Frozen section in ovary tumor

1. 

   If diagnosis of malignancy or ‘at least borderline’ is made at FS, surgical staging can be performed immediately, averting a second operation.

2. Surgical staging include: TAH-BSO, omentectomy, pelvic, para-aortic lymphadenectomy and peritoneal biopsies.

3. A review by Ratnavelu et al. of 38 studies found that intraoperative frozen section (FS) diagnosis showed concordance rates of 94% for benign tumors, 79% for borderline tumors, and 99% for malignant tumors when compared to the final diagnosis - which means we don't have excuse to miss malignant and to overcall benign to borderline.

4. 21% of borderline tumours on FS, the final diagnosis was invasive carcinoma that's why people choose to say: at least borderline; you don't want to be the 21%

5. Mucinous neoplasms in ovary FS is challenging.

6. If a high-grade cancer is identified during frozen section (FS), precise histotyping is not essential for intraoperative management. Communicating to the surgeon that the cancer is likely of Müllerian origin is typically adequate to guide surgical decisions.

7. Cytology can be performed on the external surface if there is deposit.

   
   

   

   Photo credit: Dr Julian Pulle, Specialty Trainee. Picture from https://doi.org/10.1016/j.mpdhp.2022.05.012

8. Serous cystadenoma: When areas of proliferation are observed in an otherwise benign cystadenofibroma, it is reported as "favor benign, cannot exclude focal borderline change," since precise quantification of the proliferative component is not feasible during intraoperative assessment.

https://doi.org/10.1016/j.mpdhp.2022.05.012

https://doi.org/10.1016/j.mpdhp.2022.05.012

9. HG serous carcinoma are usually straightforward, however, if a cystic HGSC mimicking SBT, cytology can be helpful; sample the fallopian tube can be helpful; and can call at least borderline; never just make the diagnosis as SBT if not extensive sampled, examined.

   
   

   

   https://doi.org/10.1016/j.mpdhp.2022.05.012

10. Let's see how cytology touch prep helps on carcinosarcoma:

    
    

    

    https://doi.org/10.1016/j.mpdhp.2022.05.012

    
    

11. Clear cell carcinoma on frozen section

    
    

    

    https://doi.org/10.1016/j.mpdhp.2022.05.012

    
    

12. Mucinous tumor in ovary: primary vs metastatic?

    
    

    

    https://doi.org/10.1016/j.mpdhp.2022.05.012

https://doi.org/10.1016/j.mpdhp.2022.05.012

https://doi.org/10.5858/arpa.2018-0289-RA

13. Seromucinous borderline tumor

    
    

    

    https://doi.org/10.1016/j.mpdhp.2022.05.012

    
    

14. Endometrioid carcinoma

    
    

    

    https://doi.org/10.1016/j.mpdhp.2022.05.012

    
    

15. Poorly differentiated sertoli-leydig cell tumor heterologous element

    
    

    

    https://doi.org/10.1016/j.mpdhp.2022.05.012

16. Mesonephric-like carcinoma

https://doi.org/10.1016/j.mpdhp.2022.05.012

https://doi.org/10.1016/j.mpdhp.2022.05.012

References:

1. Frozen section diagnosis of ovarian epithelial tumours: a practical guide for pathologists, Ralte, Angela Mercy, Diagnostic Histopathology, Volume 28, Issue 8, 341 - 352

2. Buza N. Frozen Section Diagnosis of Ovarian Epithelial Tumors: Diagnostic Pearls and Pitfalls. Arch Pathol Lab Med. 2019 Jan;143(1):47-64. doi: 10.5858/arpa.2018-0289-RA. PMID: 30785337.