Tuesday, April 8, 2008

Best Post of October '07

Back when I started this blog in October of 2007, I had no readers. Now, after about six months, I have almost no readers. So, for those of you who were not with me from the beginning, I will be featuring occasional "Best of ..." posts for each of the months that this blog has been on-line.

Here's an abbreviated version of the best post of October '07:

Frozen/Permanent discrepency article in Archives of Pathology.
This article in the October '07 issue of Archives of Pathology and Laboratory Medicine, by Plesec and Prayson at the Cleveland Clinic, looks at 57 instances of CNS tumor frozen sections (out of a pool of 2156 cases) where a diagnostic discrepancy was found between frozen and later permanent sections. Of those 57, the authors were able to identify a few pitfalls that one should be aware of when attempting to make a diagnosis at frozen section.

Important tips to be gleaned from this article include: 1. Perivascular hemosiderin deposition is more likely to be seen in schwannomas as opposed to meningiomas; 2. Consider CNS lymphoma when contemplating a frozen section diagnosis of small cell glioblastoma; 3. Consider sarcoma when contemplating a frozen section diagnosis of schwannoma.

Finally, to quote the authors: "The discrepencies did not significantly impact patient management in any of the cases because postoperative management was predicated on the final diagnosis." That goes to show you how important our frozen section diagnoses are!!!


Adam King said...

As one of the "almost no readers," I'd like to make the comment that I'm glad to not be reading this right now. LMAO

Brian E. Moore, MD (left) said...

You, sir, are among an elite group with impeccable taste in blogs.

agent 86 said...

1. About time you got a picture of RAP up. All NP fellows should take a week off to peruse the Prayson canon.

2. The hemosiderin thing is quite an underappreciated pearl of wisdom. Amyn Rojiani presented a study on this a few years ago at AANP meeting, but I don't know if a full length publication is available.

3. In some parts, PCNSL and small cell GBMs receive distinct intraopertive approaches. On the other hand, these probably aren't ultimately critical to patient outcomes.

Missed you in SD!

jd said...

AGENT 86, ROCK STAR!!!!!!!!!