Accuracy of Frozen Section in Distinguishing Primary Ovarian Neoplasia from Tumors Metastatic to the Ovary

Abstract

Frozen section is widely used in the intra-operative assessment of patients with ovarian tumors. The diagnosis of malignancy is usually straightforward but in some cases it may be difficult to distinguish whether tumors are of ovarian origin or represent matastases from other sites. Recently, Seidman and colleagues presented a simple algorithm based on tumor size and unilateral versus bilateral involvement to aid in intra-operative assessment of ovarian mucinous neoplasms. In this study we have reviewed the accuracy of frozen section in distinguishing primary ovarian malignancies from tumors metastatic to the ovaries encountered in two hospitals over a 5-year period. The algorithm was also applied to our cases retrospectively irrespective of histological type. Nine hundred fourteen ovarian frozen sections were performed in the study period including 266 cases with a final diagnosis of malignancy. Thirty-seven malignancies (13.9%) were of metastatic origin (exclusing one lymphoma), 21 of which (58.8%) were correctly identified on frozen section. In 5 additional cases metastatic origin was included in the differential diagnosis while a primary ovarian tumor was favored un 11 cases (29.7%). Application of the algorithm to the metastatic tumors led to correct classification in 26/33 (78.8%) assessable cases. Conversely, 195/228 primary ovarian malignancies were correctly identified intra-operatively but the possibility of extra-ovarian malignancy was considered or not excluded in 33 cases (14.5%). Application of the algorithm to the latter problematic primary ovarian tumors overall was not helpful in distinguishing primary or metastatic origin. However if only low-grade primary adenocarcinomas were considered then 10/12 assessable cases were correctly assigned. In conclusion frozen section is only moderately successful in distinguishing primary ovarian malignancies fron tumors metastatic to the ovaries. The simple algorithm proposed by Seidman and colleagues for assessment of ovarian mucinous tumors is helpful and can be applied to low-grade adenocarcinomas of other histological types.

Value of cytology in the intraoperative assessment of ovarian tumors

“…Otherwise, it is well known that metastatic tumors may closely mimic primary ovarian neoplasia and extensive histological sampling, detailed clinical information, and/or ancillary techniques, such as immunohistochemistry may be required to achieve a specific diagnosis in individual cases. 11,26,27 The converse problem, in which the possibility of metastases is raised in tumors ultimately determined to be of ovarian origin, has received less attention in the literature but, in our experience, represents a relatively common intraoperative dilemma. 11 In the present series, metastasis was considered, or could not be excluded, in 12 of 141 (8.5%) tumors that ultimately were determined to be primary ovarian neoplasms.…”

“…11,26,27 The converse problem, in which the possibility of metastases is raised in tumors ultimately determined to be of ovarian origin, has received less attention in the literature but, in our experience, represents a relatively common intraoperative dilemma. 11 In the present series, metastasis was considered, or could not be excluded, in 12 of 141 (8.5%) tumors that ultimately were determined to be primary ovarian neoplasms. Because there were similar interpretative problems using both frozen section and smear preparations, addition of the latter did not improve diagnostic accuracy.…”

“…[1][2][3][4] Nevertheless, there are problem areas in frozen section diagnosis, including the accurate recognition of borderline epithelial tumors and the distinction of some primary ovarian neoplasms from malignancies metastatic to the ovaries. [5][6][7][8][9][10][11][12][13] The identification of rare ovarian neoplasms and uncommon nonneoplastic conditions may also prove difficult because most individual pathologists will encounter such lesions infrequently.…”

Tumor de Krukenberg del ovario asociado a teratoma maduro

“…Desde el punto de vista práctico, el antecedente de enfermedad tumoral previa, la bilateralidad, el tamaño menor a 10-12 cm, el compromiso seroso, el aspecto multinodular sólido permiten sospechar metástasis en la macroscopía y en la biopsia rápi-da (20,21). Microscópicamente las embolias tumorales, el compromiso del hilio ovárico, la presencia de muconódulos y la invasión infiltrante apoyan el diagnóstico de metástasis (22).…”

Primer odağı safra kesesi olan metastatik over tümörleri: üç olgunun sunumu

“…Metastatik over tümörlerinde primer odak olarak biliyer sistemin oranı oldukça düşüktür ve çoğunlukla %0.9 ile %2.7 arasında değiş-mektedir (1,2,4,7). Ancak %10'a kadar çı-kan oranlar bildirilmiştir (8).…”