Making routine head and neck pathology Easy: From dissection to diagnosis

Area of Science:

• Head and Neck Pathology
• Surgical Pathology
• Oncology

Background:

• Head and neck cancer resections, including tongue, oropharynx, and neck dissections, are common in pathology workloads.
• Histological prognostic factors such as invasion depth, margin proximity, and extranodal extension are vital for guiding adjuvant therapy.

Purpose of the Study:

• To provide practical approaches for the macroscopic examination of tongue, oropharyngeal resections, and neck dissections.
• To highlight methods for identifying adverse prognostic features and diagnostic challenges in these specimens.

Main Methods:

• Discussion of differential inking and radial sectioning techniques to assess tumor proximity to margins.
• Emphasis on macroscopic sampling strategies to identify invasion extent, extranodal extension, nodal matting, and soft tissue deposits.

Main Results:

• Macroscopic examination requires tailored approaches for tongue and oropharyngeal specimens.
• Challenges in diagnosing oral epithelial dysplasia in tongue cancers are addressed, distinguishing it from reactive changes.
• p16 immunostaining and human papillomavirus (HPV) testing are critical for oropharyngeal squamous cell carcinoma (SCC) diagnosis and prognosis.

Conclusions:

• Effective macroscopic examination and sampling are essential for accurate head and neck cancer pathology reporting.
• Understanding specific diagnostic challenges, like dysplasia in tongue SCC and HPV in oropharyngeal SCC, improves patient management.
• Standardized approaches to macroscopic assessment and interpretation of ancillary tests enhance prognostic accuracy and treatment planning.