ABSTRACT
Background: Frozen Sections (FS) are used to assess margins, for staging, and primary diagnosis. FS guide intraoperative treatment decisions in oncological gastro-intestinal tract surgeries and further management of the patients. Aim: To analyze the distribution, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of frozen sections in gastrointestinal pathology in our institution during the period of 3 years (2016–2018). Material and Methods: This study was an audit to determine the accuracy of FS reports by comparing them with the paraffin section (PS) reports. The FS diagnoses and their PS diagnoses were noted in 1704 gastrointestinal surgeries during the period from 2016 to 2018. Discrepancies were noted and slides of discrepant cases were reviewed to determine the cause. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated using the standard formulae. Results: Out of 1704 cases, correct diagnosis on frozen section was made in 1649 cases (96.77%), 20 (1.17%) were deferred cases, and 35 (2.05%) were discrepant cases. The commonest discrepancies were seen in the primary diagnosis of the gall bladder and gastrectomy margins. The commonest causes for discrepancies were interpretation errors and technical errors. Sensitivity was 91.71%, specificity was 99.69%, positive predictive value was 98.84%, negative predictive value was 97.68%, and accuracy was 97.92%. Conclusion: FS diagnosis is a reliable guide to surgeons for intraoperative management. Studying deep cuts and careful sampling at frozen sections will help reduce discrepancies.
ABSTRACT
Primary hepatic epithelioid hemangioendothelioma (HEHE) is a rare tumor with an incidence of <0.1 per 100,000. The clinical course is variable with variable outcomes. Due to its rarity, treatment protocols, prognostic and predictive factors are not well established underscoring the need for such a study. Pathologists’ awareness of this entity, a meticulous morphologic examination coupled with immunohistochemistry can aid in accurate diagnosis.
ABSTRACT
AIM: The outcome of patients with advanced gastrointestinal stromal tumor (GIST) has improved with the use of imatinib. Despite high response rates with this drug resistance eventually develops in nearly all patients. We present an analysis of prospectively collected data on sunitinib efficacy and safety in patients with imatinib‑resistant GIST. SUBJECTS AND METHODS: Between November 2006 and October 2007, patients with GIST were accrued in an approved sunitinib patient access protocol. Key eligibility criteria included tumor resistance to imatinib and/or patient intolerance to this drug. Patients received sunitinib at a starting dose of 50 mg once daily for 4 weeks in a 6 week cycle, with standardized dose modification titrated to toxicity. Patients were continued on sunitinib until disease progression or unacceptable toxicity. The endpoints were safety, overall survival (OS) and objective response rate (ORR). RESULTS: Fifteen patients, all of whom had imatinib resistance and none intolerance, with median age of 48 (26–69) years, were treated on the protocol. The most common sites of primary disease were small intestine (40%), stomach (26.7%) and retroperitoneal (26.7%). A median of 10 (1–47) cycles of sunitinib were delivered, 9 (60%) patients required dose reductions due to toxicity whereas dose delay of > 2 weeks was required in only one (6.7%) patient. There were no toxicity‑related drug discontinuations. Hypothyroidism (n = 4; 26.7%) and hand‑foot syndrome (n = 3; 20%) were the most common toxicities. There were no complete and 4 (26.7%) partial responses while prolonged disease stability was seen in 8 (53.3%) patients. At a median follow‑up of 81 months in surviving patients, the median progression‑free and overall survivals were 15.5 and 18.7 months, respectively. CONCLUSIONS: Sunitinib appears to be an effective and well‑tolerated treatment for Indian patients with imatinib‑resistant GIST with outcomes similar to that reported previously. Adverse effects can be reasonably well managed using a dose modification strategy.
ABSTRACT
A 16-year old female presented to hospital with abdominal pain. Features on computed tomography raised the possibility of biliary cystadenoma or cystadenocarcinoma. She underwent a liver resection, and histopathology confirmed a serous biliary cystadenoma. This case is presented to highlight the radiological features of this uncommon pre-malignant condition as well as to summarize a management algorithm for cystic liver lesions.
Una mujer de 16 años de edad acudió al hospital con un dolor abdominal. Las características observadas con tomografía computarizada apuntaban a un cistoadenoma biliar o un cistoadenocarcinoma como diagnósticos diferenciales. La paciente fue sometida a una resección del hígado, y la histopatología confirmó un cistoadenoma biliar seroso. Presentamos este caso para resaltar los rasgos radiológicos de esta condición premaligna rara, así como para resumir un algoritmo de tratamiento para las lesiones císticas de hígado.