title: Intraoperative consultation for renal lesions. Implications and diagnostic pitfalls in 324 cases.
abstract: Intraoperative consultation rarely is requested for lesions in the kidney. Of 324 renal lesions submitted for gross or frozen section intraoperative consultation, 199 specimens were submitted for gross consultation only; no diagnostic pitfalls were noted. The clinical implications and diagnostic pitfalls in 125 specimens submitted for frozen section were the focus of our study. Frozen section intraoperative consultation was requested to evaluate surgical margins in partial nephrectomy specimens, solid renal mass in an unusual clinical or radiologic setting, synchronous renal and extrarenal masses, cystic renal lesion, ureteral surgical margins for transitional cell carcinoma, multiple renal masses, solid mass in a diffusely cystic kidney, and renal injury. Among the 125 cases, the diagnoses were deferred in 17 (6 renal cell carcinomas with granular cytoplasm, 7 cystic lesions, 3 metastatic tumors, 1 leiomyoma). The frozen section diagnoses were incorrect owing to limited sampling in 5 and misinterpretation in 4 (melanoma vs angiomyolipoma, lymphoma vs angiomyolipoma, benign cyst vs cystic renal cell carcinoma, metastatic renal cell carcinoma vs pheochromocytoma). Awareness of distinctive indications for frozen section intraoperative consultation and diagnostic pitfalls should improve diagnostic accuracy and facilitate proper management of these lesions.
authors.affiliation: Department of Pathology, Baylor College of Medicine, Veterans Affairs Medical Center, Houston, TX, USA.
authors.forename: Bhuvaneswari
authors.initials: B
authors.lastname: Krishnan
authors.forename: Juan
authors.initials: J
authors.lastname: Lechago
authors.forename: Gustavo
authors.initials: G
authors.lastname: Ayala
authors.forename: Luan
authors.initials: L
authors.lastname: Truong
mesh_terms: D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005629:Frozen Sections; D006801:Humans; D007432:Intraoperative Period; D007674:Kidney Diseases / Q000175:diagnosis*; D010340:Pathology, Surgical / Q000379:methods*; D012017:Referral and Consultation