Intraoperative Scrape Cytology from Ovarian Masss Lesions: A Study of 81 Cases

Abstract

Background: Intraoperative evaluation of an ovarian mass is of crucial importance in its further management, accomplished by frozen section (FS) and scrape smear (SS) examination.

Aim: To evaluate utility of SS over FS and to study scrape cytological features of a variety of ovarian neoplasms.

Materials and methods: The study comprised ovarian tumors studied over a period of 1 year (2014-2015) that were submitted for intraoperative assessment. SS and FS were examined and evaluated independently. The results were compared with final pathological diagnosis in each case, and cases with discordant diagnoses were reviewed. All the SSs of ovarian tumors were re-evaluated with Giemsa-stained smears, and cytological features were described.

Results: The results of SS and FS were 100% concordant. On histopathology, of 81 cases, 43 were epithelial [(categorized further as serous, mucinous, or malignant mixed Mullerian tumor (MMMT)] along with subcategorization of benign, borderline, and malignant), 16 were germ cell (categorized as teratoma: mature/immature and yolk sac tumor), 11 were sex cord stromal tumors (fibroma, granulosa cell tumor, Sertoli-Leydig cell tumor), 8 cases were hemorrhagic cysts (torsion, endometroid, corpus luteal cyst, etc.), and 3 were metastasis. There were 61 benign, 2 borderline, and 18 malignant cases on FS and scrape. Combining all the values, sensitivity and specificity were 76% and 98.21%, respectively. The diagnostic accuracy in diagnosing malignant lesions was 91%.

Conclusion: Adequate knowledge on cytohistological correlation of ovarian scrape cytology may phase out the use of cryostat in intraoperative diagnosis of ovarian neoplasms, and thus be a boon for resource-deprived settings.

Keywords: Frozen section; intraoperative cytology; ovarian mass lesions; scrape smears.

Figure 1

(a) Gross examination of serous papillary adenocarcinoma. (b and c) Toluidine blue smear: compact papillary cluster with atypia (×100). (d) Giemsa smear showig papillary fragment with necrotic background (×100). (e) Haematoxylin and eosin smear shows papillary fragments with a fibrovascular core (×100)

Figure 2

Immature teratoma: (a) toluidine-blue-stained smear showing papillaroid and loosely cohesive clusters of small round cells with minimal amount of cytoplasm (×200). (b) Giemsa-stained smear showing clusters of small round cells with minimal amount of cytoplasm and mature squames in the background (×200). (c) Haematoxylin and eosin section showing intricate mixture of hyaline cartilage and glandular epithelium (×100). Inset: immature neuroepithelium (×200)

Figure 3

Sertoli–Leydig cell tumor: (a) Haematoxylin and eosin section showing sheets of Sertoli and Leydig cells (×200). (b) Giemsa-stained smear showing Sertoli cells with some showing cytoplasmic vacuoles and Leydig cells with moderate amount of granular cytoplasm (×200). (c) Toluidine blue smear showing Sertoli cells (with single prominent nucleolus) (×100)