DZI20-199-Case-9

Sequence	Case	Clinical history	Diagnosis
1	DZI20-199-Case-1 DZI20-199-Case-1	Whipple - pancreatic transection margin. Whipple - pancreatic transection margin.	Small neuroendocrine tumorlet (<0.5 cm) at margin. Discussed with surgeon. (not present on permanents) Small neuroendocrine tumorlet (<0.5 cm) at margin. Discussed with surgeon. (not present on permanents)
2	DZI20-199-Case-2 DZI20-199-Case-2	Whipple FX1: Duodenal peritoneal nodule (1st slide) FX3: Cyst wall (2nd slide) FX3A: Mass to uncinate margin (3rd slide) Whipple FX1: Duodenal peritoneal nodule (1st slide) FX3: Cyst wall (2nd slide) FX3A: Mass to uncinate margin (3rd slide)	FX1: Fibroadipose tissue with hyalinization, no carcinoma seen. (permanent same) FX3 (cyst wall): Fibrotic cyst wall with chronic inflammation, negative for carcinoma. (Psuedocyst) FX3A (mass to uncinate margin): High-grade carcinoma, uncinate margin negative, but comes to within 0.2 cm. (Recurrent undifferentiated carcinoma with osteoclastic giant cells, uncinate ngative) FX1: Fibroadipose tissue with hyalinization, no carcinoma seen. (permanent same) FX3 (cyst wall): Fibrotic cyst wall with chronic inflammation, negative for carcinoma. (Psuedocyst) FX3A (mass to uncinate margin): High-grade carcinoma, uncinate margin negative, but comes to within 0.2 cm. (Recurrent undifferentiated carcinoma with osteoclastic giant cells, uncinate ngative)
3	DZI20-199-Case-3 DZI20-199-Case-3	Pancreatic mass - whipple FX1: pancreas transection margin FX2: Bile duct margin FX3: Bile duct margin Pancreatic mass - whipple FX1: pancreas transection margin FX2: Bile duct margin FX3: Bile duct margin	FX1 (pancreas transection margin): TINEM FX2: (bile duct margin): single highly atypical gland. Discussed with surgeon (permanent: eroded bile duct with rare atypical glands. The atypical glands are best seen on frozen section). FX3 (bile duct margin): TINEM FX1 (pancreas transection margin): TINEM FX2: (bile duct margin): single highly atypical gland. Discussed with surgeon (permanent: eroded bile duct with rare atypical glands. The atypical glands are best seen on frozen section). FX3 (bile duct margin): TINEM
4	DZI20-199-Case-4 DZI20-199-Case-4	Pancreas tumor - whipple FX1: pancreatic transection margin FX1A: mass Pancreas tumor - whipple FX1: pancreatic transection margin FX1A: mass	FX1 (pancreatic transection margin): TINEM FX2 (mass): neuroendocrine tumor (permanent: neuroendocrine neoplasm, low grade (G1) FX1 (pancreatic transection margin): TINEM FX2 (mass): neuroendocrine tumor (permanent: neuroendocrine neoplasm, low grade (G1)
5	DZI20-199-Case-5 DZI20-199-Case-5	pancreas mass - middle segment resection FX2: Distal margin (radial) FX2A: Tumor pancreas mass - middle segment resection FX2: Distal margin (radial) FX2A: Tumor	FX2 (distal margin): Margin negative for high-grade dysplasia and malignancy. FX2A (tumor): At least intermediate grade dysplasia, negative for carcinoma (permanent: IPMN with high-grade dysplasia, branch duct type) FX2 (distal margin): Margin negative for high-grade dysplasia and malignancy. FX2A (tumor): At least intermediate grade dysplasia, negative for carcinoma (permanent: IPMN with high-grade dysplasia, branch duct type)
6	DZI20-199-Case-6 DZI20-199-Case-6	pancreas mass - whipple FX2: common bile duct margin FX3: pancreatic transection margin FX4: Mass to uncinate pancreas mass - whipple FX2: common bile duct margin FX3: pancreatic transection margin FX4: Mass to uncinate	FX2 (common bile duct margin): TINEM FX3 (pancreatic transection margin): TINEM (permanent: chronic pancreatitis) FX4 (Mass to uncinate): adenocarcinoma, viable cells are present. Uncinate margin, negative for tumor (permanent: ductal adenocarcinoma) FX2 (common bile duct margin): TINEM FX3 (pancreatic transection margin): TINEM (permanent: chronic pancreatitis) FX4 (Mass to uncinate): adenocarcinoma, viable cells are present. Uncinate margin, negative for tumor (permanent: ductal adenocarcinoma)
7	DZI20-199-Case-7 DZI20-199-Case-7	pancreas mass - whipple FX1: bile duct margin FX2 + level: pancreatic transection margin (2nd and 3rd slides) FX2A: mass (4th slide) pancreas mass - whipple FX1: bile duct margin FX2 + level: pancreatic transection margin (2nd and 3rd slides) FX2A: mass (4th slide)	FX1 (bile duct margin): TINEM FX2 (pancreatic transection margin): positive for carcinoma FX2A (mass): Positive for carcinoma Permanent for part 2: Invasive adenocarcinoma with involved pancreatic transection margin FX1 (bile duct margin): TINEM FX2 (pancreatic transection margin): positive for carcinoma FX2A (mass): Positive for carcinoma Permanent for part 2: Invasive adenocarcinoma with involved pancreatic transection margin
8	DZI20-199-Case-8 DZI20-199-Case-8	pancreas mass - whipple FX2: bile duct margin FX4 + level: Pancreas transection margin FX5: thickened common bile duct pancreas mass - whipple FX2: bile duct margin FX4 + level: Pancreas transection margin FX5: thickened common bile duct	FX2 (bile duct margin): TINEM FX4 (pancreatic transection margin): Small ducts with involvement by intramucosal malignancy, at least high-grade dysplasia (permanent: invasive adenocarcinoma, moderately differentiated) FX5 (thickened common bile duct): Invasive adenocarcinoma (permanent: invasive adenocarcinoma, moderately differentiated - pancreatic head origin, possibility of bile duct considered by favored against) FX2 (bile duct margin): TINEM FX4 (pancreatic transection margin): Small ducts with involvement by intramucosal malignancy, at least high-grade dysplasia (permanent: invasive adenocarcinoma, moderately differentiated) FX5 (thickened common bile duct): Invasive adenocarcinoma (permanent: invasive adenocarcinoma, moderately differentiated - pancreatic head origin, possibility of bile duct considered by favored against)
9	DZI20-199-Case-9 DZI20-199-Case-9	pancreas mass - whipple FX3+level: Bile duct margin FX4: Bile duct margin pancreas mass - whipple FX3+level: Bile duct margin FX4: Bile duct margin	FX3: Positive for adenocarcinoma FX4: Positive for adenocarcinoma FX3: Positive for adenocarcinoma FX4: Positive for adenocarcinoma
10	DZI20-199-Case-10 DZI20-199-Case-10	pancreas mass - whipple FX1: Liver wedge biopsy FX3: Pancreas transection margin FX4: Mass pancreas mass - whipple FX1: Liver wedge biopsy FX3: Pancreas transection margin FX4: Mass	FX1 (Liver wedge biopsy): Biliary proliferation (permanent: bile duct adenoma) FX3: Pancreas transection margin: TINEM FX4: Mass: Adenocarcinoma, partially necrotic, greater than 2 cm away from transection margin (permanent: adenocarcinoma of the pancreas) FX1 (Liver wedge biopsy): Biliary proliferation (permanent: bile duct adenoma) FX3: Pancreas transection margin: TINEM FX4: Mass: Adenocarcinoma, partially necrotic, greater than 2 cm away from transection margin (permanent: adenocarcinoma of the pancreas)

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