Pitfalls in Frozen Section: A Case of Incidental Papillary Mesothelioma

Our plain-English summary of Pitfalls in Frozen Section: A Case of Incidental Papillary Mesothelioma, by E. Shkolnik, J. Marcus, D.S. Heller (International Journal of Surgical Pathology, 2021).

The study

• Authors: E. Shkolnik, J. Marcus, D.S. Heller
• Journal: International Journal of Surgical Pathology
• Published: 2021;29(8):844-846
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Well-differentiated papillary mesothelioma is an uncommon benign, although potentially recurrent mesothelial lesion that occurs in the peritoneum of women over a wide age range. We recently encountered an incidental case sent for frozen section at the time of hysterectomy for endometrial carcinoma. Familiarity with this lesion will help prevent overinterpretation as a serous carcinoma.

In plain English

This article was a case report about one patient. A 37-year-old female had a robotic hysterectomy for a noninvasive grade I endometrial adenocarcinoma, a cancer of the lining of the uterus, after medical treatment failed. During surgery, surgeons saw several nodules in the pelvis, the largest 1.5 cm, and asked for a frozen section, a rapid microscope examination done during the operation. On frozen section, pathologists read the nodules as a low-grade papillary growth that favored mesothelial origin and deferred the final diagnosis. On permanent sections, the nodules were diagnosed as well-differentiated papillary mesothelioma (WDPM). Stains for AE1/3, CK7, WT-1 and calretinin were consistent with mesothelial origin. The article did not report whether this patient had any asbestos exposure. Its background section said that WDPM mostly occurs in young women without a history of asbestos exposure. The authors concluded that diagnosing WDPM at frozen section can be challenging, but that if suspected it can at least be raised as a possibility, as happened in this case.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 37-year-old female who had a robotic hysterectomy for noninvasive International Federation of Gynecology and Obstetrics grade I endometrial adenocarcinoma. Reported by authors at Rutgers-New Jersey Medical School, Newark, NJ, USA. Dates not given.
• Exposure: Not reported. The article gives no information about asbestos or any other exposure for this patient. Its introduction states, as general background, that WDPM predominantly occurs in young women without a history of asbestos exposure.
• Main results:
  • During surgery, multiple pelvic nodules were found, the largest 1.5 cm, and a frozen section was requested.
  • On frozen section, the pelvic nodules were interpreted as a low-grade papillary proliferation favoring mesothelial origin, and the final diagnosis was deferred to permanent sections.
  • On permanent sections, the pelvic nodules were interpreted as well-differentiated papillary mesothelioma (WDPM).
  • Immunohistochemistry showed staining for AE1/3, cytokeratin 7 (CK7), wilms tumor-1 (WT-1) and calretinin, which the authors described as consistent with mesothelial origin.
• The authors' conclusion: The authors concluded that diagnosing WDPM at frozen section can be challenging, but that if suspected it can at least be raised in the differential diagnosis, as in their case.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Frozen Section, Well-Differentiated Papillary Mesothelioma, Peritoneum, Carcinoma.

Related studies

• Incidental finding of multiple well-differentiated papillary mesotheliomas in peritoneum — M. Jakobsen, B. Engvad, et al. (2016)
• Collagenous Spherulosis in Well-Differentiated Papillary Mesothelioma in a Female With Multilocular Peritoneal Inclusion Cysts — B. AbdullGaffar, L.G. Raman (2019)
• Quality of life after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: a prospective study of 216 patients — G. Passot, N. Bakrin, et al. (2014)
• Simultaneous occurrence of a rectal carcinoma and a diffuse well differentiated papillary mesothelioma of the peritoneum — G.R. Jatzko, J. Jester (1997)
• Simultaneous bilateral spontaneous pneumothorax in a patient with peritoneal and pleural papillary mesothelioma — P. Höllinger, D. Gaeng (1997)
• Can pulmonary sclerosing haemangioma be accurately diagnosed by intra-operative frozen section? — A.C. Chan, J.K. Chan (2002)

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