Role of electron microscopy in head and neck pathology in adults and children

Diagnostic electron microscopic studies specific to the head and neck region are limited in both children and adults. Even information about the workload created by specimen acquisition from this region in the electron microscopy laboratory is lacking. To address these deficiencies, various specimens gathered from adults (N = 6607) and children (N = 1556), over a 5- and 10-year period, respectively, and blocked in plastic resin were surveyed. Head and neck samples accounted for 16.4% of these samples from adults and 13.5% from children, representing sizable contributions to workload from an anatomic region amounting to less than 10% of body mass. In adults, diagnostic problems posed by metastatic neoplasms account for a considerable proportion of the cases submitted for electron microscopy; in the pediatric age group, undifferentiated primary tumors of the head and neck region frequently require ultrastructural study. In both circumstances, spindle cell, look-alike, neuroendocrine, and small cell tumors can frequently be rapidly assessed and differentiated by ultrastructural details. Problem cases are inevitable given the complexity of this region and the number of different tissues and organs in close proximity. It is advantageous to anticipate the possibility of encountering difficult differential diagnostic problems by sampling lesions of the head and neck for glutaraldehyde fixation more frequently.