Intraoperative Frozen Section Pathology Research Articles

Endoscopic Extended Transsphenoidal Approach for Sellar and Suprasellar Xanthogranuloma: Potential Implications for Surgical Strategies in Adult Craniopharyngioma

Differentiation of suprasellar xanthogranuloma (XG) from adult craniopharyngioma (CP) can be problematic in endoscopic extended transsphenoidal surgery. We reviewed the clinical data, preoperative imaging, intraoperative endoscopic findings, and intraoperative frozen section pathology in newly diagnosed adult CPs (19 patients) and XGs (6 patients). Intracystic signal intensity was often high on T1-weighted magnetic resonance images in the XGs but low in the CPs (P= 0.015). Capsular intensity was low on T2-weighted imaging in XGs but iso to high in CPs (P < 0.001). Capsular gadolinium enhancement was often seen in CPs and not in XGs (P < 0.001). CPs often had a solid component with contrast enhancement but none in XGs (P < 0.001). Intraoperative endoscopic observations frequently found a whitish solid component in the CPs but yellow to brown fibrous granulomatous lesions in XGs (P < 0.001). The tumor capsule was dark grayish and soft in CPs, whereas it was fibrously hard in XGs (P= 0.002). Yellowish hemosiderin deposits were seen in all XGs (P= 0.003). Intraoperative pathologic diagnosis of CP was all verified whereas no evidence of tumor was found in XGs (P < 0.001). Partial removal was performed in 4 patients with XGs. No recurrence was observed in these patients during the follow-up period (1.5-8 years). Careful interpretation of preoperative magnetic resonance imaging, intraoperative endoscopic findings, and intraoperative frozen section diagnosis may be important for the differential diagnosis between XG and CP. In endoscopic-extended transsphenoidal surgery, intentional partial removal can be effective for XG after careful diagnosis.

Exploring the value of intraoperative frozen section in the diagnosis and treatment of patients with early-stage ovarian cancer: A retrospective analysis of 421 patients.

e17568 Background: Rapid and accurate judgment of the source and nature of tumors is conducive for surgeons to select the appropriate scope and method of surgery, and avoid unnecessary over-treatment or under-treatment. This study aimed to explore the diagnostic and treatment value of intraoperative frozen section pathology in patients with early-stage ovarian cancer (EOC) in the real world. Methods: We retrospectively collected the clinical and pathological data of EOC at West China Second University Hospital between January,2013 and December,2017, which diagnosed as stage ⅠA- IIA EOC according to the International Federation of Gynecology and Obstetrics (FIGO) 2014 standard of Ovarian cancer, fallopian tube cancer and peritoneal cancer. Results: There were totally 421 cases of EOC in the Second West China Hospital of Sichuan University from 2013 to 2017. The average age was 42.9 ± 13.5 years old. There were 395 patients who had finished the comprehensive staging surgeries. Group A consisted of 239 patients (60.5%) who had completed staging operation through only one surgery, while Group B consisted of 156 cases (39.5%) who had completed that through a second-time surgery. The frozen section submission rate of staging operation in the two groups were 99.2% (237/239) and 35.3% (55/156), respectively. Meanwhile, the coincidence rates of frozen and paraffin sections in the two groups were 98.3% (233/237) and 70.9% (39/55). The submission rate and coincidence rate of intraoperative frozen sections in Group A were higher than those in Group B (the submission rate: X2= 199.983, P&lt; 0.05; the coincidence rate: X2= 52.541, P &lt; 0.05). Conclusions: Our results confirm that increasing the submission rate of intraoperative frozen section and improving the accuracy of frozen section attach great importance to the diagnosis and treatment of EOC. Once identified, timely and comprehensive staging surgery can help improve patient outcomes for those who do not take fertility preservation into consideration.[Table: see text]

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.

Role of short-term follow-up magnetic resonance imaging in the detection of post-operative residual breast cancer.

The aim of the present study was to evaluate the role of short-term follow-up magnetic resonance imaging (MRI) in the detection of postoperative residual breast cancer. A retrospective analysis was performed on 10 patients who were diagnosed with non-malignant breast lesions by preoperative clinical, ultrasound and mammography examinations and intraoperative frozen-section pathology. These patients were finally confirmed as having malignant breast lesions by paraffin-embedded tissue histology and corresponding received second surgeries. Routine MRI, enhancement MRI and echo-planar imaging-diffusion-weighted imaging were performed on the 10 patients within 1 month after the first surgery. All the cases showed a local distortion of mammary architecture revealed by routine MRI and enhancement MRI images. The enhancement characteristics of the 10 cases were as follows: 3 cases featured stippled enhancement, 2 had small nodular enhancement, 1 showed dendritic enhancement, 1 had a ring-shaped enhancement of the cystic wall and 3 had no abnormal enhancement. The lesions of 7 cases had a type-I enhancement curve (progressive enhancement pattern) and 3 cases had a type-II curve (plateau pattern). The lesions of 4 cases had a decreased apparent diffusion coefficient. In total, 4 cases of tumor residue were diagnosed by MRI and the second pathological examination, while in 1 case the tumor residue was misdiagnosed by MRI but confirmed by the second pathological examination. In conclusion, the present study suggested that short-term follow-up MRI may be of value in the diagnosis of postoperative residual breast tumors and may be helpful for surgeons to develop an accurate surgical plan.

Descending colo-colonic intussusception secondary to signet ring cell carcinoma: A case report.

The incidence of intussusception is low in adults, particularly in the descending colon, due to the anatomical attachment of the descending colon to the retroperitoneum. Signet ring cell histology represents ~1% of colon adenocarcinomas and is associated with young patients and a poor clinical outcome. The present study describes a case of descending colo-colonic intussusception caused by signet ring cell carcinoma in a 27-year-old male. The patient presented with a history of intermittent left upper-quadrant abdominal pain for more than six months without any evident etiology. A computed tomography scan of the abdomen revealed left-sided colo-colonic intussusception. Upon laparotomy, a left hemicolectomy was performed according to intraoperative frozen-section pathology. Post-operative pathological evaluation revealed signet ring cell carcinoma invasion of the serosa, and 31.8% (7/22) of the regional lymph nodes were positive for cancerous cells. The post-operative course was uneventful and the patient was discharged on the tenth post-operative day.

P1–070 - Significance of Renal Mass Biopsy for Deciding the Treatment Strategy of Renal Tumor

Introduction: We sometimes encounter difficult cases for diagnosis of renal mass because of the lack of typical findings of RCC in imaging studies. We have been performing percutaneous needle biopsy of renal mass for indicated cases to obtain the pathological diagnosis and to decide treatment strategy of renal tumor. We report our experience of renal mass biopsy to examine its utility in the diagnosis and management of renal tumor. Materials and methods: Since 2008, we have performed percutaneous needle biopsy of renal mass in 17 patients. Indications of tumor biopsy are histological diagnosis between RCC and non-RCC, and histological diagnosis of clear cell RCC versus non-clear cell RCC in patients with poor performance status or advanced disease in whom upfront primary surgery was considered impractical. If imaging studies suggested the presence of tumor necrosis, we combined intraoperative frozen section pathology for diagnostic accuracy. Results: Median age was 69 (51-80) years old. Ultrasonography (US) and computerized tomography (CT) guided biopsies were performed in 15 and 2 patients, respectively. Pathological diagnosis was RCC in 12 patients and urothelial carcinoma (UC) in 5. Diagnostic discrepancy was noted in 2 patients, each of whom was diagnosed RCC in CT scans but were histologically diagnosed UC by tumor biopsy. Among 12 patients who were histologically diagnosed RCC, clear cell type was noted in 7 patients and non-clear cell type in 5. Intraoperative frozen section pathology was used for 5 patients who exhibited necrosis within the renal tumor on CT scans. Biopsy-related adverse events were noted in 2 cases. One case developed needle tract implantation and died 3 months after nehroureterectomy for UC. The other patient, in whom intraoperative frozen section pathology was not used, had failed histological diagnosis because of only necrotic tissue in biopsy specimens. Conclusions: Treatment strategy of metastatic RCC is different depending on histology and risk classification. Correct pathological diagnosis by US or CT guided needle biopsy of renal tumor contributes to appropriate use of molecular-targeted drugs for patients with metastatic RCC. In addition, we can differentiate RCC from UC. Renal tumor biopsy should be considered as diagnostic test for indicated cases.

Surgical algorithm for heterogeneous bilateral quadruple pulmonary nodules

A 65-year old female with no history of smoking reported experiencing 6 months of tightness in the chest. Chest computed tomography showed two pulmonary nodules in the left upper lobe (one in S3 segment, the other in S4 segment), one nodule in the left lower lobe and a ground-glass opacity (GGO) in the right upper lobe. Synchronous bilateral thoracoscopic wedge resections of the lung were performed to investigate the nodules. Intraoperative frozen section pathology revealed that the two nodules in the left upper lobe were malignant, the nodule in the left lower lobe was a benign lesion and the GGO in the right upper lobe was an atypical adenomatous hyperplasia. As a result, a left upper lobectomy with lymph node dissection was performed. The final pathological diagnosis of the nodule in the left S3 segment was well differentiated adenocarcinoma (pT1bN0M0, IA), the nodule in the left S4 segment was moderately to poorly differentiated adenocarcinoma (pT1aN0M0, IA), the nodule in the left lower lobe was cryptococcal granuloma and the GGO in the right upper lobe was adenocarcinoma in situ. The patient is currently following a favourable course in her recovery. Here, we would like to share the surgical algorithm used for the treatment of heterogeneous bilateral quadruple pulmonary nodules.

Collision Tumor of the Facial Nerve

To report a novel case of a collision tumor involving an intraparotid neurofibroma and a mastoid segment facial nerve schwannoma. Clinical capsule report. Tertiary academic referral center. A 29-year-old woman with a 2-year history of an asymptomatic enlarging left infraauricular mass and normal FN function presented to a tertiary care referral center. Computed tomography and magnetic resonance imaging demonstrated a cystic lesion in the deep portion of the parotid gland extending into the stylomastoid foramen. The patient underwent superficial parotidectomy, and a cystic parotid mass was found to be intrinsic to the intraparotid facial nerve. A portion of the mass was biopsied, and intraoperative frozen section pathology was consistent with a neurofibroma. A mastoidectomy with FN decompression was then performed until a normal-appearing segment was identified just proximal to the second genu. After biopsy, proximal facial nerve stimulation failed to elicit evoked motor potentials, and en bloc resection was performed. Final pathology demonstrated a schwannoma involving the mastoid segment and a neurofibroma involving the proximal intraparotid facial nerve. We report the first case of a facial nerve collision tumor involving an intraparotid neurofibroma and a mastoid segment facial nerve schwannoma. Benign FN sheath tumors of the parotid gland are rare but should be considered in the differential diagnosis of a parotid mass.

Diagnosis and Treatment of Xanthogranulomatous Cholecystitis: A Report of 39 Cases

This study focuses on providing diagnosis and treatment for xanthogranulomatous cholecystitis (XGC). Clinical data from 39 patients diagnosed with XGC by pathological examination between 2002 and 2010 were analyzed retrospectively. As a result, in this group of patients, the male to female ratio was 30:9 and the average age of XGC onset was 62.2 years. Clinical manifestation of the disease was similar to general cholecystitis and preoperative CT examination showed that there were only 4 XGC cases, while the others were possibly misdiagnosed. Intraoperative observations showed that all the patients had gallbladder wall thickening. This was associated with gallbladder stones in 37 patients (94.9 %), choledocholith in 11 patients (28.2 %), and Mirizzi syndrome in 5 patients (12.8 %). In this study, intraoperative frozen section pathology was conducted in 14 patients and no gallbladder cancer was found. Laparoscopic cholecystectomy was performed on 7 patients, of which two were transferred to laparotomy. Of the remaining 32 cases, 25 were subjected to open cholecystectomy, 3 to partial cholecystectomy, and 4 to the cholecystectomy and partial liver wedge resection. It was concluded that XGC is a unique type of cholecystitis with atypical clinical manifestations and is often difficult to diagnose preoperatively. Pathological examination is a key to diagnose XGC and cholecystectomy is the primary surgical treatment. In patients with choledochectasia or jaundice, for whom we cannot exclude calculus of common bile duct, common bile duct exploration should be considered. The prognosis of XGC appears to be good with the above approaches.

Complications of Central Neck Dissection in Patients with Papillary Thyroid Carcinoma: Results of a Study on 1087 Patients and Review of the Literature

Prophylactic central neck dissection (CND) has been proposed in the treatment of patients affected by papillary thyroid carcinoma (PTC) with clinically negative neck lymph nodes. The procedure allows pathologic staging of lymph nodes of the central compartment and treatment of the micrometastases. Nevertheless, the morbidity that its routine use adds to the total thyroidectomy must be taken into account. The aim of this study was to characterize the morbidity that CND adds to the total thyroidectomy. This was a retrospective study of 1087 patients with PTC and clinically negative neck lymph nodes. Patients were divided into three study groups: Group A, total thyroidectomy; Group B, total thyroidectomy and ipsilateral CND; Group C, total thyroidectomy and bilateral CND. Primary endpoints of the study were evaluated by comparing the rates of transient and permanent recurrent laryngeal nerve (RLN) injury and hypoparathyroidism in the three study groups. Analysis of data showed no significant differences in the rate of transient (Group A: 3.6%, Group B: 3.9%, and Group C: 5.5%; p=0.404) and permanent (Group A: 1%, Group B: 0.5%, and Group C: 2.3%; p=0.099) RLN injury between the three study groups. Both ipsilateral CND and bilateral CND were associated with a higher rate of transient hypoparathyroidism (Group: A 27.7%, Group B: 36.1%, and Group C: 51.9%; p=0.014; odds ratio [OR]: 1.477; 95% confidence interval [CI]: 1.091-2.001; p<0.001; OR: 2.827; 95% CI: 2.065-3.870, respectively). Bilateral CND had a higher rate of permanent hypoparathyroidism (Group A: 6.3%, Group B: 7%, and Group C: 16.2%; p<0.001; OR: 2.860; 95% CI: 1.725-4.743). The increased rates of transient and permanent hypoparathyroidism in our series suggest a critical review of indications for the routine use of prophylactic CND for PTC. Prophylactic CND ipsilateral to the tumor associated with total thyroidectomy may represent an effective strategy for reducing the rate of permanent hypoparathyroidism. Concomitant completion contralateral paratracheal lymph node neck dissection should be performed in presence of lymph node metastasis on intraoperative frozen-section pathology. This approach limits the use of bilateral CND to patients with intraoperative pathological findings of lymph node metastases.

Diagnostic Discordance of Intraoperative Frozen-Section Pathology at an Academic Medical Center

Diagnostic Discordance of Intraoperative Frozen-Section Pathology at an Academic Medical Center