Challenges in Head and Neck Pathology

  • Anna Laury
Part of the Cancer Treatment and Research book series (CTAR, volume 174)


The surgical pathologist plays a crucial role in the multidisciplinary team. In nearly all cases, a tissue diagnosis is required to confirm the disease process before treatment begins. Even in settings where the diagnosis appears straightforward, a timely and appropriate report is necessary. The pathologist is also responsible for providing many of the more specific data elements that will guide treatment decisions: examples include evidence of virally driven malignancy, margin status, and the precise depth to which tumor invades. Each of these diagnoses and findings has its own specific set of difficulties and limitations, which require nuanced interpretation by a well-informed pathologist.


p16 Extranodal extension Depth of invasion Frozen section Margin evaluation 


  1. 1.
    Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, Gershenwald JE, Compton CC, Hess KR, Sullivan DC, Jessup JM, Brierley JD, Gaspar LE, Schilsky RL, Balch CM, Winchester DP, Asare EA, Madera M, Gress DM, Meyer LR (2016) AJCC cancer staging manual, 8th edn. Springer International PublishingGoogle Scholar
  2. 2.
    Ebrahimi A, Gil Z, Amit M, Yen TC, Liao CT, Chaturvedi P, Brandao J (2014) The international consortium for outcome research in and C. Neck. Primary tumor staging for oral cancer and a proposed modification incorporating depth of invasion: an international multicenter retrospective study. JAMA Otolaryngol Head Neck Surg 140:1138–1148Google Scholar
  3. 3.
    Hinni ML, Ferlito A, Brandwein-Gensler MS, Takes RP, Silver CE, Westra WH, Seethala RR, Rodrigo JP, Corry J, Bradford CR, Hunt JL, Strojan P, Devaney KO, Gnepp DR, Hartl DM, Kowalski LP, Rinaldo A, Barnes L (2013) Surgical margins in head and neck cancer: a contemporary review. Head Neck 35:1362–1370CrossRefPubMedGoogle Scholar
  4. 4.
    Chang AM, Kim SW, Duvvuri U, Johnson JT, Myers EN, Ferris RL, Gooding WE, Seethala RR, Chiosea SI (2013) Early squamous cell carcinoma of the oral tongue: comparing margins obtained from the glossectomy specimen to margins from the tumor bed. Oral Oncol 49:1077–1082CrossRefPubMedGoogle Scholar
  5. 5.
    Maxwell JH, Thompson LDR, Brandwein-Gensler MS, Weiss BG, Canis M, Purgina B, Prabhu AV, Lai C, Shuai Y, Carroll WR, Morlandt A, Duvvuri U, Kim S, Johnson JT, Ferris RL, Seethala R, Chiosea SI (2015) Early oral tongue squamous cell carcinoma sampling of margins from tumor bed and worse local control. JAMA Otolaryngol Head Neck Surg 141:1104–1110Google Scholar
  6. 6.
    Varvares MA, Poti S, Kenyon B, Christopher K, Walker RJ (2015) Surgical margins and primary site resection in achieving local control in oral cancer resections. Laryngoscope 125:2298–2307CrossRefPubMedGoogle Scholar
  7. 7.
    Chung CH, Gillison ML (2009) Human papillomavirus in head and neck cancer: its role in pathogenesis and clinical implications. Clin Cancer Res 15:6758–6762CrossRefPubMedGoogle Scholar
  8. 8.
    Human papillomaviruses (2007) IARC Monogr Eval Carcinog Risks Hum 90:1–636Google Scholar
  9. 9.
    Lai K, Killingsworth M, Matthews S, Caixeiro N, Evangelista C, Wu X, Wykes J, Samakeh A, Forstner D, Niles N, Hong A, Lee CS (2016) Differences in survival outcome between oropharyngeal and oral cavity squamous cell carcinoma in relation to HPV status. J Oral Pathol MedGoogle Scholar
  10. 10.
    Chandarana SP, Lee JS, Chanowski EJP, Sacco AG, Bradford CR, Wolf GT, Prince ME, Moyer JS, Eisbruch A, Worden FP, Giordano TJ, Kumar B, Cordell KG, Carey TE, Chepeha DB (2013) Prevalence and predictive role of p16 and epidermal growth factor receptor in surgically treated oropharyngeal and oral cavity cancer. Head Neck 35:1083–1090CrossRefPubMedGoogle Scholar
  11. 11.
    Satgunaseelan L, Chia N, Suh H, Virk S, Ashford B, Lum T, Ranson M, Clark J, Gupta R (2017) p16 expression in cutaneous squamous cell carcinoma of the head and neck is not associated with integration of high risk HPV DNA or prognosis. Pathology 49:494–498CrossRefPubMedGoogle Scholar
  12. 12.
    McDowell LJ, Young RJ, Johnston ML, Tan TJ, Kleid S, Liu CS, Bressel M, Estall V, Rischin D, Solomon B, Corry J (2016) p16-positive lymph node metastases from cutaneous head and neck squamous cell carcinoma: no association with high-risk human papillomavirus or prognosis and implications for the workup of the unknown primary. Cancer 122:1201–1208CrossRefPubMedGoogle Scholar
  13. 13.
    Bishop J, Ma X, Wang H, Luo Y, Illei P, Begum S, Taube J, Koch W, Westra W (2012) Detection of transcriptionally active high risk HPV in patients with head and neck squamous cell carcinoma as visualized by a novel E6/E7 mRNA in situ hybridization method. Am J Surg Pathol 36:1874–1882CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Westra WH (2014) Detection of human papillomavirus (HPV) in clinical samples: evolving methods and strategies for the accurate determination of HPV status of head and neck carcinomas. Oral Oncol 50:771–779CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Robinson M, Suh YE, Paleri V, Devlin D, Ayaz B, Pertl L, Thavaraj S (2013) Oncogenic human papillomavirus-associated nasopharyngeal carcinoma: an observational study of correlation with ethnicity, histological subtype and outcome in a UK population. Infect Agent Cancer 8:30Google Scholar
  16. 16.
    Dalin MG, Watson PA, Ho AL, Morris LGT (2017) Androgen receptor signaling in salivary gland cancer. Cancers 9:17. (02/08 12/22/received 02/03/accepted 2017)Google Scholar
  17. 17.
    Clauditz TS, Reiff M, Gravert L, Gnoss A, Tsourlakis MC, Munscher A, Sauter G, Bokemeyer C, Knecht R, Wilczak W (2011) Human epidermal growth factor receptor 2 (HER2) in salivary gland carcinomas. Pathology 43:459–464CrossRefPubMedGoogle Scholar
  18. 18.
    Yin LX, Ha PK (2016) Genetic alterations in salivary gland cancers. Cancer 122:1822–1831CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Griffith CC, Schmitt AC, Little JL, Magliocca KR (2017) New developments in salivary gland pathology: clinically useful ancillary testing and new potentially targetable molecular alterations. Arch Pathol Lab Med 141:381–395CrossRefPubMedGoogle Scholar
  20. 20.
    Ferreiro JA, Myers JL, Bostwick DG (1995) Accuracy of frozen section diagnosis in surgical pathology: review of a 1-year experience with 24,880 cases at Mayo Clinic Rochester. Mayo Clin Proc 70:1137–1141CrossRefPubMedGoogle Scholar
  21. 21.
    DiNardo LJ, Lin J, Karageorge LS, Powers CN (2000) Accuracy, utility, and cost of frozen section margins in head and neck cancer surgery. The Laryngoscope 110:1773–1776CrossRefPubMedGoogle Scholar
  22. 22.
    Olson SM, Hussaini M, Lewis JS (2011) Frozen section analysis of margins for head and neck tumor resections: reduction of sampling errors with a third histologic level. Mod Pathol 24:665–670. (05//print 2011)Google Scholar
  23. 23.
    Krishnan L, Karpagaselvi K, Kumarswamy J, Sudheendra US, Santosh KV, Patil A (2016) Inter- and intra-observer variability in three grading systems for oral epithelial dysplasia. J Oral Maxillofac Pathol 20:261–268Google Scholar
  24. 24.
    Kujan O, Khattab A, Oliver RJ, Roberts SA, Thakker N, Sloan P (2007) Why oral histopathology suffers inter-observer variability on grading oral epithelial dysplasia: an attempt to understand the sources of variation. Oral Oncol 43:224–231Google Scholar
  25. 25.
    Roychoudhury S, Souza F, Gimenez C, Glass R, Cocker R, Chau K, Kohn N, Das K (2017) Utility of intraoperative frozen sections for thyroid nodules with prior fine needle aspiration cytology diagnosis. Diagn CytopatholGoogle Scholar
  26. 26.
    Trosman SJ, Bhargavan R, Prendes BL, Burkey BB, Scharpf J (2017) The contemporary utility of intraoperative frozen sections in thyroid surgery. Am J OtolaryngolGoogle Scholar
  27. 27.
    Roy S, Parwani AV, Dhir R, Yousem SA, Kelly SM, Pantanowitz L (2013) frozen section diagnosisis there discordance between what pathologists say and what surgeons hear? Am J Clin Pathol 140:363–369CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Cedars-Sinai Medical CenterLos AngelesUSA

Personalised recommendations