Diagnostic accuracy of frozen section in Central nervous system lesions, a 10-year study.

How to Cite This Article: Khoddami M, Akbarzadeh A, Mordai A, Bidari Zerehpoush F, Alipour H, Samadzadeh S, Alipour B.Diagnostic Accuracy of Frozen Section of Central Nervous System Lesions: A 10-Year Study. Iran J Child Neurol. 2015 Winter;9(1):25-30. AbstractObjectiveDefinitive diagnosis of the central nervous system (CNS) lesions is unknown prior to histopathological examination. To determine the method and the endpoint for surgery, intraoperative evaluation of the lesion helps the surgeon.In this study, the diagnostic accuracy and pitfalls of using frozen section (FS) ofCNS lesions is determined.Materials & MethodsIn this retrospective study, we analyzed the results of FS and permanent diagnoses of all CNS lesions by reviewing reports from 3 general hospitals between March 2001 and March 2011.Results273 cases were reviewed and patients with an age range from 3 to 77 years of age were considered. 166 (60.4%) had complete concordance between FS and permanent section diagnosis, 83 (30.2%) had partial concordance, and 24 cases (9.5%) were discordant. Considering the concordant and partially concordant cases, the accuracy rate was 99.5%, sensitivity was 91.4%, specificity was 99.7%, and positive and negative predictive values were 88.4% and 99.8%, respectively.ConclusionOur results show high sensitivity and specificity of FS diagnosis in the evaluation of CNS lesions. A Kappa agreement score of 0.88 shows high concordance for FS results with permanent section. Pathologist’s misinterpretation, small biopsy samples (not representative of the entire tumor), suboptimal slides, and inadequate information about tumor location and radiologic findings appear to be the major causes for these discrepancies indicated from our study. ReferencesTaxy JB, Anthony G. Biopsy interpretation: the frozen section. 1st ed. China: Lippincott Williams & Wilkins; 2010. P.301-3.Somerset HL, Kleinschmidt-DeMasters BK. Approach to the intraoperative consultation for neurosurgical specimens. Adv Anat Pathol 2011; 18:446-9. doi: 10.1097/ PAP.0b013e3182169934.Regragui A, Amarti Riffi A, Maher M, El Khamlichi A, Saidi A. Accuracy of Intraoperative diagnosis in central nervous system tumors: report of 1315 cases. Neurochirurgie 2003; 49(2-3 Pt 1):67-72.Plesec TP, Prayson RA. Frozen section discrepancy in the evaluation of central nervous system tumors. Arch Pathol Lab Med 2007; 131:1532-40.Savargaonkar P, Farmer PM. Utility of intra-operative consultations for the diagnosis of central nervous system lesions. Ann Clin Lab Sci 2001; 31:133-9.Talan-Hraniloviæ J, Vuèiæ M, Ulamec M, Belicza M. Intraoperative frozen section analysis in of the central nervous system and pituitary gland pathology. Acta Clin Croat 2005; 44:217-21.Roessler K, Dietrich W, Kitz K. High diagnostic accuracy of cytologic smears of central nervous system tumors. A 15-year experience based on 4,172 patients. Acta Cytol 2002; 46:667-74.Ud Din N, Memon A, Idress R, Ahmad Z, Hasan S. Central Nervous System Lesions: Correlation of  Intraoperative and Final Diagnoses, Six Year Experience at a Referral Centre in a Developing Country, Pakistan. Asian Pac J Cancer Prev 2011; 12:1435-7.Burger PC, Scheithauer BW. Tumors of the Central Nervous System. In: AFIP Atlas of Tumor Pathology Series 4. Washington DC: American Registry of Pathology; 2007.Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO Classification of Tumours of the Central Nervous System. Acta Neuropathol. 2007; 114: 97–109. doi: 10.1007/s00401- 007-0243-

Tumors of the Central Nervous System: An 18-Year Retrospective Review in a Tertiary Pediatric Referral Center

How to Cite This Article: Aghayan Golkashani H, Hatami H, Farzan A, Mohammadi HR, Nilipour Y, Khoddami M, Jadali F. Tumors of the Central Nervous System: An 18-Year Retrospective Review in a Tertiary Pediatric Referral Center. Iran J Child Neurol. Summer 2015;9(3):24-33. AbstractObjectiveFew studies exist on the demographics and trends of pediatric central nervous system (CNS) tumors in Iran. In this study, we retrospectively reviewed all cases with confirmed CNS tumors admitted to Mofid Pediatric Hospital, Tehran, Iran during the last 18 years.Materials & MethodsData on gender, age of diagnosis, pathologic classification and tumor location were extracted from the available medical records. We used the last version of International Classification of Childhood Cancer.ResultOverall, 258 (81.9%) brain tumors and 57 (18.1%) spinal tumors were identified.Our subjects comprised of 147 (46.7%) female and 168 (53.3%) male children.More male dominancy was observed in brain tumors with a male to female ratio of 1.2 compared with 1.03 of spinal tumors. Malignant CNS tumors were most common in 1-4 yr age group. The four most common brain tumors in our subjects were astrocytomas, medulloblastoma, ependymoma and craniopharyngioma.Overall, 53.1% of the brain tumors were supratentorial. Gliomas, PNET and neuroblastma were the most frequent primary spinal tumors in our study. We observed an increasing trend for both brain and spinal tumors that was more remarkable in the last 5 years.ConclusionOur results are comparable with similar single center studies on CNS tumors during childhood. The observed disparities could be attributed to the single center nature of our study and geographical, environmental and racial variations in pediatric CNS tumors. The increasing trend of both brain and spinal tumors could warrant further investigations at provincial and national levels to investigate probable contributing environmental risk factors.

Multifocal kaposiform hemangioendothelioma of soft tissue with bilateral pulmonary involvement in an adolescent

Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular tumor of intermediate malignancy with resemblance to Kaposi sarcoma. It occurs predominantly in pediatric age groups as a cutaneous lesion with focal infiltration into the adjacent soft tissue and bone. Although visceral involvement is very uncommon, several cases with bone, retroperitoneal, or mediastinal involvement have been described. KHE has been reported to occasionally occur in unusual sites such as the thymus, tonsils, larynx, paranasal sinuses, deltoid muscle, spleen, uterine cervix, thoracic spine, and even the breast. Multifocal KHE is an extremely rare entity with few reports available in the literature, none of which describes pulmonary involvement. Herein, we report a unique case of multifocal KHE in a 13-year-old boy presenting with a huge soft tissue mass in the upper extremity complicated by bilateral pulmonary nodules that developed into large, necrotic tumor masses

Diagnostic Accuracy of Frozen Section in Ovarian Tumors: A 12-Year Review

ABSTRACT Background and objective: To determine the diagnostic accuracy and pitfalls of frozen section in ovarian tumors in one of the largest university affiliated gynecologic oncology centers in Tehran, and determine the cause of discrepancies. Materials and Methods: We retrospectively analyzed the results of frozen section and permanent diagnoses of ovarian masses by reviewing the reports in the department of Pathology of Imam Hussein Hospital from 1997 to 2009. Results: Among 1498 cases of ovarian lesions, only 187 patients had both frozen and paraffin section diagnoses (age range 10-82 yr). 71.7% of these cases had complete concordance, 26.7% had partial and 1.6% had no concordance. The overall sensitivity and specificity of frozen section diagnosis were 100% and 99.3%, respectively. The sensitivity of frozen section diagnosis for benign, borderline, and malignant lesions was 99.3%, 100% and 94.9%; and the specificities were 100%, 98.9% and 99.3% respectively. Conclusion: Our results show high sensitivity and specificity of frozen section diagnosis in ovarian masses. Pathologist's misinterpretation was the only cause of discrepancies

Hodgkin's Lymphoma Presenting with Myocardial Metastasis and Heart Failure

ABSTRACT Although involvement of the heart by malignant lymphoma is relatively common, it is unusual to be detected premortem. We report a case of Hodgkin's lymphoma who presented with systemic signs and symptoms including abdominal distension, weakness, pallor, chills and fever, hepatosplenomegaly and generalized lymphadenopathy as well as signs of heart failure. Echocardiography revealed lucent myocardial lesions, pericardial effusion, and left ventricular hypertrophy. Right cervical lymph node and bone marrow biopsies established the diagnosis of nodular sclerosis Hodgkin's lymphoma with bone marrow involvement. After 14 periods of chemotherapy, systemic and cardiac abnormalities improved. To the best of our knowledge, Hodgkin's lymphoma primarily presenting with myocardial metastasis and heart failure is not previously reported

Ciliated Hepatic Foregut Cyst: Two Case Reports in Children and Review of the Literature

Ciliated hepatic foregut cyst (CHFC) is a rare lesion which originates from detached hepatic diverticulum or from detachment and migration of buds from the esophageal and bronchial regions of the foregut which subsequently get entrapped by the liver during the early embryonic development of the foregut. CHFCs are mostly seen in adults and are rarely reported in children, with only about 10 cases reported in this age group. Hereby, we present two cases of CHFC in two 3.5-year-old boys; one of them had cystic lesion at medial segment of left lobe of liver (common site), and in the other one it was located at right lobe of liver (less common site). Histologically, both cysts had four layers composed of inner ciliated, pseudostratified, columnar epithelium; subepithelial connective tissue; smooth muscle layer; and an outer fibrous layer

Congenital Pleomorphic Adenoma in a Submandibular Gland of a Newborn- A Case Report

Introduction: Pleomorphic adenoma is a rare benign salivary gland neoplasm in children, which can be treated by simple excision. This tumor is rarely included in the differential diagnosis of solid submandibular masses in children. In the neonates, congenital pleomorphic adenoma usually presents in the nasopharynx. Surgical excision is the treatment of choice and recurrence is not expected. We report what appears to be the first case of congenital pleomorphic adenoma in the submandibular region in a one-day-old newborn.   Case Report: The case of a one-day-old term baby is presented with a 5x2 cm left submandibualr mass with extension to the oral cavity. The mass was hard and non-mobile. During Ultrasonography and Contrast-enhanced Computed Tomography (CT) scan, the mass was solid with a heterogeneous internal structure. The tumor was completely excised and proved to be a pleomorphic adenoma during histopathological examination.   Conclusion:  Congenital pleomorphic adenoma rarely occurs in the nasopharynx and is treated by surgical excision. Our case is unique because the congenital pleomorphic adenoma is located in the submandibular gland of a newborn

Abdominal Neuroblastoma and Early Onset Acinetobacter Septicemia in a Newborn

Background: Neonatal sepsis is a leading cause of mortality and morbidity in the first month of life. The underlying risk factors for early-onset infection (in the first 3 days of life) are prematurity, low birth weight, maternal history of infection, difficult delivery, male gender, twin pregnancy, and congenital malformations. Acinetobacter is a nosocomial infection and rarely caused the early-onset-sepsis and meningitis. The most common neonatal tumor is neuroblastoma; however, it is not defined as a risk factor for early-onset sepsis.  Case  report: A 13-day-old newborn female was referred to our hospital due to ventriculitis, persistent meningitis, and an abdominal mass. She was a term neonate delivered by cesarean section from a mother with a nearly normal pregnancy with no complications, such as chorioamnionitis, prolonged rupture of membrane, urinary tract infection, preeclampsia, and diabetes.  A fetal abdominal mass was detected on the left kidney in prenatal sonography. The patient was admitted to the Neonatal Intensive Care Unit in the first minutes of life because of respiratory distress and cyanosis. Subsequently, mechanical ventilation, endotracheal surfactant instillation, and antibiotic therapy were prescribed. Due to the deterioration of the general condition, fever, seizure, and hematuria on the third day, sepsis workup and changing the antibiotics were performed. Blood culture and cerebrospinal fluid (CSF) were positive for Acinetobacter baumannii. Persistent positive CSF culture led to the diagnosis of ventriculitis which was confirmed by brain computed tomography scan (CTS) and ventricular tap. The condition of the patient got better after intraventricular amikacin injection in addition to intravenous colistin and piperacillin.  Postnatal sonography and CTS confirmed the abdominal neuroblastoma. Chemotherapy was initiated after the complete treatment of sepsis, meningitis, and ventriculitis. This case report presents a term and female neonate with early-onset neonatal sepsis and  meningitis, caused by an unusual microorganism, and a prenatal history of abdominal neuroblastoma. Conclusion: By this case report, the clinicians are suggested to consider the Acinetobacter baumannii as the cause of fulminant sepsis and meningitis in a term neonate with no underlying risk factors for infection.   Keyword