Intraoperative evaluation of the liver, extrahepatic bile ducts, gallbladder, and pancreas

Evaluation of frozen sections of the liver and pancreatobiliary tree is one of the most challenging tasks in surgical pathology. Pathologists may be called upon to perform intraoperative consultations on hepatic tumors, both for primary diagnosis and assessment of resection margins. On the other hand, benign bile ductular proliferations can pose diagnostic challenges when encountered during curative operations for carcinomas derived from extrahepatic sites because some closely simulate metastatic carcinoma. A substantial proportion of gallbladder adenocarcinomas are not suspected prior to cholecystectomy; these cases may prompt frozen section evaluation for diagnosis and assessment of tumor extent. Evaluation of pancreatic resection margins (i.e., distal pancreatectomy and pancreaticoduodenectomy) is also a common indication for frozen section consultation, in which case correct interpretation may be hampered by tumor-related chronic pancreatitis and/or neoadjuvant therapy, both of which cause changes that closely mimic neoplasia. The aim of this chapter is to provide surgical pathologists with a framework for dealing with hepatic and pancreatobiliary specimens in the frozen section area by covering common clinical scenarios and histologic findings. It emphasizes distinction between primary hepatic neoplasia and metastatic diseases and emphasizes features of benign mimics of malignancy. Finally, assessment of donor liver biopsy for organ transplant evaluation is discussed.