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Can Frozen Section Can Be Done In Case To Decide The Malignancy ?

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Posted on 1 day ago
Question: I have big fibroids and a few cysts. Please suggest what I should do next.

Also, As I heard from a few of my friends, the forzen section is important to do now a days. So I want to check if a frozen section can be done in this case to decide the malignancy before hand and then decide which type of surgery we can proceed with, either open or  robotic or laproscypy, to remove the fibroid/cycst

MRI report-

Large 16x16x10cm (CCxTRxAP) sized well marginated heterogeneous solid mass lesion arising from the fundus of the uterus. Bridging vessels are across the fundus and the lesion. Multiple cystic areas are seen within the lesion. The lesion shows heterogeneous enhancement on post contrast enhancement. The lesion is extending superiorly, just below the level of umbilicus resulting in displacement of the small bowel loops laterally. Posteriorly on the left side there lesion is compressing the left ureter, abutting the common and internal iliac artery and vein. Both the ovaries are seen separate from the lesion and displaced posteriorly. There is no obvious infiltration of the surrounding structures. Numeral collateral vascular channels noted feeding the lesion and in the adnexal region.
The above features are suggestive of a large Sub serosal pedunculated mass arising from the fundus of the uterus. No features of torsion. Consider myoma with degeneration. Malignancy/ sarcoma cannot be excluded. Clinical/Lab correlation is recommended.
• FIGO TYPE 5 fibroid is seen in the anterior wall of the uterus measuring 1.5x1.4cm.
• An elongated multiseptated cystic well defined cystic lesion in the right inguinal region along the round ligament ~ 56x20x35 mm, numerous thin septations noted
within. Differential would include canal of Nuck cyst versus lymphocele/seroma.
doctor
Answered by Dr. Deepak Sundriyal (6 hours later)
Brief Answer:
Hello. Surgery should be done.

Detailed Answer:
Hello dear. I have gone through your report. So there is a likely possibility of cancerous lesion in such a huge mass arising from the uterus and surgery is warranted.
A frozen section cannot be used to define the nature/type(open vs lap vs robotic) of surgery. It is used to identify benign versus cancer lesion only. If cancer is there in frozen, then a more extensive surgery will be done.
In your case, an open surgery seems most feasible considering the huge size of lesion.
Laparoscopic surgery will be difficult to perform but can be suitable if surgeon is competent enough in such a huge size mass.
Robotic surgery has no added advantage, as robotic surgery is beneficial only in those areas where access/reaching is difficult, for example behind the tongue. In uterine surgery, access is easy.


Hope you understand.
Feel free to ask further.
Kind regards
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Deepak Sundriyal (3 days later)
Can you suggest something on below issue ? Can below cyst be treated with the same open surgery through which we will remove the fibroid?? Can this also be treated together with same incision ?

..An elongated multiseptated cystic well defined cystic lesion in the right inguinal region along the round ligament ~ 56x20x35 mm, numerous thin septations noted
within. Differential would include canal of Nuck cyst versus lymphocele/seroma.
doctor
Answered by Dr. Deepak Sundriyal (43 minutes later)
Brief Answer:
hello. Yes, it can be treated

Detailed Answer:
Hello dear. Yes, through the same incision and open surgery. cyst can be drained or removed. However, lymphocele, or seroma do not require any removal unless causing pain or enlarging rapidly.
Kind regards
feel free to ask further
Above answer was peer-reviewed by : Dr. LAKSHMI
doctor
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Follow up: Dr. Deepak Sundriyal (41 minutes later)
Thanks for answering my query so fast. I really appreciate it.

One more question: Can the removal of fibroid based on an MRI attached previously require uterus removal as well? Manipal Doc is saying we can remove the uterus; Fortis Doc is saying it is not needed. So I'm a bit confused.
doctor
Answered by Dr. Deepak Sundriyal (1 hour later)
Brief Answer:
Hello. Uterus should be removed.

Detailed Answer:
Hello dear. So, this is a huge fibroid, and simply removing it in isolation carries no meaning, as the uterus will be prone to the development of further fibroids in the future. Moreover, uterus function will not be required at this age, I suppose ( if the family is completed), so the best is to get it removed.
Hope this helps. You can ask further if required.
Kind regards
Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
Answered by
Dr.
Dr. Deepak Sundriyal

Oncologist

Practicing since :2005

Answered : 1633 Questions

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Can Frozen Section Can Be Done In Case To Decide The Malignancy ?

Brief Answer: Hello. Surgery should be done. Detailed Answer: Hello dear. I have gone through your report. So there is a likely possibility of cancerous lesion in such a huge mass arising from the uterus and surgery is warranted. A frozen section cannot be used to define the nature/type(open vs lap vs robotic) of surgery. It is used to identify benign versus cancer lesion only. If cancer is there in frozen, then a more extensive surgery will be done. In your case, an open surgery seems most feasible considering the huge size of lesion. Laparoscopic surgery will be difficult to perform but can be suitable if surgeon is competent enough in such a huge size mass. Robotic surgery has no added advantage, as robotic surgery is beneficial only in those areas where access/reaching is difficult, for example behind the tongue. In uterine surgery, access is easy. Hope you understand. Feel free to ask further. Kind regards