens and may reduce the number of sampling errors.