Zhu X, et al. - In view of the challenges encountered in frozen section examination of adenocarcinomas with poorly cohesive growth, including signet-ring cell carcinoma, and the possibility of tumor cells to be indistinct and difficult to distinguish from inflammatory or stromal cells due to their diffuse morphology, researchers here performed a detailed retrospective analysis of such cases, researchers sought to inscribe features that may aid in avoiding misdiagnosis at the time of frozen section. The original frozen section slides were reviewed from 50 patients with poorly cohesive carcinoma (PCC) including 32 with positive and 18 with negative frozen section slides. Specificity, sensitivity, PPV, and negative predictive value (NPV) were high (all > 75%) in correlation with following features: irregular nuclear contours, large nuclear size with many nuclei > 4× the size of a small lymphocyte, and disruption/obliteration of normal structures. High specificity and PPV (both ≥ 85%) but relatively low sensitivity and NPV were observed in correlation with following features: crescent-shaped/indented nuclei, prominent nucleoli, anisonucleosis (> 4:1 difference in nuclear size), multinucleation, and the presence of mitotic figures. These useful histologic features of poorly cohesive carcinoma may aid in distinguishing carcinoma cells from benign inflammatory or stroma cells. Information concerning the relatively specific features, in particular, may enable surgical pathologists to avoid false-negative interpretation resulting in significant clinical morbidity.