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Pathology of head and neck neoplasms

Jerome B Taxy, MD
Section Editor
Bruce E Brockstein, MD
Deputy Editor
Michael E Ross, MD


The region commonly referred to as the "head and neck" includes the upper aerodigestive tract (oral cavity, paranasal sinuses, pharynx, larynx, cervical esophagus (figure 1)), thyroid, associated lymph nodes, soft tissues, and bone. The diverse tissues in this anatomic region give rise to a broad spectrum of tumors and tumor-like conditions.

The most common malignancy is squamous cell carcinoma (SCC) and its variants. SCC of the head and neck is the sixth most common malignancy worldwide and accounts for approximately 62,000 cases and 13,000 deaths annually in the United States [1]. Other important primary neoplasms in the head and neck region include salivary gland tumors and mesenchymal lesions of the soft tissues and paranasal sinuses.

This section will deal with SCC, including its precursors and variants. Selected benign epithelial proliferations are also clinically relevant and are considered here because of their clinical presentation as tumors and their associated management issues. Major types of salivary gland neoplasms as well as mesenchymal tumors of special clinical significance to this anatomic region are also included. Detailed pathologic discussions of these entities are available in standard references of head and neck pathology [2-5].


Much energy is expended in the histopathologic analysis of any given tumor, including squamous carcinoma and its variants. The diagnostic workup may take place using biopsy material or a cytologic specimen (ie, fine needle aspiration [FNA] or cell block). The diagnosis will help determine the extent of the resection. The resection specimen asks additional questions of the pathologist, which will complete the major substance of the final report: ie, where (anatomically) is the tumor and is it completely/adequately excised?

Given the compact and complex anatomy of the head and neck and the potential distortion of anatomic landmarks during a resection, communication between the surgeon and the pathologist is essential [6]. The geographic relationship of the surgeon and the pathologist varies among institutions. To avoid miscommunication, especially over telephone or intercom lines, it may be necessary for the surgeon to accompany the specimen to the gross pathology lab to speak directly with the pathologist. Proper orientation, accurate margin designation (usually by inking), and other points of clinical interest are discussed at that time. If indicated, immediate assessments by frozen section can then be initiated. The pathologic study of any specimen is not simply a technical exercise, but should yield a clinically relevant report used to guide further treatment.


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Literature review current through: Sep 2016. | This topic last updated: Sep 26, 2016.
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