Forty-six percent of the patients had undergone a previous hysterectomy for benign disease or for cervical intraepithelial neoplasia; 14. All patients were treated with primary surgery consisting of total abdominal hysterectomy, bilateral salpingo-oophorectomy, selective pelvic and paraaortic lymphadenectomy and peritoneal cytology. We aimed to discuss the source and the nature of inaccuracies associated with this procedure. They ranged from 17 to 46 years old median 31. Disagreements were found in nine cases 2.
Emphasizes differential diagnosis and avoiding diagnostic pitfalls so you can overcome difficult diagnostic challenges. One of 12 women with a frozen-section diagnosis of microinvasion had deeper invasion on permanent sections. Intraoperative consultation is often sought for specimens from the cervix. It accounts for 5% of all cancer deaths, with a mortality rate that exceeds the combined rates of cervical and endometrial carcinoma. The first, a decidual reaction, occurred in a 27-year-old pregnant woman with squamous cell carcinoma of the cervix.
Clinical, gross, microscopic, immunohistochemical, and molecular genetic features are integrated as appropriate for all tumors and tumor-like lesions, addressing all of the investigative contexts relevant to formulating an accurate diagnosis. In approximately 70% of patients with cervical cancer, the disease is limited to the cervix. Most of the discrepancies were due to misinterpretation of tubal metaplasia, tubo-endometrioid metaplasia, and atypical tubal metaplasia as adenocarcinoma in situ. The specificity 100% and accuracy 97. Intraoperative frozen section is a useful procedure to identify poor prognostic pathological factors as well as to diagnose endometrial cancer in patients undergoing hysterectomy for a preoperative biopsy diagnosis of atypical hyperplasia.
Each volume is heavily illustrated with a full color art program, while the text follows a user-friendly outline format. The text presents how to perform, and stain the cytologic preparations, and how to interpret them. Intraoperative Consultation in Surgical Pathology offers an approach minimizing errors and allowing the pathologist to render diagnoses with greater confidence. The median follow-up time for all surviving patients was 5. In 62% of the cases, in addition to obvious areas of invasion, there were 2 patterns difficult to recognize as invasive, disorganized orphan papillae, and irregular well-developed glands.
Comes with access to expertconsult. The median follow-up was 108 months range 6-266 months. Two patients had invasive squamous cell cervical cancer, one had invasive cervical adenocarcinoma extending to the endometrial cavity, and two had microinvasion. Ovarian cancer is the fourth most frequent cause of cancer death in women. Of the 11 false negative frozen section diagnoses, 9 82% were due to limited sampling for frozen section. Frozen section diagnosis is often a highly demanding situation for the pathologist who must render a diagnosis quickly, based on careful gross examination of specimens to select optimal areas for microscopic examination.
The Frozen Section Library series will provide concise, user-friendly, site specific handbooks that are well illustrated and highlight the pitfalls, artifacts and differential diagnosis issues that arise in the hurried frozen section scenario. There was no significant increase in the blood loss or intraoperative complication rate when frozen conization was added to either abdominal or vaginal hysterectomy. Although the 5-year survival rate was 94. Surgical exploration is indicated in many of these cases in order to clarify the nature of the lesions and manage the disease Table 6. The result is a practical, affordable resource for study and review as well as for everyday clinical reference. The advantages and disadvantages of both frozen sections and cytologic preparations of various kinds are discussed. Only one patient with an initial diagnosis of superficial Paget's disease of the vulva developed invasive adenocarcinoma.
In addition, squamous cell carcinoma antigen may be a useful marker to detect this disease preoperatively. Five patients 14% had an associated invasive adenocarcinoma of the vulva at the time of diagnosis. The past few years have seen the definition of prognostic variables that predict the ultimate outcome of patients with endometrial carcinoma. Reviews of the Frozen Section Library: Gynecologic Pathology Intraoperative Consultation Thus far concerning the e-book we've got Frozen Section Library: Gynecologic Pathology Intraoperative Consultation suggestions customers have not however still left their own writeup on the action, you aren't read it still. In patients with grade 1 disease, the surgical specimen was intraoperatively evaluated by frozen section, and lymph node sampling was carried out if deep invasion was determined. Also presented is the practical use of ancillary studies such as molecular diagnostic testing and immunohistochemistry.
Sixty-nine patients having had pretreatment biopsy diagnosis of vulvar intraepithelial neoplasia were treated with surgical excision of all visible lesions. Thirty-six patients with Paget's disease of the vulva were reviewed. These studies recorded excellent results, but were limited to evaluation by pathologists with specific expertise in gynecologic pathology. Seventy-nine of 763 surgically treated cervical cancer patients 10% had a tumor in the parametria in hysterectomy specimens. This thoroughly revised New Edition integrates cutting-edge procedures well as the latest staging and classification information. Alternative methods, such as frozen section, should be considered when evaluating depth of invasion, especially when this affects intraoperative decisions regarding lymph node sampling. Most problematic cases were mucinous tumors, followed by tumors resembling fibrothecomas, in addition sections without viable tissue fragments or presence of extensive hemorrhage and necrosis also obscured the frozen diagnosis.
Beginning with an overview of epidemiology and developmental defects in the female genital tract, each of the following chapters examines a different type of tumour. In most centres, standard treatment for this cancer is radiotherapy. The accurate prediction rate gradually diminished for both the surgeon and the pathologist as the histologic grade increased. We performed a retrospective study including 70 patients. The status of the pelvic lymph nodes plays only a minor role in the immediate intraoperative decision-making in the case of ovarian lesions; thus, lymph node sampling for frozen section consultation is not routinely requested. This method was found to be useful in identifying Paget cells on the margins thought to be free of disease by conventional histological evaluation. The depth of invasion was accurately determined by gross examination in 55 of 63 87.
The main indications for frozen section in gynecologic surgery are to aid the surgeon in determining the extent of tumor spread, locally and in lymph nodes, to confirm the diagnosis of ovarian or other malignant condition prior to radical surgery, and to ensure the adequacy of biopsy or resection. Histologic slides from 19 cases of radical trachelectomy performed for invasive endocervical adenocarcinoma were evaluated for correlation between the frozen and permanent sections of the endocervical margin. Destructive areas of invasion were present in all cases; however, in 25 of the 40 cases obvious invasive areas were mixed with foci that were difficult to recognize as invasive. Yao, William Pearce, Jon Matsumura, Mark Morasch, and Mark Eskandari. Another factor was the lack of an effective communication between the surgeon and the pathologist.