Frozen section diagnosis of gastrointestinal poorly cohesive and signet-ring cell adenocarcinoma: useful morphologic fea
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ORIGINAL ARTICLE
Frozen section diagnosis of gastrointestinal poorly cohesive and signet-ring cell adenocarcinoma: useful morphologic features to avoid misdiagnosis Xiaoqin Zhu 1 & Jacob R. Bledsoe 1 Received: 14 January 2020 / Revised: 25 February 2020 / Accepted: 17 March 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Frozen section examination of adenocarcinomas with poorly cohesive growth, including signet-ring cell carcinoma, is challenging. Due to their diffuse morphology, the tumor cells may be indistinct and difficult to distinguish from inflammatory or stromal cells. Misdiagnosis may result in significant adverse clinical outcome. We performed a detailed retrospective analysis of such cases to identify features that are helpful to avoid misdiagnosis at the time of frozen section. We reviewed the original frozen section slides from 50 patients with poorly cohesive carcinoma (PCC) including 32 with positive and 18 with negative frozen section slides. Tumor cells and inflammatory cells were evaluated for 17 distinct cytologic and nine architectural or stromal features. Features with 100% specificity and positive predictive value (PPV) for carcinoma included the presence of cells with a single distinct cytoplasmic mucin vacuole, focal gland formation, and perineural invasion. Features with high specificity, sensitivity, PPV, and negative predictive value (NPV) (all > 75%) included irregular nuclear contours, large nuclear size with many nuclei > 4× the size of a small lymphocyte, and disruption/obliteration of normal structures. Other features with high specificity and PPV (both ≥ 85%) but relatively low sensitivity and NPV-included crescent-shaped/indented nuclei, prominent nucleoli, anisonucleosis (> 4:1 difference in nuclear size), multinucleation, and the presence of mitotic figures. We characterized useful histologic features of poorly cohesive carcinoma that may serve to distinguish carcinoma cells from benign inflammatory or stroma cells. Knowledge of the relatively specific features in particular may help surgical pathologists avoid false-negative interpretation resulting in significant clinical morbidity. Keywords Poorly cohesive . Signet-ring cell . Gastric carcinoma . Frozen section . Intraoperative consultation
Introduction Poorly cohesive carcinoma (PCC) refers to a distinct morphologic subtype of adenocarcinoma that demonstrates a diffuse and infiltrative growth pattern composed of individual or small clusters of carcinoma cells, with no or only focal and inconspicuous gland formation [1]. Signet-ring cell carcinoma is included in this category, as are non-signet-ring cell types of PCC [1]. Within the gastrointestinal tract, PCCs arise most Previous publication Parts of this study were presented at the USCAP 2019 annual meeting. * Jacob R. Bledsoe [email protected] 1
Department of Pathology, UMass Memorial Medical Center, University of Massachusetts, One Innovation Drive, Biotech 3, Worcester, MA 01605, USA
commonly from the stomach and less frequent
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