This document provides guidance for interpreting frozen section biopsies from the lung, pleura, and mediastinum. It discusses 5 scenarios for lung biopsies depending on whether the diagnosis is known or unknown. For the pleura, it notes that mesotheliomas are most common and can vary in appearance. In the mediastinum, the spectrum of tumors is highly variable and basic patient information can help. Overall, the goal is to guide surgeons while recognizing limitations, and clear communication is most important.
8 th edition TNM classification and significance of depth of invasionishita1994
Diagnosis of oral cancer is completed for:
Initial diagnosis
Staging
Treatment planning
A complete history, and clinical examination is first completed, then a wedge of tissue is cut from the suspicious lesion for tissue diagnosis. In this procedure, the surgeon cuts all, or a piece of the tissue, to have it examined under a microscope by a pathologist.
New AJCC/UICC Staging System for Head & Neck, and Thyroid CancerHimanshu Soni
The AJCC/UICC staging system is a major tool in oncology, currently used worldwide for clinical,
pathological and recurrent disease staging. The objective of this presentation is to
describe the characteristics of the TNM staging system and review the changes made to head and neck
cancer staging in the most recent (8th) edition.
8 th edition TNM classification and significance of depth of invasionishita1994
Diagnosis of oral cancer is completed for:
Initial diagnosis
Staging
Treatment planning
A complete history, and clinical examination is first completed, then a wedge of tissue is cut from the suspicious lesion for tissue diagnosis. In this procedure, the surgeon cuts all, or a piece of the tissue, to have it examined under a microscope by a pathologist.
New AJCC/UICC Staging System for Head & Neck, and Thyroid CancerHimanshu Soni
The AJCC/UICC staging system is a major tool in oncology, currently used worldwide for clinical,
pathological and recurrent disease staging. The objective of this presentation is to
describe the characteristics of the TNM staging system and review the changes made to head and neck
cancer staging in the most recent (8th) edition.
Carcinoma Ex-pleomorphic Adenoma with Squamoid Differentiation: An Unusual Cy...asclepiuspdfs
Carcinoma ex-pleomorphic adenoma (CxPA) represents approximately 11.6% of all malignant neoplasms of salivary gland. The majority of CxPA develops from epithelial component of pleomorphic adenoma. Pleomorphic adenoma with foci of squamous and mucinous differentiation can potentially be misdiagnosed as low-grade mucoepidermoid carcinoma. The circumscribed borders of the tumor, gradual merging of mucoepidermoid foci into areas typical of pleomorphic adenoma, and presence of keratinization are features against the latter diagnosis. We present a rare cytological case of a 55-year-old male patient of CxPA with squamoid differentiation.
Liposarcoma: A Pictorial and Literature Reviewasclepiuspdfs
Liposarcomas (LSs) are uncommon malignant mesenchymal tumors with adipose differentiation. There are different histological subtypes, and they can present in different anatomic regions. LSs are classified into five different categories: Well differentiated, dedifferentiated, myxoid, pleomorphic, and mixed type. The most common involved anatomical sites are the lower extremities, retroperitoneum, and trunk. It is important to understand that the anatomical distribution for LSs presentation is closely related to the histological subtype; however, there are some important differences regarding their presentation, radiological features, diagnosis, treatment, and prognosis.
Angiosarcomas are rare and represent less than 2 percent of all sarcomas. The most frequently involved primary sites are heart, liver and breast with over 100 cases of each reported. Angiosarcomas of the lungs are usually metastasis. Differential diagnosis of vascular neoplasm metastatic to the lungs includes Kaposi sarcoma, epithelioid hemangioendothelioma, and angiosarcoma.
Primary angiosarcoma of the lung is extremely rare and is usually diagnosed quite late due to low index of suspicion.
Reported chest radiograph findings have ranged from normal to multiple nodular densities with or without pleural effusions to diffuse alveolar infiltrates compatible with pulmonary haemorrhage. Metastatic angiosarcoma lung lesions are commonly multiple. There have been reported as solid nodular or thin-walled cysts, with haemorrhagic change.
The HPE was consistent with an epithelioid angiosarcoma and this was also supported by positive reaction for factor VIII-related antigen, CD34 and CD31, which are specific markers for tumours derived from the endothelium.
Predisposing factors for angiosarcomas include polyvinyl chloride and thorium dioxide exposure, postmastectomy and postirradiation states (cutaneous angiosarcoma) and chronic empyema for pleural space angiosarcomas.
It is a presentation on the epidemiology, clinical presentation, diagnostics, staging, surgical management options, principles of alternate therapy for esophageal cancer.
Carcinoma Ex-pleomorphic Adenoma with Squamoid Differentiation: An Unusual Cy...asclepiuspdfs
Carcinoma ex-pleomorphic adenoma (CxPA) represents approximately 11.6% of all malignant neoplasms of salivary gland. The majority of CxPA develops from epithelial component of pleomorphic adenoma. Pleomorphic adenoma with foci of squamous and mucinous differentiation can potentially be misdiagnosed as low-grade mucoepidermoid carcinoma. The circumscribed borders of the tumor, gradual merging of mucoepidermoid foci into areas typical of pleomorphic adenoma, and presence of keratinization are features against the latter diagnosis. We present a rare cytological case of a 55-year-old male patient of CxPA with squamoid differentiation.
Liposarcoma: A Pictorial and Literature Reviewasclepiuspdfs
Liposarcomas (LSs) are uncommon malignant mesenchymal tumors with adipose differentiation. There are different histological subtypes, and they can present in different anatomic regions. LSs are classified into five different categories: Well differentiated, dedifferentiated, myxoid, pleomorphic, and mixed type. The most common involved anatomical sites are the lower extremities, retroperitoneum, and trunk. It is important to understand that the anatomical distribution for LSs presentation is closely related to the histological subtype; however, there are some important differences regarding their presentation, radiological features, diagnosis, treatment, and prognosis.
Angiosarcomas are rare and represent less than 2 percent of all sarcomas. The most frequently involved primary sites are heart, liver and breast with over 100 cases of each reported. Angiosarcomas of the lungs are usually metastasis. Differential diagnosis of vascular neoplasm metastatic to the lungs includes Kaposi sarcoma, epithelioid hemangioendothelioma, and angiosarcoma.
Primary angiosarcoma of the lung is extremely rare and is usually diagnosed quite late due to low index of suspicion.
Reported chest radiograph findings have ranged from normal to multiple nodular densities with or without pleural effusions to diffuse alveolar infiltrates compatible with pulmonary haemorrhage. Metastatic angiosarcoma lung lesions are commonly multiple. There have been reported as solid nodular or thin-walled cysts, with haemorrhagic change.
The HPE was consistent with an epithelioid angiosarcoma and this was also supported by positive reaction for factor VIII-related antigen, CD34 and CD31, which are specific markers for tumours derived from the endothelium.
Predisposing factors for angiosarcomas include polyvinyl chloride and thorium dioxide exposure, postmastectomy and postirradiation states (cutaneous angiosarcoma) and chronic empyema for pleural space angiosarcomas.
It is a presentation on the epidemiology, clinical presentation, diagnostics, staging, surgical management options, principles of alternate therapy for esophageal cancer.
Co-Chairs Kurt A. Schalper, MD, PhD, and Vamsidhar Velcheti, MD, prepared useful Practice Aids pertaining to solid tumor for this CME/MOC activity titled “PATHway to Decoding the Impact of Cancer Immunotherapy: Latest Advances in Biomarker Testing and Pathologic Response Assessment.” For the full presentation, downloadable Practice Aids, and complete CME/MOC information, and to apply for credit, please visit us at https://bit.ly/3SsmiMV. CME/MOC credit will be available until February 14, 2025.
Basics about Microcalcifications in mammography of breast as well as Review of Journal article on Residual Microcalcifications after Neoadjuvant Chemotherapy in Carcinoma Breast.
This is a presentation on most common applications of immunohistochemistry in breast lesions. Prepared by Dr Ashish Jawarkar, Assistant professor in pathology, Parul Institute of Medical sciences and research Vadodara
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ocular injury ppt Upendra pal optometrist upums saifai etawah
Thoracic pathology
1. Interactive Microscopy Session:
Common and Challenging Diagnostic
Dilemmas on Frozen Section Service:
Intraoperative Diagnostic Issues in
Thoracic Pathology
Handout
Cesar A. Moran, MD
Professor of Pathology
MD Anderson Cancer Center, Houston, TX
Course Dates: October 4-7, 2019
2. I
2
Interactive Microscopy Session | Common and Challenging Diagnostic Dilemmas on
Frozen Section Service: Intraoperative Diagnostic Issues in Thoracic Pathology |
Cesar A. Moran, MD | October 4-7, 2019
The Approach to Frozen Section in Thoracic Pathology
General Considerations
The evaluation of frozen sections (FS) in thoracic pathology presents different
challenges as their approach may be slightly different depending on the anatomic
location that is being evaluated. Thoracic frozen sections may originate from the lung
proper, the pleura, or the mediastinum. In some circumstances, the FS may originate
from the chest wall; however, often that involves tumors of soft tissues and for this
presentation, we will limit the discussion to tumors of the prior 3 different anatomic
locations.
As expected, different tumoral conditions may affect those anatomic areas and one
must be aware that the spectrum of lesions in those areas is vast and heterogeneous.
Needless to say, the thorax is also a common site for metastatic disease. Therefore,
the evaluation of FS is not only limited to the assessment of malignancy but often to the
assessment of primary site. It is also important to highlight that in current medical
practice, it is possible that the evaluation of FS is mainly to provide orientation to the
surgeon as to what extent the surgery is needed as it is very possible that a prior biopsy
has already been evaluated and the diagnosis is also known. Nevertheless, it is not
uncommon that such clinical background is not available and then the interpretation of
the FS becomes crucial in proper assessment of the case in question.
Because of the nature of the thoracic cavity, we will divide the evaluation of FS based
on the anatomic location as there are important differences in the approach, which
impact surgical options.
LUNG
The current practice of FS in lung lesions can be separated in the different aspects:
Scenario 1
• The diagnosis is already known and the FS are essentially performed for staging
purposes. An example of it will be a patient with an intrapulmonary mass in
which the prior biopsy revealed a non-small cell carcinoma (adenocarcinoma,
squamous cell carcinoma, etc.) and now multiple lymph nodes are sent for FS
evaluation as well as the bronchial margin. In these cases, the interpretation of
the lymph nodes can be done in two different ways:
o Positive or negative for metastatic carcinoma
o Positive or negative for the specific carcinoma
3. 3
Interactive Microscopy Session | Common and Challenging Diagnostic Dilemmas on
Frozen Section Service: Intraoperative Diagnostic Issues in Thoracic Pathology |
Cesar A. Moran, MD | October 4-7, 2019
o Important to document the origin of the lymph node as such interpretation
may affect N1 or N2 disease.
o The interpretation of the bronchial margin is either positive or negative.
§ If positive, it is important to determine whether the bronchial
epithelium is positive or whether the tumor is around peribrochial
soft tissue.
Scenario 2
• The diagnosis is already known. The procedure is a wedge resection and the
entire tumor is sent to pathology to evaluate on FS the parenchymal margin of
resection. If that is the case:
o Proper orientation of the specimen is required in order to make such
determination.
§ Parenchymal margin is either positive or negative.
§ Some pathologists provide an approximate distance from the
margin to the tumor (mm).
Scenario 3
1. Carcinoma
• The diagnosis is not known and a section from the tumor is provided for
interpretation. In this setting, one can provide the following interpretation:
o If convince that the tumor in question is a carcinoma, then make the
assessment whether it is small or non-small cell carcinoma.
o If the interpretation is that of non-small cell carcinoma, and if the sample is
adequate for further interpretation, then one can do so by stating c/w
squamous cell carcinoma or adenocarcinoma.
o It is important to separate one particular tumor and that is the
adenocarcinoma with lepidic growth pattern. Since this tumor has been
re-coded as In Situ Adenocarcinoma, one needs to be careful in the
interpretation of this tumor on FS. The entire tumor must be evaluated in
order to make such claim; therefore in the FS one is limited to the
interpretation of lepidic growth pattern.
o At the same time, one can also assess for the possibility of metastatic
disease. Common carcinomas metastatic to the lung include colorectal
and head and neck carcinomas. In those settings, the clinical history will
help just as the presence of multiple pulmonary nodules.
4. I
4
Interactive Microscopy Session | Common and Challenging Diagnostic Dilemmas on
Frozen Section Service: Intraoperative Diagnostic Issues in Thoracic Pathology |
Cesar A. Moran, MD | October 4-7, 2019
2. Neuroendocrine Carcinomas
• The FS interpretation of neuroendocrine carcinomas may pose significant
problems as the spectrum of these tumors go from low to intermediate to high
grade neoplasms. In addition, one is limited by the sample of the tissue available
for interpretation. However, one can assess these tumor as follows:
o Separate low and intermediate grade neoplasms (Carcinoid and Atypical
Carcinoid) from high grade neoplasms (small cell and large cell
neuroendocrine carcinoma)
o In the low and intermediate grade neoplasms, evaluate for necrosis and
mitotic activity and state the findings. However, one must state that final
classification is after complete evaluation of the neoplasm on permanent
sections.
o If small cell carcinoma, it is likely that the surgical procedure may stop.
o By definition, large cell neuroendocrine carcinoma is a non-small cell
carcinoma with neuroendocrine pattern. However, for such a diagnosis, it
is important to have neuroendocrine markers positive (chromogranin,
synaptophysin, or CD56). Therefore, one can only suggest the possibility
but the final interpretation is after performing IHC stains.
Scenario 4
3. Spindle cell neoplasms
• The evaluation on FS of intrapulmonary spindle cell neoplasms can be
challenging, namely if there is not pertinent clinical history. The spectrum of
tumors that may have spindle cell morphology is wide and encompasses
epithelial, neuroendocrine, and mesenchymal neoplasms. Therefore, their
assessment needs to be done carefully and although often one is not able to
make a definitive diagnosis on FSW, it is common to favor a particular neoplasm.
Needless to say, the occurrence of metastatic sarcomas to the lung (including
melanomas) is very common and special attention needs to be given for such
possibility.
Scenario 5
4. Unclassifiable neoplasm
• Often one is confronted with lesions that on FS cannot be classified or one can
be misled by the appearance of the neoplasm. One of those examples is the so-
called Sclerosing Hemangioma – Pneumocytoma. The epithelial appearance of
5. 5
Interactive Microscopy Session | Common and Challenging Diagnostic Dilemmas on
Frozen Section Service: Intraoperative Diagnostic Issues in Thoracic Pathology |
Cesar A. Moran, MD | October 4-7, 2019
the tumor may be misinterpreted by the pathologist towards the possibility of
carcinoma. However, it is important to keep such possibility in mind in
intrapulmonary coin lesion in young or middle age women, as those tumors occur
predominantly in that age and gender group. The identification of areas
mimicking a vascular neoplasm admixed with more solid and papillary areas may
help in the interpretation. However, if in doubt there no other choice but to defer
the final interpretation for permanent sections.
The Pleura
Essentially primary tumors of the pleura are dominated by one particular entity and that
is malignant mesothelioma. Therefore, it is important to keep that in mind and to be
aware that mesotheliomas may also show a spectrum of differentiation that may go from
the most conventional morphology of anastomosing pseudoglandular areas with
papillary features to the more sarcomatoid neoplasms that may mimic a mesenchymal
neoplasm. Thus,
• Is it recommended to make an unequivocal diagnosis of mesothelioma in a
patient who has not had a previous biopsy? The most appropriate response will
be that it is not. Because the treatment options for mesothelioma are different
from other neoplasm, it is important not only to properly perform adequate IHC
but also to correlate the findings with the imaging.
• For an epithelioid neoplasm, the differential diagnosis will be that of
adenocarcinoma invading the pleura or in rare circumstance the so-called
Pseudomesotheliomatous adenocarcinoma. The latter tumor may invade the
pleura in a manner similar to that of mesothelioma.
• For a sarcomatoid neoplasm, the consideration would be a true sarcoma or a
spindle cell carcinoma that is invading the pleura.
o Recommendations for interpretation include:
§ Is there diffuse pleura thickening?
§ Is there a pleural based mass?
§ Is there a dominant intrapulmonary tumor?
§
• On occasion, the pleura may also be the site for metastatic neoplasms from other
sources below the diaphragm or above the thoracic inlet. Therefore, clinical and
radiological information are highly important in the final interpretation.
• One important consideration in pleural pathology for FS is solitary fibrous tumor
(SFT). SFT is a common neoplasm in the serosal surface and it is common in
the pleura. In these cases, the tumor is a pleural based mass that may be
pedunculated. The histology of SFT is variable; however, the presence of a
spindle cell proliferation with hypo and hyper cellular areas with a subtle HPC
6. I
6
Interactive Microscopy Session | Common and Challenging Diagnostic Dilemmas on
Frozen Section Service: Intraoperative Diagnostic Issues in Thoracic Pathology |
Cesar A. Moran, MD | October 4-7, 2019
pattern is highly suggestive of SFT. However, as the tumor shows variable
histology, SFT may also mimic other sarcomas.
The Mediastinum
The spectrum of mediastinal neoplasm is highly variable and may be challenging on FS
as the mediastinum can be the site of numerous neoplasms of epithelial, mesenchymal,
lymphoid, and germ cell tumors among others.
In the interpretation of FS for mediastinal neoplasm, some basic information may be of
high importance such as gender and age. For instance, germ cell tumors are neoplasm
predominantly occurring in younger men. On the other hand, thymomas are uncommon
in younger patients (<35 years). Also, MALT lymphomas of the thymus are more
common in younger women with the history of collagen vascular disease or Sjogren
syndrome. These are only a few examples of how, some basic information may help in
the interpretation of possible FS for mediastinal tumors.
If on the other hand, one wants to approach these lesions by histological features, here
are some possible scenarios:
Scenario 1
• Lymphocyte rich lesions
o Lymphocyte rich thymoma (WHO type B1) and normal thymus can be
indistinguishable on FS. The same applies for the solid areas of a
multilocular thymic cyst.
o Thymic lymphoma B cell type on FS may be indistinguishable from a
lymphocyte rich thymoma.
o MALT lymphoma of the thymus can be indistinguishable from thymic
hyperplasia.
Scenario 2
• Epithelial rich or mixed cellularity lesions
o The most common challenge would be attempting to differentiate epithelial
rich so called atypical thymoma (WHO B3) from thymic carcinoma. Often
such differentiation is difficult unless one finds unequivocal histology of
carcinoma.
o Important to distinguish is thymoma from seminoma as both tumors may
show some lymphocytic component.
7. 7
Interactive Microscopy Session | Common and Challenging Diagnostic Dilemmas on
Frozen Section Service: Intraoperative Diagnostic Issues in Thoracic Pathology |
Cesar A. Moran, MD | October 4-7, 2019
o Because of the lobulation that may be present in mediastinal tumors,
Hodgkin lymphoma also enter in the differential diagnosis of mixed
cellularity thymomas (WHO B2) on FS.
Scenario 3
• Spindle cell lesions
o Spindle cell tumor of the mediastinum may be represented by different
tumors of different lineage.
§ Spindle cell thymoma, Spindle cell neuroendocrine neoplasm
(Carcinoid tumor), or mesenchymal neoplasm such as synovial
sarcoma or SFT.
§ In such cases, unless one is very familiar with the histology of the
particular tumor, one can make a final interpretation on FS.
Otherwise, it may be necessary to defer for permanent sections.
§ Mediastinal sarcomas are rather rare but represent an important
part of mediastinal pathology. Their histology is variable and
includes smooth muscle tumors, vascular neoplasms, and
fibrohistiocytic tumors.
TAKE HOME MESSAGE
Often the interpretation of FS does not necessarily include a definitive diagnosis of a
particular lesion. As pathologist, we play a role in guiding the surgeon about the best
possible surgical approach. Therefore, in many cases, the mere interpretation of
positive for malignancy or negative for malignancy is the needed interpretation that the
surgeon needs to continue with his/her plan of treatment. Of course, the goal is to
provide the best possible information so that proper care is undertaken. However, in
some circumstances, the limitations of tissue dictate otherwise. However, no matter
what the interpretation is, the most important element is to have proper communication
with the surgical team in order to provide the best medical care.