Pancreatic frozen section nightmares

Pancreatic resections have steadily increased over the past few decades and as a consequence so have the number of pancreatic specimens submitted for intraoperative frozen section consultation. Frozen section evaluation of the pancreas is generally performed for tumour confirmation and the assessment of margin status. An accurate and prompt diagnosis is therefore critical in guiding surgical management. However, pancreatic frozen sections are among the most challenging specimens submitted to the pathologist. While the main diagnostic dilemma is between adenocarcinoma and chronic pancreatitis, the spectrum of reactive changes, preinvasive neoplasms, neoadjuvant treatment effect and incidental lesions can further confound this assessment. The purpose of this review is to briefly discuss practical guidelines in specimen handling, common tissue artifacts, non-neoplastic and neoplastic frozen section histology, and challenging scenarios. In addition, it is our hope that this review will serve to facilitate better communication between the surgeon and pathologist to enhance patient care.