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Pathology of head and neck neoplasms

Jerome B Taxy, MD
Section Editors
Bruce E Brockstein, MD
Marvin P Fried, MD, FACS
David M Brizel, MD
Marshall R Posner, 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.

Cancer of the head and neck is the sixth most common malignancy worldwide and accounts for approximately 63,000 cases and 13,000 deaths annually in the United States [1]. The most common malignancy is squamous cell carcinoma (SCC) and its variants. Worldwide, cancers of the head and neck are estimated to occur in 560,000 patients per year and cause 380,000 deaths [2]. 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 [3-6].


The discussion in this section is focused on squamous cell carcinoma since it is the most common malignant tumor affecting the upper aerodigestive tract. Tumors of salivary gland or mesenchymal origin may be similarly approached. The pathology of thyroid cancer is covered separately. (See "Atlas of thyroid cytopathology".)

Much attention is given to the histopathologic analysis of squamous carcinoma and its variants, including grading, pattern of infiltration, and margin status. There is no generally accepted and reproducible grading system for squamous carcinoma. The pattern of infiltration at the interface of tumor and underlying connective tissue has been subdivided into as many as five subtypes, ranging from "pushing" to finger-like extensions of variable numbers of cells [7]. Although this assessment has potential value, a multitiered system can be subjective, and its application and does not lend itself to reproducibility. Last, margin status, while measurable and of prognostic value, does not affect the final tumor, node, metastasis (TNM) staging, which depends on tumor size and regional lymph node status.  

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Literature review current through: Nov 2017. | This topic last updated: Jan 12, 2017.
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