High-Grade Ovarian Epithelial Tumor and Intraoperative Frozen Section: Consequences of a Discordant Diagnosis

Abstract Ovarian neoplasms are a common specimen received for intraoperative consultation (frozen section) as an accurate diagnosis is necessary to determine the next steps in surgery. We present the case of a 79-year-old woman with a 5.3-cm right ovarian lesion as well as a large appendiceal mass. The frozen section of the ovarian lesion showed a high-grade tumor with areas of luminal necrosis. These morphologic findings, along with the presence of a colonic mass, led to an intraoperative consultation diagnosis of “high grade adenocarcinoma, favor metastasis from gastrointestinal tract primary,” and to the surgery ending after removal of the appendix and cecum. However, the permanent section revealed high-grade serous carcinoma. We review the differential diagnosis of high-grade ovarian lesions on frozen section, examine the challenges that can occur, and discuss the potential downstream effects and consequences for patient care.