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Ductal adenocarcinoma is the most common primary malignant neoplasm of the pancreas, representing more than 90% of the exocrine pancreatic tumors. Variants of ductal adenocarcinoma can mimic involvement by the pancreas from other tumors (pancreatic and metastatic).
The pre- and intra-operative diagnosis of cystic pancreatic lesions is important since the management and prognosis varies between different lesions. The majority of pancreatic cystic lesions are pseudocysts that do not require major surgical resections. Fig. 5.1 shows the typical intra-operative management for cystic lesions in response to frozen section diagnosis. Generally the surgeon submits a...
Although most pancreatic tumors seen at frozen section are adenocarcinomas, occasionally other types of pancreatic neoplasms are present. Table 6.1 compares some of the typically solid pancreatic tumors.
Secondary tumors involving the pancreas (metastatic or by direct extension) may not be treated by surgical resection. They are usually suspected with the proper clinical history and imaging techniques. Tissue confirmation may be obtained through fine needle aspiration or biopsy. In some cases, the diagnosis of a primary pancreatic neoplasm is suspected pre-operatively, and the surgeon may be surprised...
Liver lesions, enlarged lymph nodes, and suspicious peritoneal nodules may be biopsied in an attempt to diagnose metastatic pancreatic adenocarcinoma and help determine resectability. Small, radiologically inapparent liver metastases are often subcapsular and must be distinguished from benign liver lesions such as bile duct adenoma, bile duct hamartoma (von Meyenburg complex), focal scarring, or reactive...
Frozen section of pleural tissue is performed during surgery to confirm that diagnostic tissue has been obtained for permanent section examination and to decide on intraoperative therapy. Benign reactive/inflammatory conditions (infections, plaques, pleuritis of various etiologies), benign neoplasms, primary pleural malignancies, and metastatic cancers may produce overlapping radiologic, clinical,...
Metastases to the pleura are much more common than primary cancers of the pleura. Pleural metastases produce pleural effusions and pleural-based nodules or masses or pleural thickening, features that are also produced by primary tumors of the pleura and by reactive processes. Whereas DMMs account for about 1,500 pleural effusions in the USA each year, metastatic cancers account for about 200,000 pleural...
All primary neoplasms of the pleura are very rare. As noted in Chap. 1, DMM is the most frequent primary neoplasm of the pleura and only about 2,000 new cases occur per year in the USA. Other primary neoplasms of the pleura may be unfamiliar to the surgeon and pathologist because of the infrequency with which they are encountered, making diagnosis challenging. Since some of these neoplasms are benign...
Pleuritis is a reactive process that may or may not include inflammatory cell infiltrates. In the typical frozen section, the pathologist may see fibrinous exudates on the pleural surface (fibrinous pleuritis), organization of the fibrin by granulation tissue (organizing pleuritis), or maturing or mature connective tissue (fibrous pleuritis). Causes of fibrinous and fibrous pleuritis are listed in...
There are several nonneoplastic lesions of the pleura that, although uncommon, should be differentiated from pleural neoplasms. Sclerosing mediastinitis presents as an extensive dense fibrous tissue in the mediastinum that compresses, entraps, and invades chest structures, including pleura, bronchi, and lungs, often grossly mimicking invasive neoplasm (Fig. 5.1). Patients may be of any age, with the...
One of the most frequent questions at frozen section of pleural tissue is whether or not a pleural lesion is benign or malignant. Differentiating benign reactive mesothelial hyperplasia or organizing pleuritis from a malignancy on frozen section may be a more difficult and a more immediately important differential than determining the type of cancer that a patient has on frozen section (Figs. 6.1-6...
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