Intraoperative Macroscopic Examination Research Articles

Ultrasonography, macroscopy, and frozen section: whıch is better for predicting deep myometrial invasıon in endometrial cancer?

The aim of this study was to compare the power of preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section for predicting deep myometrial invasion in endometrial cancer. This is a retrospective review involving 68 patients who underwent surgical staging for endometrial cancer from 2014 to 2017. Patients with grade 3 endometrial cancer and non-endometrioid tumors were excluded. The findings related to preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section were compared with definitive histopathological diagnosis. The mean age, gravidity, and body mass index of the patients were 58.1±8.9 years (range: 30-80 years), 3.2±2.1 (range: 0-9), and 33.5±6.6 kg/m2 (range: 20-52 kg/m2), respectively. Only 11 (16.2%) patients were in the premenopausal period, while 57 (83.8%) were in the postmenopausal period. Grade 1 endometrial cancer was found in 29 patients (42.6%) and grade 2 tumors were specified in 39 patients (57.4%). Stage IA disease was found in 45 (66.2%) patients, while stage IB disease was observed in 23 (33.8%) patients. The 5-year survival rate was 91.2%. The sensitivity of preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section were 56, 34, and 52%, respectively, for predicting deep myometrial invasion. In contrast, the specificity of preoperative ultrasonography, intraoperative macroscopic examination, and frozen section were 86, 100, and 100%, respectively. Transvaginal ultrasonography and intraoperative frozen section were found to have similar sensitivity and specificity for predicting deep myometrial invasion. Preoperative transvaginal ultrasonography appears as an efficient approach for predicting endometrial cancers with deep myometrial invasion.

Role of Detailed Intraoperative Macroscopic Examination of Cholecystectomy Specimens for Deciding Specimens Needing Histological Evaluation for Diagnosing Incidental Carcinoma of Gallbladder at the Earliest? A Systematic Review

Background: Several studies recommending selective or routine histopathological examination of gallbladder specimens have been done. However, the argument between these studies is based on intraoperative suspicion of IGBC (incidental gallbladder carcinoma) for deciding on specimen sending. This study aims to know whether a detailed intraoperative examination of cholecystectomy specimens is required for deciding on specimens needing histological evaluation and suspecting IGBCs at the earliest. Methodology: The systematic review has been done as per the PRISMA guidelines. Various articles were searched in Scopus, PubMed, Web of Science and Science Direct databases. This systematic review comprises studies involving patients diagnosed with benign gallbladder disease that underwent cholecystectomy but were later diagnosed with IGBC on routine or selective histological examination. Results: Out of the 26 studies that were chosen, 12 recommended routine histopathology and 14 recommended selective histopathology. The total number of gallbladders included in these studies was 79769, and the IGBCs diagnosed on histology were 494. The gross macroscopy of IGBCs diagnosed in routine histology recommending studies overlapped with the intraoperative macroscopic picture of the IGBCs diagnosed in selective histology recommending studies based on which the surgeons suspected them, thereby showing a need for detailed intraoperative macroscopic examination of gallbladders to avoid overlooking any IGBC. Conclusion: Detailed intraoperative examination of cholecystectomy specimens is essential for suspecting IGBCs at the earliest and for selective histopathology, as in its absence, a significant number of IGBCs are missed by surgeons. Keywords: cholecystectomy, pathology, gallbladder, carcinoma

Sleeve Gastrektomi Sonrası Çıkarılan Gastrektomi Materyali: Patolojik İnceleme Gerekli mi?

Laparoskopik sleeve gastrektomi, obezite cerrahisinde en sık kullanılan yöntemdir. Bu çalışmanın amacı obezitenin cerrahi tedavisinde tercih edilen sleeve gastrektomi prosedürü sonrasında çıkarılan midenin patolojik incelemesinde sıklıkla karşılaşılan histopatolojik bulguları incelemek ve çıkarılan bu parçaların rutin patolojik değerlendirme gerekliliğini tartışmaktır. Ocak 2017 ile Aralık 2020 tarihleri arasında sleeve gastrektomi uygulanan ardışık 102 hastanın dosyası retrospektif olarak analiz edildi. Patolojik incelemede normal gastrik mukoza dışındaki patolojiler inflamasyonun şiddeti, aktivitesi, atrofi varlığı, intestinal metaplazi, helikobakter pilori (HP) pozitifliği ve anormal histopatolojik bulgular yönünden değerlendirildi. Büyük çoğunluğu kadın olan (n=79, %77.5) hastaların yaş ortalaması 43.2±12.0 (16-69) idi. Ortalama preoperatif vücut ağırlıkları 128.0±16.8 kg; vücut kitle indeksleri ise 46.7±8.4 olarak belirlendi. Hiçbir hastada displazi veya metaplazi gibi tedavi modalitesini değiştirecek malign ya da premalign lezyona rastlanmadı. Preoperatif endoskopi hem patolojik bir tanının bulunabilmesi hem de reflünün belirlenmesi için önemlidir. İntraoperatif yapılacak olan makroskopik incelemede bir patoloji görülmesi halinde, piyesin histopatolojik incelemeye iletilmesi gerektiği kanaatini destekliyoruz.

Selective or Routine Histology of Cholecystectomy Specimens for Diagnosing Incidental Carcinoma of Gallbladder and Correlation with Careful Intraoperative Macroscopic Examination? A Systematic Review.

Background:Selective or Routine histology of cholecystectomy specimens for benign gallbladder disease has always been a matter of debate because of the low prevalence and bad prognosis associated with gall bladder carcinoma. The objective of this study is to ascertain whether selective histology can be preferred over Routine histology without any harm. Methods:This systematic review is conducted according to PRISMA’s checklist; relevant articles were searched in the database until September 1 2020 in PubMed, Scopus, Science Direct, and Web of Science databases, manually, with search queries and without date restrictions. Studies included in this systematic review involved patients who underwent cholecystectomy for benign gallbladder disease and were diagnosed with gallbladder carcinoma incidentally either after selective or routine histology of the gallbladder. Results:A total of 24 routine or selective histology recommending studies were selected for the systematic review after following the inclusion and exclusion criteria. These studies comprised 77,213 numbers of patients and 486 numbers of Malignancies. These studies correlate the number of IGBC diagnosed histologically with the number of IGBC’s that were suspected by the surgeons intraoperative by macroscopy. Routine recommending studies show a significant number of IGBC diagnosed histologically as missed by surgeons whereas the selective recommending studies show most of the histologically diagnosed IGBC already suspected by the surgeons intraoperative. When comparing the macroscopic details of the IGBC’s between routine and selective studies, we found that there was significant overlap. Most of the findings missed by the surgeons as suspicious in routine studies were suspected by the surgeons involved in selective histology recommending studies. Thereby, favouring selective histology and emphasizing the need for careful intraoperative macroscopy for suspecting IGBC. Conclusion:Selective Histological examination of cholecystectomy specimens can be preferred if a careful intraoperative macroscopic examination is done and patient risk factors are taken into consideration.

Xanthogranulomatous cholecystitis: a rare gallbladder pathology from a single-center perspective.

PurposeThe aim of this study was to review patients with xanthogranulomatous cholecystitis (XGC).MethodsA total of 79 patients diagnosed with XGC were included in the study. The criteria for XGC in the pathology specimens were the presence of histiocytes, cholesterol deposits, lipids, and focal or widespread wall enlargement.ResultsPatients were diagnosed with XGC, of which 52 (65.8%) were male and 27 (34.2%) were female, creating a male-to-female ratio of 2:1. The mean age was 65.8 ± 14.3 years (range, 36–97 years). The most common presenting symptom was abdominal pain (63.3%), and the least common presenting symptom was jaundice (8.9%). Of the total, 25 patients were found to have pathological conditions with the potential to obstruct the bile duct or to slow bile flow. A frozen section examination was performed on 20 patients due to suspicion of a tumor by intraoperative macroscopic examination. However, no malignancy was detected in the cases who underwent a frozen section examination. An increase in wall thickness of the gallbladder was observed in 81.6% (n = 31) of the patients on computed tomography scans and in 81.8% (n = 18) of the patients on magnetic resonance imaging scans in which possible tumor lesions were reported, but no tumor was detected.ConclusionIt is difficult to diagnose XGC either preoperatively or intraoperatively, and further imaging methods are needed in the preoperative period other than ultrasonography. However, a definitive diagnosis depends exclusively on pathologic examination.

Foreign body at the level of rectal tumor formation

We present the case of a 75-year-old patient presenting with nausea, faecal emesis and intense abdominal meteorism, symptoms that began three before presentatiton and accentuated within the last 12 hours. Clinical examination revealed an incresead volume of the abdomen, painfully diffused on palpation. Abdominal radiography highlights multiple hydroaeric levels. Computerized tomography: Parietal, circumferential thickening with spiked contours of the middle sigmoid, associating the important distension of the overlying sigmoid, and, at the level of the stenosis, endoluminal, a linear image of 3mm thick and 24mm in length, spontaneous hyperdensity (180UH), important densification of neighboring fat. A rectosigmoidectomy with left flank colostomy – Hartmann’s operation, is performed. The opening of the lumen of the resected colonic portion reveals a foreign body (wooden fragment) impacted at this level. Histopathological diagnosis is colonic adenocarcinoma with a high degree of cellular differentiation (G1) invasively up to serum pT3N0. The particularity of the case consists in the difficulty of the pre- and intraoperative differential diagnosis between a neoplasia requiring an oncological visa management and an inflammatory pseudotumoral formation with a more limited surgical management. In emergency, the intraoperative macroscopic examination of the resection piece is essential. Differentiation between tumor and inflammatory aspects is difficult, which is why the presumptive diagnosis and the surgical decision must be inclined to the lesion with the most severe evolutionary potential.

Myiase furonculoïde à Dermatobia hominis : diagnostic fortuit sur la coupe macroscopique extemporanée d’un nodule cutané

Furuncular myiasis is a parasitic disease caused by the development of human botfly larva in the skin. It affects people living in tropical countries and travelers returning from these countries and concerns a number of medical specialties. One form of treatment involves surgical extraction of the parasites. We report the case of a 47-year-old man returning from Guyana presenting two furuncle-like nodules of the skin on the right buttock and on the right shoulder blade. Extemporaneous intraoperative macroscopic examination of the buttock nodule resulted in diagnosis of myiasis caused by the human botfly, Dermatobia hominis. The diagnosis of furuncular myiasis is made primarily on clinical grounds and should be suspected on observation of an abscess in subjects returning from a tropical region. It is consequently rare to find D. hominis in biopsy specimens. In the present case, macroscopic examination showed an extremely rare image of the edge of the intact larva in a longitudinal cut, which to our knowledge has never been published to date.

Intraoperative irrigation cytology of the remnant pancreas to detect remnant distinct pancreatic ductal adenocarcinoma in patients with intraductal papillary mucinous neoplasm undergoing partial pancreatectomy

Patients with intraductal papillary mucinous neoplasm (IPMN) of the pancreas may have concomitant distinct pancreatic ductal adenocarcinoma (PDAC). We evaluated the safety and usefulness of intraoperative irrigation cytology of the remnant pancreas (IICP) during pancreatectomy to detect remnant distinct PDAC in patients with IPMN. The records of all 48 patients with IPMN who underwent IICP during partial pancreatectomy at our institution from April 2007 to March 2012 were reviewed retrospectively. After division of the pancreas, a 4-French tube was inserted into the main pancreatic duct of the remnant pancreas from the cut edge, and fluid for cytologic examination was obtained by saline irrigation through the tube. If the third IICP was positive, patients underwent additional pancreatic resection. Clinical and pathologic outcomes were evaluated. The third IICP was positive in 5 patients. Postoperative pathologic examination showed that these patients all had remnant distinct PDAC in the additionally resected specimen, which was not detectable on preoperative imaging examination or on intraoperative macroscopic examination, ultrasonography, or palpation. This PDAC was stage 0 in 4 patients and stage III in 1 patient. No procedure-related complications were observed. One patient developed peritoneal metastasis after 10 months, 1 developed liver metastasis after 20 months, and 1 developed PDAC in the remnant pancreas after 24 months. IICP seems to be a safe and useful method for detection of early stage PDAC concomitant with IPMN that cannot be detected by preoperative imaging or intraoperative examination.