Approach to Common Gynecologic Frozen Sections

Course overview

Intraoperative evaluation of gynecologic specimens by frozen section evaluation remains one of the most challenging areas of surgical pathology. The most common types of gynecologic specimens evaluated are uterine tumors (specifically, endometrioid type endometrial carcinomas) and ovarian masses. In the context of endometrial carcinoma, lymph node status is the most prognostically important piece of information that the pathologist needs to provide the surgeon, and many factors will influence whether or not the surgeon will perform a complete lymphadenectomy. In many cases, dissection of endometrial sentinel lymph nodes (SLNs) will be the course of action the surgeon pursues. In cases where SNL dissection is not performed, the pathologist needs to be able to evaluate an endometrial tumor via frozen section and know what questions need to be answered to help guide the surgeon's management. In the context of ovarian masses, the pathologist is often providing the primary diagnosis via frozen section evaluation; thus, the pathologist needs to come to the intraoperative evaluation well-armed with a knowledge of clinical history and imaging findings, as well as a knowledge of what gross and microscopic features favor a primary ovarian neoplastic process versus metastasis (specifically when evaluating mucinous neoplasms). After this presentation, participants will be able to: -Discuss what information pathologists are expected to provide the surgeon during the intraoperative evaluation of uteri for endometrial carcinoma. -Describe the how and why an evaluation of the endometrial sentinel lymph node is performed and implemented in staging of endometrial carcinomas. -Review the gross and microscopic findings pathologists need to be familiar with in order to make an intraoperative distinction between primary and metastatic mucinous neoplasms involving the ovary.