Tubulosquamous Polyp of the Vagina: Misplaced Skene's Glands Analogous to the Male Prostate.

Tubulosquamous polyp (TSP) of the vagina is a rare and benign lesion, best considered along the spectrum of lesions derived from Skene's glands, the female counterpart of male prostatic glands. It is likely underdiagnosed and represents a challenging diagnosis if one is unfamiliar with this entity. We present an illustrative case of TSP occurring as an upper vaginal wall nodule of a 75-year-old woman, with characteristic morphology and broad immunophenotype. It should be suspected in postmenopausal women with a polyp that demonstrates biphasic squamous and glandular components, which show a prostatic immunophenotype.

Complete frozen section margins for cancer of the tongue: part 1: animal experience.

OBJECTIVE: Positive margins for squamous cell carcinoma of the oral tongue on final pathology are a poor prognostic factor associated with a higher likelihood of local recurrence. Obtaining margin status in a relatively short time by using complete frozen sections, such as Mohs margins for skin cancer, would lower the recurrence rate. The goal of this study was to compare, on pig tongue, the efficacy of different techniques used to obtain complete frozen sections on histologic glass slides of optimal quality. STUDY DESIGN: We compared the quality of frozen section glass slides on fresh pig tongues. The partial glossectomy was executed with either a sharp instrument (scalpel and scissors), electrocautery in the cutting mode, or electrocautery at the coagulation mode. For each of the three methods, we also compared the frozen section, obtained on the line of resection and for a thickness of 1 to 1.3 mm, using either the cryostat or isopentane for the freezing phase. The percentage and quality of epithelium and muscle present on histologic glass slides were assessed by a pathologist independently. RESULTS: Complete frozen margins of high quality were obtained in a relatively short time for all techniques (28-38 minutes). Sharp dissection showed better results: a shorter processing time for the specimens and better quality for the histologic glass slides. Using cryostat or isopentane for the freezing phase did not show any significant difference. CONCLUSION AND SIGNIFICANCE: Complete frozen margins (Mohs margins) of high quality are feasible. Histologic glass slides of very good quality are obtained when using a sharp dissection technique. For the freezing period, both isopentane and cryostat offer very good results. This approach is appropriate on animals and needs further study in clinical situations. The human experience will be presented in the next article which is: Complete frozen section margins (with measurable 1 or 5 mm thick free margin) for cancer of the oral tongue (Clinical experience Part 2 [CSO2008]).

Complete frozen section margins (with measurable 1 or 5 mm thick free margin) for cancer of the tongue: part 2: clinical experience.

OBJECTIVE: To obtain completely negative margins of 1 to 5 mm at the time of surgery for oral tongue squamous cell carcinoma by using a Mohs-like technique. STUDY DESIGN: Case series of 12 patients (4 T1, 5 T2, 2 T3, 1 T4) and a review of the literature. RESULTS: For the first six cases, complete, colored for precise orientation, frozen margins of high quality were obtained in a relatively short time (20-75 minutes). Four levels were evaluated within 1 to 2 mm of the line of resection. Obtaining complete free margins for a thickness of 5 mm was done for the last six cases. The time was longer (70-120 minutes) but did not exceed the time necessary to perform the neck dissection, except for one patient. The technique using the scalpel and scissors implied slightly more bleeding, which was never a problem. We have observed no recurrence for these 12 patients (follow-up 12-34 months). CONCLUSION: The review of the literature demonstrates that invaded and close margins confer a higher recurrence rate. We have obtained 1 to 2 mm (first six patients) and 5 mm (last six patients) thick, complete, oriented, and free frozen margins with success and no recurrence, but the follow-up was short. We prefer to obtain a 5 mm thick margin when possible. The delay to obtain the pathologic result is reasonable. This approach should reduce dramatically the problem of positive and close margins at the final pathology and, consequently, the rate of local control.

Mohs surgery - a new approach with a mould and glass discs: review of the literature and comparative study.

OBJECTIVE: Mohs surgery is a frozen section-guided surgical excision that is the treatment of choice for aggressive cutaneous malignancy. But it is labour intensive, particularly because numerous levels are needed on each specimen to obtain a complete histologic section. Three different techniques to Mohs surgery are compared. Our new approach with moulds and glass discs is explained and discussed. DESIGN: Review of the literature and comparative study using skin specimens of fresh cadavers. SETTING: Regional care centre. METHOD: First, we evaluate, for each of the three different techniques, the number of 10 micron-thick frozen sections required to obtain a macroscopically complete cross section of the specimen. Second, we examine microscopically the quality of these first complete sections. Finally, once we have obtained a macroscopically complete cross section, we evaluate the number of deeper levels required to obtain an adequate microscopic section. RESULTS: In the first experiment, with the modern method, 90.1 sections were needed to obtain a full macroscopic section, 36.8 sections with the heat extractor method, and 10.6 sections with the new mould. The quality of the histologic glass slides was superior with the new mould. The number of deeper levels required to obtain an adequate microscopic section was 5.9 for the modern method, 4.4 for the heat extractor method, and 2.3 for the new approach (new mould). CONCLUSION: Our new approach with moulds and glass discs is simple and allows us to flatten the specimen (to obtain a complete tissue section) more reliably and efficiently compared with both the modern and the heat extractor methods. The new approach allows us to obtain these results in less time and with fewer histologic glass slides. Some other aspects are discussed.