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Intraoperative Evaluation of the Gastrointestinal Tract

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Frozen Section Pathology

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Abstract

Intraoperative consultation for diseases of the luminal gut can facilitate the immediate management of surgical patients in several situations. Most of the tubular gut is easily accessible to endoscopic evaluation, and, thus, many patients have an established diagnosis prior to surgery. The most common indication for intraoperative consultation of the tubular gut is evaluation of resection margins in the setting of neoplasia. Frozen sections may also be used to establish a primary diagnosis when lesions are not amenable to endoscopic evaluation, intraoperative findings raise the possibility of malignancy, or incidental peritoneal nodules are detected during cancer operations. Frozen sections are performed in the latter situation to exclude the possibility of metastatic disease; many patients with stage IV disease do not benefit from resection of the primary tumor. Lastly, the intraoperative evaluation of patients with possible Hirschsprung disease relies heavily on pathologists to identify the extent of aganglionosis in order to optimize extent of resection. It is important that pathologists offer timely, accurate diagnoses with full understanding of the specific concerns to be addressed in all of these scenarios. The purpose of this chapter is to discuss the situations in which pathologists may be asked to perform intraoperative consultations for surgeons treating patients with diseases of the tubular gut.

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References

  1. Arnold M, Soerjomataram I, Ferlay J, Forman D. Global incidence of oesophageal cancer by histological subtype in 2012. Gut. 2015;64(3):381–7.

    Article  PubMed  Google Scholar 

  2. Lordick F, Mariette C, Haustermans K, Obermannova R, Arnold D, Committee EG. Oesophageal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27(suppl 5):v50–v7.

    Article  CAS  PubMed  Google Scholar 

  3. Brenner H, Stock C, Hoffmeister M. Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: systematic review and meta-analysis of randomised controlled trials and observational studies. BMJ. 2014;348:g2467.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Benson AB, Venook AP, Al-Hawary MM, Cederquist L, Chen YJ, Ciombor KK, et al. NCCN guidelines insights: colon cancer, version 2.2018. J Natl Compr Cancer Netw. 2018;16(4):359–69.

    Article  Google Scholar 

  5. Barbour AP, Rizk NP, Gonen M, Tang L, Bains MS, Rusch VW, et al. Adenocarcinoma of the gastroesophageal junction: influence of esophageal resection margin and operative approach on outcome. Ann Surg. 2007;246(1):1–8.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Bickenbach KA, Gonen M, Strong V, Brennan MF, Coit DG. Association of positive transection margins with gastric cancer survival and local recurrence. Ann Surg Oncol. 2013;20(8):2663–8.

    Article  CAS  PubMed  Google Scholar 

  7. Nagata T, Ichikawa D, Komatsu S, Inoue K, Shiozaki A, Fujiwara H, et al. Prognostic impact of microscopic positive margin in gastric cancer patients. J Surg Oncol. 2011;104(6):592–7.

    Article  PubMed  Google Scholar 

  8. Raziee HR, Cardoso R, Seevaratnam R, Mahar A, Helyer L, Law C, et al. Systematic review of the predictors of positive margins in gastric cancer surgery and the effect on survival. Gastric Cancer. 2012;15(Suppl 1):S116–24.

    Article  PubMed  Google Scholar 

  9. Bissolati M, Desio M, Rosa F, Rausei S, Marrelli D, Baiocchi GL, et al. Risk factor analysis for involvement of resection margins in gastric and esophagogastric junction cancer: an Italian multicenter study. Gastric Cancer. 2017;20(1):70–82.

    Article  PubMed  Google Scholar 

  10. Shin D, Park SS. Clinical importance and surgical decision-making regarding proximal resection margin for gastric cancer. World J Gastrointest Oncol. 2013;5(1):4–11.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Allum WH, Blazeby JM, Griffin SM, Cunningham D, Jankowski JA, Wong R, et al. Guidelines for the management of oesophageal and gastric cancer. Gut. 2011;60(11):1449–72.

    Article  CAS  PubMed  Google Scholar 

  12. Kuwano H, Masuda N, Kato H, Sugimachi K. The subepithelial extension of esophageal carcinoma for determining the resection margin during esophagectomy: a serial histopathologic investigation. Surgery. 2002;131(1 Suppl):S14–21.

    Article  PubMed  Google Scholar 

  13. Donahue JM, Nichols FC, Li Z, Schomas DA, Allen MS, Cassivi SD, et al. Complete pathologic response after neoadjuvant chemoradiotherapy for esophageal cancer is associated with enhanced survival. Ann Thorac Surg. 2009;87(2):392–8; discussion 8–9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hornick JL, Farraye FA, Odze RD. Prevalence and significance of prominent mucin pools in the esophagus post neoadjuvant chemoradiotherapy for Barrett’s-associated adenocarcinoma. Am J Surg Pathol. 2006;30(1):28–35.

    Article  PubMed  Google Scholar 

  15. Spicer J, Benay C, Lee L, Rousseau M, Andalib A, Kushner Y, et al. Diagnostic accuracy and utility of intraoperative microscopic margin analysis of gastric and esophageal adenocarcinoma. Ann Surg Oncol. 2014;21(8):2580–6.

    Article  PubMed  Google Scholar 

  16. Papachristou DN, Agnanti N, D’Agostino H, Fortner JG. Histologically positive esophageal margin in the surgical treatment of gastric cancer. Am J Surg. 1980;139(5):711–3.

    Article  CAS  PubMed  Google Scholar 

  17. Celli R, Barbieri AL, Colunga M, Sinard J, Gibson JA. Optimal intraoperative assessment of gastric margins. Am J Clin Pathol. 2018;150(4):353–63.

    Article  PubMed  Google Scholar 

  18. Miettinen M, Sarlomo-Rikala M, Sobin LH, Lasota J. Esophageal stromal tumors: a clinicopathologic, immunohistochemical, and molecular genetic study of 17 cases and comparison with esophageal leiomyomas and leiomyosarcomas. Am J Surg Pathol. 2000;24(2):211–22.

    Article  CAS  PubMed  Google Scholar 

  19. Stelow EB, Jones DR, Shami VM. Esophageal leiomyosarcoma diagnosed by endoscopic ultrasound-guided fine-needle aspiration. Diagn Cytopathol. 2007;35(3):167–70.

    Article  PubMed  Google Scholar 

  20. Sano T, Aiko T. New Japanese classifications and treatment guidelines for gastric cancer: revision concepts and major revised points. Gastric Cancer. 2011;14(2):97–100.

    Article  PubMed  Google Scholar 

  21. Delle Fave G, O’Toole D, Sundin A, Taal B, Ferolla P, Ramage JK, et al. ENETS consensus guidelines update for gastroduodenal neuroendocrine neoplasms. Neuroendocrinology. 2016;103(2):119–24.

    Article  CAS  PubMed  Google Scholar 

  22. La Rosa S, Inzani F, Vanoli A, Klersy C, Dainese L, Rindi G, et al. Histologic characterization and improved prognostic evaluation of 209 gastric neuroendocrine neoplasms. Hum Pathol. 2011;42(10):1373–84.

    Article  PubMed  CAS  Google Scholar 

  23. Vanoli A, La Rosa S, Miceli E, Klersy C, Maragliano R, Capuano F, et al. Prognostic evaluations tailored to specific gastric neuroendocrine neoplasms: analysis of 200 cases with extended follow-up. Neuroendocrinology. 2018;107(2):114–26.

    Article  CAS  PubMed  Google Scholar 

  24. Rindi G, Solcia E. Endocrine hyperplasia and dysplasia in the pathogenesis of gastrointestinal and pancreatic endocrine tumors. Gastroenterol Clin N Am. 2007;36(4):851–65. vi

    Article  Google Scholar 

  25. Kim SJ, Choi CW, Mun YC, Oh SY, Kang HJ, Lee SI, et al. Multicenter retrospective analysis of 581 patients with primary intestinal non-hodgkin lymphoma from the Consortium for Improving Survival of Lymphoma (CISL). BMC Cancer. 2011;11:321.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Wang GB, Xu GL, Luo GY, Shan HB, Li Y, Gao XY, et al. Primary intestinal non-Hodgkin’s lymphoma: a clinicopathologic analysis of 81 patients. World J Gastroenterol. 2011;17(41):4625–31.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Huang J, Jiang W, Xu R, Huang H, Lv Y, Xia Z, et al. Primary gastric non-Hodgkin’s lymphoma in Chinese patients: clinical characteristics and prognostic factors. BMC Cancer. 2010;10:358.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  28. Ono S, Kato M, Takagi K, Kodaira J, Kubota K, Matsuno Y, et al. Long-term treatment of localized gastric marginal zone B-cell mucosa associated lymphoid tissue lymphoma including incidence of metachronous gastric cancer. J Gastroenterol Hepatol. 2010;25(4):804–9.

    Article  PubMed  Google Scholar 

  29. Isaacson PG. Gastrointestinal lymphoma. Hum Pathol. 1994;25(10):1020–9.

    Article  CAS  PubMed  Google Scholar 

  30. Takeshita M, Iwashita A, Kurihara K, Ikejiri K, Higashi H, Udoh T, et al. Histologic and immunohistologic findings and prognosis of 40 cases of gastric large B-cell lymphoma. Am J Surg Pathol. 2000;24(12):1641–9.

    Article  CAS  PubMed  Google Scholar 

  31. Chan W, Lai J, Nakamura S, Rosenwald A. Haematolymphoid tumors of the digestive system: diffuse large B-cell lymphoma. 5th ed. Lyon: International Agency for Research on Cancer; 2019.

    Google Scholar 

  32. Nakamura S, Jafffe E, Swerdlow S. Mature B-cell neoplasms: EBV-positive diffuse large B-cell lymphoma, not otherwise specified. In: Swerdlow S, Campo E, Harris N, Jaffe E, Pileri S, Stein H, et al., editors. WHO classification of tumours of haematopoietic and lymphoid tissue. 4th ed. Lyon: International Agency for Research on Cancer; 2017. p. 304–6.

    Google Scholar 

  33. Everett M, Gutman H. Surgical management of gastrointestinal stromal tumors: analysis of outcome with respect to surgical margins and technique. J Surg Oncol. 2008;98(8):588–93.

    Article  PubMed  Google Scholar 

  34. DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg. 2000;231(1):51–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Sakai A, Tsujimae M, Masuda A, Iemoto T, Ashina S, Yamakawa K, et al. Clinical outcomes of ampullary neoplasms in resected margin positive or uncertain cases after endoscopic papillectomy. World J Gastroenterol. 2019;25(11):1387–97.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Benhamiche AM, Jouve JL, Manfredi S, Prost P, Isambert N, Faivre J. Cancer of the ampulla of Vater: results of a 20-year population-based study. Eur J Gastroenterol Hepatol. 2000;12(1):75–9.

    Article  CAS  PubMed  Google Scholar 

  37. Sekine S, Shia J. Tumours of the small intestine and ampulla: ampullary adenoma. In: Carneiro F, Chan J, Cheung N, Cree I, Fitzgibbons P, Gasson S, et al., editors. WHO classification of tumours: digestive system tumours. 5th ed. Lyon: International Agency for Research on Cancer; 2019. p. 121–3.

    Google Scholar 

  38. Adsay N, Reid M. Tumours of the small intestine and ampulla: ampullary adenocarcinoma. In: Carneiro F, Chan J, Cheung N, Cree I, Fitzgibbons P, Gasson S, et al., editors. WHO classification of tumours. 5th ed. Lyon: International Agency for Research on Cancer; 2019. p. 127–30.

    Google Scholar 

  39. Donow C, Pipeleers-Marichal M, Schroder S, Stamm B, Heitz PU, Kloppel G. Surgical pathology of gastrinoma. Site, size, multicentricity, association with multiple endocrine neoplasia type 1, and malignancy. Cancer. 1991;68(6):1329–34.

    Article  CAS  PubMed  Google Scholar 

  40. Relles D, Baek J, Witkiewicz A, Yeo CJ. Periampullary and duodenal neoplasms in neurofibromatosis type 1: two cases and an updated 20-year review of the literature yielding 76 cases. J Gastrointest Surg. 2010;14(6):1052–61.

    Article  PubMed  Google Scholar 

  41. Hamilton SR, Reese J, Pennington L, Boitnott JK, Bayless TM, Cameron JL. The role of resection margin frozen section in the surgical management of Crohn’s disease. Surg Gynecol Obstet. 1985;160(1):57–62.

    CAS  PubMed  Google Scholar 

  42. Kotanagi H, Kramer K, Fazio VW, Petras RE. Do microscopic abnormalities at resection margins correlate with increased anastomotic recurrence in Crohn’s disease? Retrospective analysis of 100 cases. Dis Colon Rectum. 1991;34(10):909–16.

    Article  CAS  PubMed  Google Scholar 

  43. Fazio VW, Marchetti F, Church M, Goldblum JR, Lavery C, Hull TL, et al. Effect of resection margins on the recurrence of Crohn’s disease in the small bowel. A randomized controlled trial. Ann Surg. 1996;224(4):563–71; discussion 71–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Kumar S, Fend F, Quintanilla-Martinez L, Kingma DW, Sorbara L, Raffeld M, et al. Epstein-Barr virus-positive primary gastrointestinal Hodgkin’s disease: association with inflammatory bowel disease and immunosuppression. Am J Surg Pathol. 2000;24(1):66–73.

    Article  CAS  PubMed  Google Scholar 

  45. Kelly MD, Stuart M, Tschuchnigg M, Turner J, Tydd T. Primary intestinal Hodgkin’s disease complicating ileal Crohn’s disease. Aust N Z J Surg. 1997;67(7):485–9.

    Article  CAS  PubMed  Google Scholar 

  46. Li S, Borowitz MJ. Primary Epstein-Barr virus-associated Hodgkin disease of the ileum complicating Crohn disease. Arch Pathol Lab Med. 2001;125(3):424–7.

    Article  CAS  PubMed  Google Scholar 

  47. Iwamuro M, Okada H, Kawahara Y, Shinagawa K, Morito T, Yoshino T, et al. Endoscopic features and prognoses of mantle cell lymphoma with gastrointestinal involvement. World J Gastroenterol. 2010;16(37):4661–9.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Kodama T, Ohshima K, Nomura K, Taniwaki M, Nakamura N, Nakamura S, et al. Lymphomatous polyposis of the gastrointestinal tract, including mantle cell lymphoma, follicular lymphoma and mucosa-associated lymphoid tissue lymphoma. Histopathology. 2005;47(5):467–78.

    Article  CAS  PubMed  Google Scholar 

  49. Misdraji J, Harris NL, Hasserjian RP, Lauwers GY, Ferry JA. Primary follicular lymphoma of the gastrointestinal tract. Am J Surg Pathol. 2011;35(9):1255–63.

    Article  PubMed  Google Scholar 

  50. Shia J, Teruya-Feldstein J, Pan D, Hegde A, Klimstra DS, Chaganti RS, et al. Primary follicular lymphoma of the gastrointestinal tract: a clinical and pathologic study of 26 cases. Am J Surg Pathol. 2002;26(2):216–24.

    Article  PubMed  Google Scholar 

  51. Poggi MM, Cong PJ, Coleman CN, Jaffe ES. Low-grade follicular lymphoma of the small intestine. J Clin Gastroenterol. 2002;34(2):155–9.

    Article  PubMed  Google Scholar 

  52. Takata K, Okada H, Ohmiya N, Nakamura S, Kitadai Y, Tari A, et al. Primary gastrointestinal follicular lymphoma involving the duodenal second portion is a distinct entity: a multicenter, retrospective analysis in Japan. Cancer Sci. 2011;102(8):1532–6.

    Article  CAS  PubMed  Google Scholar 

  53. Domizio P, Owen RA, Shepherd NA, Talbot IC, Norton AJ. Primary lymphoma of the small intestine. A clinicopathological study of 119 cases. Am J Surg Pathol. 1993;17(5):429–42.

    Article  CAS  PubMed  Google Scholar 

  54. Gale J, Simmonds PD, Mead GM, Sweetenham JW, Wright DH. Enteropathy-type intestinal T-cell lymphoma: clinical features and treatment of 31 patients in a single center. J Clin Oncol. 2000;18(4):795–803.

    Article  CAS  PubMed  Google Scholar 

  55. Delabie J, Holte H, Vose JM, Ullrich F, Jaffe ES, Savage KJ, et al. Enteropathy-associated T-cell lymphoma: clinical and histological findings from the international peripheral T-cell lymphoma project. Blood. 2011;118(1):148–55.

    Article  CAS  PubMed  Google Scholar 

  56. Carr NJ, Sobin LH. Neuroendocrine tumors of the appendix. Semin Diagn Pathol. 2004;21(2):108–19.

    Article  PubMed  Google Scholar 

  57. Jarvinen P, Lepisto A. Clinical presentation of pseudomyxoma peritonei. Scand J Surg. 2010;99(4):213–6.

    Article  CAS  PubMed  Google Scholar 

  58. Gundogar O, Kimiloglu E, Komut N, Cin M, Bektas S, Gonullu D, et al. Evaluation of appendiceal mucinous neoplasms with a new classification system and literature review. Turk J Gastroenterol. 2018;29(5):533–42.

    Article  PubMed  Google Scholar 

  59. Carr NJ, Cecil TD, Mohamed F, Sobin LH, Sugarbaker PH, Gonzalez-Moreno S, et al. A consensus for classification and pathologic reporting of pseudomyxoma peritonei and associated appendiceal neoplasia: the results of the peritoneal surface oncology group international (PSOGI) modified delphi process. Am J Surg Pathol. 2016;40(1):14–26.

    Article  PubMed  Google Scholar 

  60. Lowes H, Rowaiye B, Carr NJ, Shepherd NA. Complicated appendiceal diverticulosis versus low-grade appendiceal mucinous neoplasms: a major diagnostic dilemma. Histopathology. 2019;75(4):478–85.

    Article  PubMed  Google Scholar 

  61. Hissong E, Goncharuk T, Song W, Yantiss RK. Post-inflammatory mucosal hyperplasia and appendiceal diverticula simulate features of low-grade appendiceal mucinous neoplasms. Mod Pathol. 2020;33(5):953–61.

    Article  CAS  PubMed  Google Scholar 

  62. Oliak D, Yamini D, Udani VM, Lewis RJ, Arnell T, Vargas H, et al. Initial nonoperative management for periappendiceal abscess. Dis Colon Rectum. 2001;44(7):936–41.

    Article  CAS  PubMed  Google Scholar 

  63. Simillis C, Symeonides P, Shorthouse AJ, Tekkis PP. A meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon). Surgery. 2010;147(6):818–29.

    Article  PubMed  Google Scholar 

  64. Andersson RE, Petzold MG. Nonsurgical treatment of appendiceal abscess or phlegmon: a systematic review and meta-analysis. Ann Surg. 2007;246(5):741–8.

    Article  PubMed  Google Scholar 

  65. Couvelard A, Perren A, Sipos B. Digestive system tumours: appendiceal neuroendocrine neoplasms. 5th ed. Lyon: International Agency for Research of Cancer; 2019.

    Google Scholar 

  66. Misdraji J, Carr N, Pai R. Tumours of the appendix: Appendiceal goblet cell adenocarcinoma. In: Carneiro F, Chan J, Cheung N, Cree I, Fitzgibbons P, Gasson S, et al., editors. WHO classification of tumours: digestive system tumours. 5th ed. Lyon: International Agency for Research on Cancer; 2019. p. 149–51.

    Google Scholar 

  67. Taggart MW, Abraham SC, Overman MJ, Mansfield PF, Rashid A. Goblet cell carcinoid tumor, mixed goblet cell carcinoid-adenocarcinoma, and adenocarcinoma of the appendix: comparison of clinicopathologic features and prognosis. Arch Pathol Lab Med. 2015;139(6):782–90.

    Article  PubMed  Google Scholar 

  68. Tang LH, Shia J, Soslow RA, Dhall D, Wong WD, O’Reilly E, et al. Pathologic classification and clinical behavior of the spectrum of goblet cell carcinoid tumors of the appendix. Am J Surg Pathol. 2008;32(10):1429–43.

    Article  PubMed  Google Scholar 

  69. Yozu M, Johncilla ME, Srivastava A, Ryan DP, Cusack JC, Doyle L, et al. Histologic and outcome study supports reclassifying appendiceal goblet cell carcinoids as goblet cell adenocarcinomas, and grading and staging similarly to colonic adenocarcinomas. Am J Surg Pathol. 2018;42(7):898–910.

    Article  PubMed  Google Scholar 

  70. Rullier E, Laurent C, Bretagnol F, Rullier A, Vendrely V, Zerbib F. Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg. 2005;241(3):465–9.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Zhao GP, Zhou ZG, Lei WZ, Yu YY, Wang C, Wang Z, et al. Pathological study of distal mesorectal cancer spread to determine a proper distal resection margin. World J Gastroenterol. 2005;11(3):319–22.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Cross SS, Bull AD, Smith JH. Is there any justification for the routine examination of bowel resection margins in colorectal adenocarcinoma? J Clin Pathol. 1989;42(10):1040–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Moore HG, Riedel E, Minsky BD, Saltz L, Paty P, Wong D, et al. Adequacy of 1-cm distal margin after restorative rectal cancer resection with sharp mesorectal excision and preoperative combined-modality therapy. Ann Surg Oncol. 2003;10(1):80–5.

    Article  PubMed  Google Scholar 

  74. Gomes RM, Bhandare M, Desouza A, Bal M, Saklani AP. Role of intraoperative frozen section for assessing distal resection margin after anterior resection. Int J Color Dis. 2015;30(8):1081–9.

    Article  Google Scholar 

  75. Kim YW, Kim NK, Min BS, Huh H, Kim JS, Kim JY, et al. Factors associated with anastomotic recurrence after total mesorectal excision in rectal cancer patients. J Surg Oncol. 2009;99(1):58–64.

    Article  PubMed  Google Scholar 

  76. Leo E, Belli F, Miceli R, Mariani L, Gallino G, Battaglia L, et al. Distal clearance margin of 1 cm or less: a safe distance in lower rectum cancer surgery. Int J Color Dis. 2009;24(3):317–22.

    Article  Google Scholar 

  77. Panarelli NC, Somarathna T, Samowitz WS, Kornacki S, Sanders SA, Novelli MR, et al. Diagnostic challenges caused by endoscopic biopsy of colonic polyps: a systematic evaluation of epithelial misplacement with review of problematic polyps from the bowel cancer screening program, United Kingdom. Am J Surg Pathol. 2016;40(8):1075–83.

    Article  PubMed  Google Scholar 

  78. Loughrey MB, Shepherd NA. Problematic colorectal polyps: is it cancer and what do I need to do about it? Surg Pathol Clin. 2017;10(4):947–60.

    Article  PubMed  Google Scholar 

  79. Richardson AJ, Laurence JM, Lam VW. Transarterial chemoembolization with irinotecan beads in the treatment of colorectal liver metastases: systematic review. J Vasc Interv Radiol. 2013;24(8):1209–17.

    Article  PubMed  Google Scholar 

  80. Donadon M, Ribero D, Morris-Stiff G, Abdalla EK, Vauthey JN. New paradigm in the management of liver-only metastases from colorectal cancer. Gastrointest Cancer Res. 2007;1(1):20–7.

    PubMed  PubMed Central  Google Scholar 

  81. Cao CQ, Yan TD, Liauw W, Morris DL. Comparison of optimally resected hepatectomy and peritonectomy patients with colorectal cancer metastasis. J Surg Oncol. 2009;100(7):529–33.

    Article  PubMed  Google Scholar 

  82. Rakha E, Ramaiah S, McGregor A. Accuracy of frozen section in the diagnosis of liver mass lesions. J Clin Pathol. 2006;59(4):352–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  83. Koppe MJ, Boerman OC, Oyen WJ, Bleichrodt RP. Peritoneal carcinomatosis of colorectal origin: incidence and current treatment strategies. Ann Surg. 2006;243(2):212–22.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Klaver YL, Lemmens VE, de Hingh IH. Outcome of surgery for colorectal cancer in the presence of peritoneal carcinomatosis. Eur J Surg Oncol. 2013;39(7):734–41.

    Article  CAS  PubMed  Google Scholar 

  85. Varban O, Levine EA, Stewart JH, McCoy TP, Shen P. Outcomes associated with cytoreductive surgery and intraperitoneal hyperthermic chemotherapy in colorectal cancer patients with peritoneal surface disease and hepatic metastases. Cancer. 2009;115(15):3427–36.

    Article  PubMed  Google Scholar 

  86. de Haas RJ, Wicherts DA, Adam R. Resection of colorectal liver metastases with extrahepatic disease. Dig Surg. 2008;25(6):461–6.

    Article  PubMed  Google Scholar 

  87. Makapugay LM, Dean PJ. Diverticular disease-associated chronic colitis. Am J Surg Pathol. 1996;20(1):94–102.

    Article  CAS  PubMed  Google Scholar 

  88. Yantiss RK, Clement PB, Young RH. Endometriosis of the intestinal tract: a study of 44 cases of a disease that may cause diverse challenges in clinical and pathologic evaluation. Am J Surg Pathol. 2001;25(4):445–54.

    Article  CAS  PubMed  Google Scholar 

  89. Butler Tjaden NE, Trainor PA. The developmental etiology and pathogenesis of Hirschsprung disease. Transl Res. 2013;162(1):1–15.

    Article  CAS  PubMed  Google Scholar 

  90. Langer JC. Hirschsprung disease. Curr Opin Pediatr. 2013;25(3):368–74.

    Article  PubMed  Google Scholar 

  91. Parisi MA, Kapur RP. Genetics of Hirschsprung disease. Curr Opin Pediatr. 2000;12(6):610–7.

    Article  CAS  PubMed  Google Scholar 

  92. Shayan K, Smith C, Langer JC. Reliability of intraoperative frozen sections in the management of Hirschsprung’s disease. J Pediatr Surg. 2004;39(9):1345–8.

    Article  PubMed  Google Scholar 

  93. Maia DM. The reliability of frozen-section diagnosis in the pathologic evaluation of Hirschsprung’s disease. Am J Surg Pathol. 2000;24(12):1675–7.

    Article  CAS  PubMed  Google Scholar 

  94. Rouzrokh M, Jadali F, Gharib A, Khaleghnejad-Tabari A, Tavassoli A, Mohajerzadeh L. Can we rely on frozen sections of a rectal biopsy for one-stage trans-anal pull-through operation in Hirschsprung’s disease? Iran J Pediatr. 2011;21(1):72–6.

    PubMed  PubMed Central  Google Scholar 

  95. Staines WA, Bettolli M, De Carli C, Swinton E, Sweeney B, Krantis A, et al. Fast evaluation of intraoperative biopsies for ganglia in Hirschsprung’s disease. J Pediatr Surg. 2007;42(12):2067–70.

    Article  CAS  PubMed  Google Scholar 

  96. Holland SK, Hessler RB, Reid-Nicholson MD, Ramalingam P, Lee JR. Utilization of peripherin and S-100 immunohistochemistry in the diagnosis of Hirschsprung disease. Mod Pathol. 2010;23(9):1173–9.

    Article  CAS  PubMed  Google Scholar 

  97. Agrawal RK, Kakkar N, Vasishta RK, Kumari V, Samujh R, Rao KL. Acetylcholinesterase histochemistry (AChE)--a helpful technique in the diagnosis and in aiding the operative procedures of Hirschsprung disease. Diagn Pathol. 2015;10:208.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  98. Kanitakis J. Mammary and extramammary Paget’s disease. J Eur Acad Dermatol Venereol. 2007;21(5):581–90.

    CAS  PubMed  Google Scholar 

  99. Leboit P. WHO classification of tumours: pathology and genetics of skin tumours. 3rd ed. Lyon: IARC; 2008.

    Google Scholar 

  100. Coldiron BM, Goldsmith BA, Robinson JK. Surgical treatment of extramammary Paget’s disease. A report of six cases and a reexamination of Mohs micrographic surgery compared with conventional surgical excision. Cancer. 1991;67(4):933–8.

    Article  CAS  PubMed  Google Scholar 

  101. Del Castillo LF, Garcia C, Schoendorff C, Garcia JF, Torres LM, Garcia Almagro D. Spontaneous apparent clinical resolution with histologic persistence of a case of extramammary Paget’s disease: response to topical 5-fluorouracil. Cutis. 2000;65(5):331–3.

    PubMed  Google Scholar 

  102. Mirer E, El Sayed F, Ammoury A, Lamant L, Messer L, Bazex J. Treatment of mammary and extramammary Paget’s skin disease with topical imiquimod. J Dermatolog Treat. 2006;17(3):167–71.

    Article  PubMed  Google Scholar 

  103. Watring WG, Roberts JA, Lagasse LD, Berman ML, Ballon SC, Moore JG, et al. Treatment of recurrent Paget’s disease of the vulva with topical bleomycin. Cancer. 1978;41(1):10–1.

    Article  CAS  PubMed  Google Scholar 

  104. Pittman ME, Milsom J, Yantiss RK. Treatment effects can mimic recurrent extramammary Paget disease in perianal skin. Am J Surg Pathol. 2018;42(11):1472–9.

    Article  PubMed  Google Scholar 

  105. Longacre TA, Kong CS, Welton ML. Diagnostic problems in anal pathology. Adv Anat Pathol. 2008;15(5):263–78.

    Article  PubMed  Google Scholar 

  106. Ryan DP, Mayer RJ. Anal carcinoma: histology, staging, epidemiology, treatment. Curr Opin Oncol. 2000;12(4):345–52.

    Article  CAS  PubMed  Google Scholar 

  107. Shia J. Tumours of the anal canal: anal adenocarcinoma. In: Carneiro F, Chan J, Cheung N, Cree I, Fitzgibbons P, Gasson S, et al., editors. WHO classification of tumours: digestive system tumours. Lyon: International Agency for Research on Cancer; 2019. p. 208–11.

    Google Scholar 

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Authors and Affiliations

  1. Department of Pathology, University of Michigan, Ann Arbor, MI, USA

    Erika Hissong

  2. Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA

    Rhonda K. Yantiss

Authors
  1. Erika Hissong
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  2. Rhonda K. Yantiss
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Correspondence to Rhonda K. Yantiss .

Editor information

Editors and Affiliations

  1. Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA

    Alain C. Borczuk

  2. Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA

    Rhonda K. Yantiss

  3. Weill Cornell Medical College, NewYork–Presbyterian Hospital, New York, NY, USA

    Brian D. Robinson

  4. Weill Cornell Medical College, NewYork–Presbyterian Hospital, New York, NY, USA

    Theresa Scognamiglio

  5. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Timothy M. D'Alfonso

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Hissong, E., Yantiss, R.K. (2021). Intraoperative Evaluation of the Gastrointestinal Tract. In: Borczuk, A.C., Yantiss, R.K., Robinson, B.D., Scognamiglio, T., D'Alfonso, T.M. (eds) Frozen Section Pathology. Springer, Cham. https://doi.org/10.1007/978-3-030-71308-9_3

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