What's your frozen diagnosis?

How to work up the case?

All are good ideas and considerations. Here are a few permanent paraffin H&E sections.

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What immunostains do you want? What's your working differential diagnoses on paraffin sections now?

All are good discussions and suggested immunostains are very reasonable.  The lesson for this case is that you should never be too confident; if there is any doubt on frozen, leave your diagnoses broader. Here are a few immunstains that you requested.

Fig. 1 - Pan-CK

Fig. 2 - CD68

Fig. 3 - S100

Thanks for participation!

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Please share your interesting frozen case!

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问一句，CD68（+）说明这是组织细胞，难道这是组织细胞来源的恶性肿瘤？那冰冻您是怎么报的呢？

墨子: Welcome back and thanks for your comment and share your experience!

We also made the mistake at the time of the frozen. We call it "atypical nests of epithelioid cells with necrosis, consistent with malignant neoplasm".  I am aware of fact that fat necrosis, lipogranulomatous reaction in abdominal cavity or lymph nodes on frozen section can be mistaken for malignant neoplasm. The pitfalls from this case is the nested pattern of cells and presence of necrosis.