Frozens Digital Study Set

Introduction

Intraoperative frozen section diagnoses play a significant role in patient management. Evaluation is often challenging due to various artifacts, time constraints, and lack of ancillary tests. Interpretation is solely dependent on H&E morphology, and thus mastery of this skill requires extensive practice. Various specimen types are encountered daily on a busy service, which requires a broad scope of knowledge. This study set includes a sampling of frozen sections collected from the Massachusetts General Hospital frozen section service and is meant to serve as an educational resource for pathology trainees.

Nida Safdar, MD

Table of contents

1. Spermatocele (0 slides)
2. Adenomatoid tumor (0 slides)
3. Prostatic adenocarcinoma, Gleason 3+ 4 (0 slides)
4. Adrenal cortical adenoma, oncocytic (0 slides)
5. Benign prostatic tissue (0 slides)
6. There is no evidence of malignancy (benign prostatic tissue including partial atrophy) (0 slides)
7. Renal cell carcinoma (clear cell papillary type); margin negative (0 slides)
8. Hyperkeratosis. There is no evidence of malignancy (0 slides)
9. Metanephric adenoma (0 slides)
10. Small focus of prostatic adenocarcinoma, Gleason 3+3 (0 slides)
11. Adrenal cortical adenoma (0 slides)
12. Chromophobe renal cell carcinoma; less than 0.1 cm from margin (0 slides)
13. There is no evidence of malignancy (0 slides)
14. Ureter with moderate urothelial dysplasia (0 slides)
15. Urothelial carcinoma in situ (0 slides)
16. Epithelioid angiomyolipoma with atypia (0 slides)
17. Ureter with reactive von Brunn's nests; negative for carcinoma (0 slides)
18. Urothelial carcinoma in situ (0 slides)
19. Papillary urothelial carcinoma, non-invasive, with inverted growth pattern. (0 slides)
20. Malignant mixed germ cell tumor (seminoma 90% and embryonal carcinoma 10%) (0 slides)
21. Pheochromocytoma (0 slides)
22. Severe urothelial dysplasia bordering on urothelial carcinoma in-situ (0 slides)
23. Seminoma (0 slides)
24. Germ cell tumor with component of embryonal carcinoma (0 slides)
25. Benign urethra and corpus spongiosum (0 slides)
26. Angiomyolipoma (0 slides)
27. Ganglioneuroma (0 slides)
28. Small round blue cell neoplasm (permanent dx: synovial sarcoma, monophasic spindle-cell type) (0 slides)
29. Poorly differentiated carcinoma (0 slides)
30. Organization pneumonia; negative for malignancy (0 slides)
31. Carcinoid tumor (0 slides)
32. Metastatic poorly differentiated carcinoma (permanent dx: small cell carcinoma) (0 slides)
33. Positive for neoplasia with epithelioid features (permanent dx: Metastatic poorly differentiated adenocarcinoma consistent with lung primary) (0 slides)
34. Small focus of adenoid cystic carcinoma present in the adventitia (0 slides)
35. No definitive malignancy, some atypical cells, favor reactive mesothelial cells; chronic inflammation (permanent dx: chronic pleuritis with multiple lymphoid follicles and mesothelial hyperplasia) (0 slides)
36. Organizing pneumonia with chronic and histiocytic inflammation with atypical pneumocytes, favor reactive atypia (Permanent dx: Fibroinflammatory nodule; there is no evidence of malignancy) (0 slides)
37. Low grade spindle cell neoplasm (Permanent dx: Smooth muscle neoplasm; no over features of malignancy; may represent benign pulmonary leiomyoma which is exceptionally rare; metastasis from other sites including cutaneous and uterine origins should be clinically excluded; benign metastasizing leiomyoma of the uterus cannot be excluded) (0 slides)
38. Germ cell tumor (Permanent dx: yolk sac tumor) (0 slides)
39. High-grade malignancy, favor carcinoma (permanent dx small cell carcinoma) (0 slides)
40. Fibroelastotic scarring; negative for malignancy (0 slides)
41. Lung parenchyma with extended alveolar spaces with mucin and a focus of atypical epithelium lining alveolar walls away from margin (0 slides)
42. Atypical cells suggestive of non-small cell carcinoma (permanent dx: classic Hodgkin lymphoma) (0 slides)
43. Atypical pneumocyte proliferation associated with lymphoplasmacytic inflammation (permanent dx: adenocarcinoma) (0 slides)
44. Adenocarcinoma, 0.5 cm from parenchymal margin (0 slides)
45. Fibrous and organizing pleuritis with abundant acute inflammation. No granulomas. No evidence of malignancy (0 slides)
46. Small cell carcinoma with significant crush artifact (0 slides)
47. Vascular tumor with hemorrhage and intracellular fat (Oil-Red-O), consistent with hemangioblastoma (permanent dx: hemangioblastoma, WHO grade I of IV) (0 slides)
48. Brain with abundant tumor cells consistent with known glioblastoma (0 slides)
49. Meningothelial tumor consistent with known atypical meningioma, viable and without evidence of progression to anaplastic meningioma (permanent dx: recurrent/residual atypical meningioma) (0 slides)
50. Malignant glioma with extensive necrosis (permanent dx: glioblastoma) (0 slides)
51. Reactive gliosis with abundant hemosiderin. Additional tissue requested. (0 slides)
52. Neoplasm with neuroendocrine features and marked pleomorphism, consistent with adenoma (permanent dx: corticotroph adenoma with elevated proliferation index) (0 slides)
53. Schwannoma with abundant xanthomatous change (0 slides)
54. High grade glioma (permanent dx: glioblastoma) (0 slides)
55. Recurrent/residual glioma. No necrosis or microvascular proliferation seen (permanent dx: recurrent/residual high grade malignant astrocytoma) (0 slides)
56. Ependymoma (permanent dx: subependymoma) (0 slides)
57. Consistent with contents of Rathke's cleft cyst (permanent dx: acellular fluid material consistent with contents of a Rathke's cyst) (0 slides)
58. Low grade glial tumor with abundant Rosenthal material (permanent dx: pilocytic astrocytoma, WHO grade I) (0 slides)
59. Meningioma (permanent dx: meningioma with atypical features and mildly elevated proliferation index) (0 slides)
60. High grade glioma (permanent dx: glioblastoma) (0 slides)
61. Pineal-type parenchyma with calcifications, no definitive lesion seen (permanent dx: pineal cyst) (0 slides)
62. Brain with infiltrating by cells of patient's known astrocytoma (permanent dx: recurrent/residual infiltrating astrocytoma) (0 slides)
63. Schwannoma (0 slides)
64. Suggestive of myxopapillary ependymoma (permanent dx: Schwannoma with abundant myxoid change) (0 slides)
65. Pituitary adenoma (0 slides)
66. Atypical lymphoid infiltrate consistent with follicular lymphoma (permanent dx: follicular lymphoma, follicular pattern) (0 slides)
67. Atypical lymphoid lesion, favor Hodgkin lymphoma (permanent dx: nodular lymphocyte predominant Hodgkin lymphoma) (0 slides)
68. Lymphoid tissue present (permanent dx: lymph node with reactive hyperplasia) (0 slides)
69. Reactive appearing lymph node (permanent dx: reactive lymphoid hyperplasia) (0 slides)
70. Diffuse large B-cell lymphoma with extensive lymphovascular invasion and necrosis (0 slides)
71. Atypical lymphoid infiltrate. No carcinoma identified (permanent dx: follicular lymphoma, follicular pattern) (0 slides)
72. Atypical lymphoid infiltrate (permanent dx: classic Hodgkin lymphoma, favor mixed cellularity type) (0 slides)
73. Consistent with lymphoma (permanent dx: Splenic B-cell lymphoma/leukemia, unclassifiable) (0 slides)
74. Favor thymoma, type A (permanent dx: thymoma, type A) (0 slides)
75. Fibroma of tendon sheath versus collagen fibroma (permanent dx: collagenous fibroma) (0 slides)
76. Subcutaneous nodule with marked acute and chronic inflammation and atypical stromal cells most suggestive of myxoinflammatory fibroblastic sarcoma (0 slides)
77. Chordoma (0 slides)
78. Myxoma (0 slides)
79. Neurofibroma (permanent dx: diffuse neurofibroma) (0 slides)
80. Spindle cell lipoma (0 slides)
81. Malignant neoplasm (permanent dx: diffuse large B-cell lymphoma) (0 slides)
82. Metastatic carcinoma (permanent dx: metastatic carcinoma, consistent with mammary primary) (0 slides)
83. Schwannoma (0 slides)
84. Giant cell tumor of bone (0 slides)
85. Granulomatous inflammation and fibrosis (permanent dx: Subcutaneous tissue with histiocytic inflammation, fibrosis, fat necrosis, perivascular lymphocytic infiltrate, and dystrophic calcifications; there is no evidence of malignancy) (0 slides)
86. Endometriosis (0 slides)
87. Plasma cell neoplasm with abundant amyloid (0 slides)
88. Tubal ectopic pregnancy (0 slides)
89. Mucinous carcinoma with signet ring cells (Krukenberg tumor) (0 slides)
90. Fibroma with infarct and edema (0 slides)
91. Infarcted Brenner tumor (0 slides)
92. *Slide 1 and 2 (ovary): Adenocarcinoma (permanent dx: low grade serous carcinoma) *Slide 3 (anterior uterine peritoneum): Scant atypical epithelium with abundant psammoma bodies (permanent dx: metastatic low grade serous carcinoma) (0 slides)
93. Hyalinized cyst wall with abundant pigmented macrophages (permanent dx: hyalinized cyst wall with abundant pigmented macrophages and few endometrial glands with stroma consistent with endometriotic cyst) (0 slides)
94. Atypical endometrial hyperplasia. No invasive carcinoma present. (0 slides)
95. Atypical endometrial hyperplasia. (0 slides)
96. Invasive adenocarcinoma with high-grade malignancy ?PNET (permanent dx: small cell carcinoma (neuroendocrine type) in a background of invasive endometrioid adenocarcinoma, grade 1 of 3). (0 slides)
97. Sex cord stromal tumor (permanent dx: adult granulosa cell tumor) (0 slides)
98. Endometriosis with polypoid appearance (0 slides)
99. Cellular thecoma with cystic degeneration (0 slides)
100. Trabecular carcinoid (0 slides)
101. Benign spindle cell neoplasm, favor fibroma (permanent dx: fibroma) (0 slides)
102. Serous borderline tumor (0 slides)
103. High grade serous carcinoma (0 slides)
104. Immature teratoma, high grade (0 slides)
105. Adenocarcinoma (permanent dx: clear cell carcinoma) (0 slides)
106. Serous cystadenofibroma (0 slides)
107. Serous borderline tumor (0 slides)
108. Mucinous tumor with focal borderline areas (<10%) with Brenner tumor (0 slides)
109. Clear cell carcinoma (0 slides)
110. Mature cystic teratoma with struma ovarii (0 slides)
111. Cellular dense collagenous tissue (permanent dx: nodular fasciitis) (0 slides)
112. Squamous lined tissue with chronic inflammation suggestive of keratocystic odontogenic tumor (permanent diagnosis: keratocystic odontogenic tumor) (0 slides)
113. Inflammatory polyp (0 slides)
114. Fibro-osseous lesion most consistent with fibrous dysplasia (0 slides)
115. Squamous mucosa with sialometaplasia (0 slides)
116. *Slide 1 (epiglottis): Atypical squamoproliferative lesion with intraepithelial acute inflammation and focal dyskeratosis. Although worrisome, there are no overt features of malignancy (permanent dx: squamous mucosa with intramucosal acute and chronic inflammation and extensive reactive changes) *Slide 2 (Left supraglottis): Invasive squamous cell carcinoma (0 slides)
117. Invasive fungal sinusitis with vascular and stromal invasion (0 slides)
118. Numerous psammoma bodies consistent with metastatic papillary thyroid cancer (0 slides)
119. Chronic lymphocytic thyroiditis (0 slides)
120. Squamous mucosa with underlying hemorrhage and foreign body giant cell reaction with no evidence of neoplasm (0 slides)
121. Schneiderian papilloma, inverted type (0 slides)
122. Infiltrating carcinoma with polypoid granulation tissue (permanent dx: invasive squamous cell carcinoma, non-keratinizing) (0 slides)
123. Benign fibro-osseous lesion (0 slides)
124. Pleomorphic adenoma (0 slides)
125. Odontogenic keratocyst (0 slides)
126. Benign cystic tumor consistent with serous cystadenoma (permanent dx: multiloculated serous cystadenoma) (0 slides)
127. Adenocarcinoma with perineural invasion (0 slides)
128. Adenocarcinoma (permanent dx: poorly differentiated metastatic adenocarcinoma consistent with pancreatic primary) (0 slides)
129. Endometriosis (0 slides)
130. There is no evidence of malignancy (0 slides)
131. Bile duct hamartoma (0 slides)
132. Chronic cholecystitis with adenomyomatous hyperplasia (0 slides)
133. Metastatic adenocarcinoma (0 slides)
134. Dense fibrous tissue with lymphohistiocytic chronic inflammation, necroinflammatory debris and reactive changes compatible with prior therapy; negative for malignancy (0 slides)
135. Highly atypical ductal cells suspicious for malignancy (permanent dx: adenocarcinoma consistent with gallbladder cancer) (0 slides)
136. Positive for carcinoma (0 slides)
137. Neuroendocrine neoplasm (permanent dx: well-differentiated neuroendocrine tumor) (0 slides)
138. Adenomyomatous changes; there is no evidence of malignancy (0 slides)
139. Bile duct hamartoma (0 slides)
140. Adenoma with high grade dysplasia. (0 slides)
141. Simple hepatic cyst (0 slides)
142. Adenocarcinoma with focal superficial invasion of the lamina propria (0 slides)
143. Fat necrosis; there is no evidence of malignancy (0 slides)
144. Neuroendocrine tumor (permanent dx: well-differentiated neuroendocrine tumor) (0 slides)
145. Genitourinary (29 slides)
146. Pulmonary Pathology (20 slides)
147. Neuropathology (38 slides)
148. Hematopathology (9 slides)
149. Bone and Soft Tissue (13 slides)
150. Gynecologic (32 slides)
151. Head and Neck (18 slides)
152. Gastrointestinal (22 slides)