We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Diagnostic challenges of intra‐operative frozen consultation for gastrointestinal signet ring cell carcinoma†.
- Authors
Chen, Fengming; Jiang, Kun; Han, Bing
- Abstract
Aims: Signet ring cell carcinoma (SRCC) is challenging to recognise on intra‐operative frozen sections, with known high false‐negative rates. The objective of this study was to investigate common factors contributing to discrepancies between intra‐operative frozen diagnoses and those made upon review of permanent sections, and summarise our experiences gained and lessons learned on minimising errors on intra‐operative frozen diagnoses of gastrointestinal SRCC. Methods and results: We retrospectively examined our pathology database from 25 May 2000 to 1 January 2018 and re‐reviewed intra‐operative frozen sections and permanent haematoxylin and eosin (H&E) slides for specimens confirmed with SRCC on permanent sections. This study includes 83 specimens taken from 50 patients, with an accuracy of 85.5%. Main common factors causing discordance or deferral in recognising SRCC between intra‐operative frozen procedures and permanent sections include: (i) resemblance of clusters of SRCC cells with a myxoid background; (ii) disguise as normal or reactive cells (histiocytes, macrophages, large reactive lymphocytes, plasma cells or adipocytes) due to their relatively clear or depleted cytoplasmic mucin; and (iii) histological sampling errors, leading to misses of small foci of SRCC on frozen section slides. Conclusions: An accurate diagnosis of SRCC during intra‐operative frozen consultations remains challenging. Based on our experiences and lessons, the most important strategies to reduce diagnostic errors are: (i) understanding the unusual histomorphological features of SRCC cells on frozen sections including, but not limited to, intracellular mucin depletion, absence of desmoplasia and no adjacent pre‐cancer changes; and (ii) close attention to abrupt transition from normal architecture (e.g. glandular or submucosal loose connective tissue) to myxoid and/or inflammatory‐like appearance, which potentially harbours SRCC.
- Subjects
FROZEN tissue sections; PLASMA cells; SAMPLING errors; DIAGNOSTIC errors; CONNECTIVE tissues; DIAGNOSIS; FAT cells
- Publication
Histopathology, 2021, Vol 78, Issue 1, p300
- ISSN
0309-0167
- Publication type
Article
- DOI
10.1111/his.14229