Study of Frozen Section and Lymph Node in Management of Mucinous Ovarian Tumors

ObjectivesIntraoperative frozen section has greater than 90% accuracy for ovarian tumors; however, mucinous histology has been shown to be associated with increased frozen section inaccuracy. Recent data demonstrate that primary ovarian mucinous carcinomas have no lymph node involvement, even when extraovarian disease is present, and therefore may not require lymph node dissection. Our primary objective is to evaluate the accuracy of identifying mucinous histology on frozen section.Methods/MaterialsA cross-sectional review of mucinous ovarian tumors in surgical patients at one institution from 2006 to 2016 was performed. Cases reporting a mucinous ovarian tumor on frozen section or final pathology were identified. Frozen section results were compared with final diagnosis to calculate concordance rates. Analyses with χ2 and t tests were performed to identify variables associated with pathology discordance.ResultsA total of 126 mucinous ovarian tumors were identified. Of these, 106 were reported as mucinous on frozen section and 103 (97.2%) were concordant on final pathology. Discordant cases included 2 serous and 1 clear cell tumor. Among the 103 mucinous tumors, classification as malignant, borderline, or benign was concordant in 74 (71.8%) of 103 cases, whereas 22 (21.4%) of 103 were discordant and 7 (6.8%) were deferred to final pathology. Lymph node dissection was performed in 33 cases; the only case with lymph node metastasis was a gastrointestinal mucinous adenocarcinoma. Discordance between frozen section and final pathology was associated with larger tumor size and diagnosis other than benign: discordant cases had a mean tumor size of 21.7 cm compared with 14.4 cm for concordant cases (P < 0.001), and 93.5% of discordant cases were borderline or malignant, compared with 30.5% of concordant cases (P < 0.001).ConclusionsIntraoperative identification of mucinous histology by frozen section is reliable with a concordance rate to final pathology of 97.2%. No lymph node metastases were present in any malignant or borderline primary ovarian cases.

Download Full-text

Mucinous ovarian tumors and the importance of frozen section biopsy

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2018.08.337 ◽

2019 ◽

Vol 234 ◽

pp. e83

Author(s):

Konstantinos Ntzeros ◽

Nikolaos Thomakos ◽

Ioannis Papapanagiotou ◽

Maria Sotiropoulou ◽

Alexandros Rodolakis ◽

...

Keyword(s):

Frozen Section ◽

Ovarian Tumors ◽

Mucinous Ovarian Tumors

Download Full-text

Collision tumor of ovary: a case report on bilateral dermoid cyst with co-existing unilateral mucinous cystadenoma

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20202764 ◽

2020 ◽

Vol 9 (7) ◽

pp. 3078

Author(s):

Sowmya Sampurna Maddipati ◽

Sudha C. P. ◽

Sowmya K.

Keyword(s):

Case Report ◽

Dermoid Cyst ◽

Frozen Section ◽

Mucinous Cystadenoma ◽

Cystic Teratoma ◽

Collision Tumor ◽

Ovarian Tumors ◽

Favourable Prognosis ◽

Benign Cystic Teratoma ◽

Mucinous Ovarian Tumors

A collision tumor is the coexistence of two adjacent, but histologically distinct tumors without histological admixture in the same tissue or organ. Such tumors have often been reported in various organs, but location in the ovary is rare. The juxtaposition with dermoid cysts has been reported as comprising approximately 5% of benign mucinous ovarian tumors and rare examples of proliferating mucinous tumors. Authors are reporting a case of collision tumor which included benign mucinous cystadenoma and benign cystic teratoma. The gynecologists and pathologists should be aware of such combination of tumors. The case was diagnosed post-operatively. It is important to correctly diagnose the component of tumor for further management and favourable prognosis. Frozen section intra-operatively plays an important role in diagnosing such tumors.

Download Full-text

Accuracy of frozen section in the diagnosis of mucinous ovarian tumors

Gynecologic Oncology ◽

10.1016/j.ygyno.2015.01.269 ◽

2015 ◽

Vol 137 ◽

pp. 109

Author(s):

A. Tranoulis ◽

N. Thomakos ◽

D. Haidopoulos ◽

M. Sotiropoulou ◽

N. Kathopoulis ◽

...

Keyword(s):

Frozen Section ◽

Ovarian Tumors ◽

Mucinous Ovarian Tumors

Download Full-text

Lymphadenectomy for early-stage mucinous ovarian carcinoma

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001817 ◽

2020 ◽

Vol 31 (1) ◽

pp. 104-109

Author(s):

Quetrell D Heyward ◽

Dimitrios Nasioudis ◽

Lori Cory ◽

Ashley F Haggerty ◽

Emily M Ko ◽

...

Keyword(s):

Lymph Node ◽

Ovarian Carcinoma ◽

Lymph Node Metastases ◽

Early Stage ◽

Regional Lymph Node ◽

Ovarian Tumors ◽

Stage Ia ◽

Node Metastases ◽

Mucinous Ovarian Tumors ◽

Mucinous Ovarian Carcinoma

ObjectivesThere is evidence to suggest that the rate of lymph node metastases in patients with ovarian mucinous tumors is rare. The objective of this study was to investigate the prevalence of regional lymph node metastases among patients with apparent stage IA and IC mucinous ovarian carcinoma.MethodsA retrospective cohort study was performed and included patients from the National Cancer Database with apparent stage IA and IC mucinous ovarian tumors who underwent surgery between January 1, 2004 and December 31, 2015. Data collected included demographics, surgical procedures, and pathologic characteristics. The primary outcome was the effect of tumor stage, grade, and size on the risk of lymph node metastases. Categorical and continuous variables were compared using the χ2 and Mann–Whitney U tests, respectively.ResultsA total of 4379 patients were identified: 3088 and 1213 with stage IA and IC disease, respectively, with an additional 78 patients who were stage I Not Otherwise Specified (NOS). Lymphadenectomy was performed in 70.6% of patients with stage IA and 70.3% of patients with stage IC cancers. Stratifying by grade, 68.4%, 71.3%, and 72.8% of patients with grades 1, 2, and 3 tumors underwent a lymphadenectomy, respectively. Furthermore, lymphadenectomy was performed in 64.9% of patients with tumors <10 cm and 72.4% with tumors >10 cm. Lymph node metastases were identified in 1.2% and 1.6% of patients with stage IA and IC disease, respectively (p=0.063). Additionally, metastases were present in 0.6% of patients with grade 1 tumors, 1.1% of patients with grade 2 tumors, and 5.3% of patients with grade 3 tumors (p<0.001). Lastly, 0.9% of patients with tumors <10 cm and 1.4% of patients with tumors >10 cm had lymph node metastases (p=0.19).ConclusionsAmong patients with mucinous ovarian carcinoma, lymph node metastases are rare. However, metastases are significantly more common in patients with higher grade tumors. These factors may be considered when making decisions regarding the need for lymphadenectomy in early-stage mucinous ovarian tumors.

Download Full-text