This book provides guidance regarding the approach to common scenarios encountered in the frozen section laboratory while underscoring diagnostic pitfalls and providing the proper level of diagnostic information to ensure clear communication. Given the use of frozen section in molecular and research pathology, the text also serves as a guide for morphologic examination. Written by experts in the field, the book is organized according to organ system with additional chapters discussing the roles of digital pathology and molecular assays. Each chapter is extensively illustrated to highlight key points that facilitate interpretation and highlight areas for potential error. The goal of this book is to help trainees understand the need for mastery of this unique diagnostic tool, and to aid pathologists who cover frozen section convert practical information provided into diagnostic improvements.
Frozen Section Pathology is a comprehensive and state-of-the-art review and serves as a valuable resource for the general surgical pathologist with frozen section responsibilities as well as surgeons who regularly utilize frozen section.
Author(s): Alain C. Borczuk, Rhonda K. Yantiss, Brian D. Robinson, Theresa Scognamiglio, Timothy M. D'Alfonso
Publisher: Springer
Year: 2021
Language: English
Pages: 463
City: Cham
Preface
Contents
Contributors
1: Technique of Intraoperative Consultation
Introduction
Practical Approach to Frozen Section
Conclusions
References
2: Quality Assurance in Frozen Section
Background
Existing Guidelines
Accuracy: False Positives and Incompatible Diagnoses, False Negatives, and Deferrals
Special Considerations for Subspecialty Areas
Impact of QA Monitoring in Frozen Section
Touch Preparations
Telepathology in Frozen Section
Conclusion
References
3: Intraoperative Evaluation of the Gastrointestinal Tract
Introduction
Evaluation of the Esophagus
Stomach
Small Intestine
Appendix
Colorectum
Anus
References
4: Intraoperative Evaluation of the Liver, Extrahepatic Bile Ducts, Gallbladder, and Pancreas
Primary Hepatocellular Tumors
Introduction
Surgical Anatomy and Assessment of Margins
Hepatocellular Carcinoma
Hepatocellular Adenoma
Focal Nodular Hyperplasia
Hepatoblastoma
Gland-Forming Tumors of the Liver
Introduction
Large Duct (Central) Intrahepatic Cholangiocarcinoma
Small Duct (Peripheral) Intrahepatic Cholangiocarcinoma
Mucinous Cystic Neoplasm
Incidental Liver Nodules in Patients with Extrahepatic Carcinoma
Introduction
Bile Duct Hamartoma (von Meyenburg Complex)
Bile Duct Adenoma (Peribiliary Gland Hamartoma)
Inflammatory Changes in Preexisting Bile Ducts
Metastatic Disease in the Liver
Introduction
Metastatic Colorectal Carcinoma
Well-Differentiated Endocrine Neoplasms
Renal Cell Carcinoma
Melanoma
Gastrointestinal Stromal Tumor
Mesenchymal Tumors of the Liver
Angiomyolipoma
Hemangioma
Epithelioid Hemangioendothelioma
Donor Liver Assessment
Introduction
Incidentally Discovered Liver Lesions
Steatosis
Hepatocellular Necrosis
Fibrosis
Inflammation
Donor Livers with Hepatitis C Virus
Intraoperative Evaluation of the Extrahepatic Biliary Tree
Introduction
Extrahepatic Cholangiocarcinoma
Intraoperative Evaluation of the Gallbladder
Introduction
Gallbladder Adenocarcinoma
Ducts of Luschka
Rokitansky-Aschoff Sinuses
Adenomyomatous Hyperplasia and Adenomyomas
Xanthogranulomatous Cholecystitis
Intraoperative Evaluation of the Pancreas
Introduction
Specimen Preparation
Pancreatic Ductal Adenocarcinoma
Assessment of Pancreatic Margins for Dysplasia
Cystic Neoplasms of the Ductal Epithelium
Mucinous Cystic Neoplasm
Intraductal Papillary Mucinous Neoplasms
The Differential Diagnosis of Non-ductal Solid Pancreatic Tumors
Introduction
Well-Differentiated Endocrine Tumor
Acinar Cell Carcinoma
Solid Pseudopapillary Neoplasm
References
5: Head and Neck Pathology
Introduction
Evaluation of Mucosal Lesions
Assessment of Mucosal Margins
Intraoperative Diagnosis of Primary Lesion (Reactive vs Neoplastic)
Mimics of Dysplasia/Carcinoma
Reactive Epithelial Changes
Radiation-Induced Changes
Epithelial Rests
Technical Artifacts
Metaplastic/Transitional Epithelium
Sinonasal Tract/Nasopharynx
Inverted Papilloma Versus Inflammatory Polyp
Small Round Blue Cell Tumors
Nasopharyngeal Carcinoma
Invasive Fungal Sinusitis
Oropharynx
Salivary Gland
Important Diagnostic Considerations in the Assessment of Malignancy
Location of Tumor
Gross Evaluation
Overlapping Histologic Features
Pitfalls
FNA Related Changes
Mucinous Metaplasia in Warthin Tumor
Recurrent PA
Evaluation of the Neck Mass
Cystic Squamous Cell Carcinoma Versus Branchial Cleft Cyst
References
6: Thyroid and Parathyroid
Thyroid
Introduction
Papillary Thyroid Carcinoma: Pitfalls and Mimics
Frozen Section Artifact and Intraoperative Cytology Smears
Papillary Thyroid Carcinoma Versus Hyalinizing Trabecular Tumor
Papillary Thyroid Carcinoma Versus Papillary Hyperplasia
Papillary Thyroid Carcinoma Versus Reactive Atypia in Chronic Lymphocytic Thyroiditis
Follicular Lesions
Medullary Thyroid Carcinoma Versus Oncocytic Follicular Neoplasm
Evaluation of Lymph Nodes
Parathyroid
Introduction
Parathyroid Adenoma and Hyperplasia
Intraoperative Fat Stains
Pitfalls in Identification of Parathyroid Tissue
Worrisome Histologic Features in Parathyroids
References
7: Frozen Section of Breast and Sentinel Lymph Node
Introduction
Historical Use
Types of Specimens
Frozen Section Artifacts Related to Breast Specimens
Frozen Sections of Sentinel Lymph Nodes
Axillary Lymph Node Staging and Significance of Low-Volume Metastatic Deposits
Gross and Microscopic Examination of Sentinel Lymph Nodes Submitted for Intraoperative Evaluation
Benign Mimics of Metastatic Carcinoma in Lymph Nodes
Nevus Cell Aggregates
Benign Epithelial Inclusions
Frozen Section of Sentinel Lymph Node After Neoadjuvant Chemotherapy
Intraoperative Examination of Subareolar Tissue Margin for Nipple-Sparing Mastectomy
Subareolar Sampling Techniques
Intraoperative Examination of Subareolar Tissue Margin
Incidence of Residual Disease in Excised Nipple-Areolar Complex
Use of Frozen Section for Margin Assessment
References
8: Genitourinary Pathology
Kidney
Diagnosis of Renal Masses
Oncocytoma Versus Chromophobe Renal Cell Carcinoma
Angiomyolipoma
Xanthoma Versus Clear Cell Renal Cell Carcinoma
Metastatic Tumors
Lymphomas
Diagnosis of Cystic Lesions
Tumors Involving the Renal Pelvis
Frozen Section During Partial Nephrectomy
Prostate
Frozen Section During Radical Prostatectomy
Frozen Section During Transurethral Resection of the Prostate
Handling and Diagnostic Considerations with Prostate Frozen Sections
Assessment of Pelvic Lymph Nodes During Radical Prostatectomy
Bladder and Ureter
Evaluation of Ureteral and Urethral Margins
Frozen Section During Partial Cystectomy
Frozen Section During Transurethral Resection of the Bladder
Testis
Diagnosis of Testicular Mass
Diagnosis of Paratesticular Mass
References
9: Frozen Section in Lung and Pleural Pathology
Introduction
Lesion Identification
Frozen Section Diagnosis of Lepidic Pattern Adenocarcinoma and Invasion
Assessment of Margins
Benign Neoplasms That Can Be Confused with Adenocarcinoma
Reactive Lesions That Can Be Confused with Carcinoma
Other Tumors on Frozen Section [19]
Airway Margins
Lymph Node Sampling
Granulomatous Lesions
Pleural Frozen Sections
Conclusion
References
10: Frozen Sections in Neuropathology
Introduction
Before the Frozen: Know the Circumstances
Assessing the Tissue
Squash, Frozen, or Both?
Squash Technique
Frozen Section Technique
Neoplastic Versus Non-neoplastic
Low-Grade Versus High-Grade Glioma
Metastasis Versus Glioma
Glioma Versus Lymphoma
Pituitary Lesions
Conclusion
References
11: Frozen Section in Gynecologic Pathology
Endometrial Cancer
Uterine Mesenchymal Tumors
Smooth Muscle and Endometrial Stromal Tumors
Ovarian Tumors
Epithelial Tumors and Mimics
Serous and Mucinous Tumors
Benign Tumors
Borderline Tumors
Carcinomas (Including Metastases)
Endometrioid and Endometrioid-Like Tumors
Clear Cell Tumors
Other Ovarian Tumors
Vulva
Miscellaneous Specimens
Endometrial Sampling
Peritoneal Biopsy/Sampling
Cervical Mass Biopsy
References
12: Dermatopathology
Chapter Introduction
Technical Preparation
Overview
Macroscopic exam in Surgical Pathology: Overview
Macroscopic exam and Sectioning
Skin Biopsies, Small Ellipses, and “Jelly Rolls” for Vertical (Breadloaf) Sections
Sectioning of Large Ellipses/Specimens for Vertical and Tangential (En Face) Sections
Cloquet Node in Melanoma
Specimen Handling in Mohs Surgery
Macroscopic exam and Sectioning
Histology of Cutaneous Lesions
Frozen Section Artifacts
Basal Cell Carcinoma
Squamous Cell Carcinoma
Sebaceous Carcinoma
Merkel Cell Carcinoma
Extramammary Paget’s Disease
Melanoma
Deep Fungal Infection
Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis
References
13: Frozen Sections in Bone and Soft Tissue Pathology
Introduction
General Considerations
Bone Tumors
Frozen Sections in Benign or Locally Aggressive Bone Tumors
Fibrous Dysplasia
Osteoblastoma
Chondroblastoma
Chondromyxoid Fibroma
Chondromas, Intramedullary, and Juxtacortical
Langerhans Cell Histiocytosis
Osteoclast-Rich Giant Cell Lesions of Bone
Frozen Sections in Malignant Tumors of Bone
Osteosarcoma
Chondrosarcoma
Ewing Family of Tumors
Soft Tissue Tumors
Frozen Sections in Primary Benign and Locally Aggressive Soft Tissue Tumors
Nodular Fasciitis
Fibrous Hamartoma of Infancy
Plexiform Fibrohistiocytic Tumor
Dermatofibrosarcoma Protuberans
Lipofibromatosis
Desmoid-Type Fibromatosis (Desmoid Tumor)
Solitary Fibrous Tumor
Inflammatory Myofibroblastic Tumor
Vascular Tumors
Frozen Sections in Primary Malignant Soft Tissue Tumors
Generalities on Malignant Soft Tissue Tumors
Fibroblastic and Undifferentiated Sarcomas
Liposarcoma
Leiomyosarcoma
Malignant Vascular Tumors
Tumors of Uncertain Histogenesis
Extraskeletal Myxoid Chondrosarcoma
Synovial Sarcoma
Pediatric Sarcomas
Rhabdomyosarcoma
Extraskeletal Ewing Sarcoma and Ewing Sarcoma-Like Tumors
Intraoperative Frozen Sections for Nonneoplastic Conditions
References
14: Frozen Section and Intraoperative Consultation in Hematopathology
Introduction
Approach to the Specimen
Method of Performing a Touch Preparation
Examples and Considerations for Common Hematolymphoid Processes
Intraoperative Evaluation of CNS Lesions
Other Hematolymphoid Malignancies
Nonneoplastic Lymph Node Pathology
References
15: Frozen Sections in Kidney Transplantation
Introduction
When to Use Frozen Sections
Donor Biopsy Frozen Section Evaluation
Donor Biopsy Indications
Gross Analysis
Histologic Analysis
Glomeruli
Tubulointerstitium
Vasculature
Clinical Impact and Reproducibility of Donor Biopsy Evaluation
Kidney Transplant Assessment
Rejection
T-Cell-Mediated Rejection
Antibody-Mediated Rejection
Vascular Rejection
Infection
Medication-Related Injury
Acute Tubular Injury
Donor-Related, Recurrent, or De Novo Kidney Disease
Donor-Related Pathology in the Allograft Biopsy
Recurrent Pathology in the Allograft Biopsy
References
16: Intra-operative Consultation and Molecular Pathology
Introduction
Tissue Collection and Storage: Underlying Principles
Next-Generation Sequencing
Molecular Cytogenetics
Flow Cytometry
Molecular Microbiology
One-Step Nucleic Acid Amplification
Biobanking
Tissue Collection and Storage: Methods
Precipitation Fixation: Direct Smear Preparations
Freezing and Snap-Freezing
Special Fixatives for Preservation of RNA
Tissue Collection and Storage: Variables
Specimen Ischemia Time
Specimen Adequacy
Conclusion
References
Index
