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SPUC

SPUC. 2/14/11 Carrie Marshall. Frozen Sections. Why is this frozen being performed? Diagnosis (tumor vs. not?) Margin status? To determine the extent of staging? Curiosity? Call the OR and ask!. Case 1. 48y woman with history of “thyroid carcinoma” No prior path reviewed

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SPUC

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  1. SPUC 2/14/11 Carrie Marshall

  2. Frozen Sections • Why is this frozen being performed? • Diagnosis (tumor vs. not?) • Margin status? • To determine the extent of staging? • Curiosity? • Call the OR and ask!

  3. Case 1 48y woman with history of “thyroid carcinoma” No prior path reviewed Two specimens submitted during thyroidectomy as “possible parathyroids”

  4. Permanent

  5. Why do we care? • What do the parathyroids do? • What are the potential consequences of removing all of them? • What percentage of people have fewer than the “normal” number of glands?

  6. Permanent

  7. Parathyroid tissue within thymic tissue • Inferior parathyroids and the thymus are both derived from the 3rd pharyngeal pouch

  8. Case 2 • 71y man with a history of pancreatic adenocarcinoma (resected in 2001) • Now with pancreatic body mass (EUS-FNA showed adenocarcinoma) • Pancreatic margin sent for frozen

  9. Permanent

  10. Pearls • Be conscientious of how the margin is frozen (true margin up, so it is sampled first) • If the tissue is angled on the chuck, take multiple levels so that the entire cross section is evaluated

  11. Case 3 • 80y woman with “past history of sentinel lumpectomy” • No prior path reviewed • Sentinel lymph nodes submitted

  12. What next?

  13. Pan-CK

  14. Lymph node staging • Macrometastases (> 2 mm) • Micrometastases (0.2 mm or >200 cells, but no foci > 2 mm) • Isolated tumor cells (clusters <200 cells or <0.2 mm) • 0.2 mm = 1,000 tumor cells • 2 mm = 1 million tumor cells

  15. LN Pearls • When counting tumor cells, all must be in the same cross section, do not add together cells from different blocks or different levels • The largest focus of contiguous tumor in the node should be used to classify the node, do not add up multiple tumor deposits • If there is desmoplasia around the tumor, then use the measurement of the tumor + fibrosis

  16. Priority is to identify macrometastases (section LN at 2 mm intervals) • Only nodes with micrometastases are included in the number of positive nodes • If nodes only have ITC they should be reported as pN0(i+) • Micrometastases are reported as pN1mi (no matter how many nodes are +)

  17. Case 4 • 63y man with history of “undifferentiated carcinoma of the medial orbital brow” • No prior path reviewed • Frozen on a “supraorbital mass” to evaluate margins

  18. Permanent

  19. Poorly-differentiated carcinoma Present away from margins

  20. Case 5 • 27y woman with mass in the left parotid (angle of jaw) for 1 year • Ultrasound-guided FNA performed

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