Pathology of the Head and Neck

280 M. A Luna · K. Pineda-Daboin9are bisected along their longest axis plane and bothhalves submitted. Smaller lymph nodes are submittedin toto. The tissue sections of lymph nodes submittedfor processing should include a capsule of lymph node,including a rim of perinodal connective tissue or fat. Ifa group of matted lymph nodes is present, two or threesections through the nodes are often adequate to documentthe extent of the tumour. Tissue sections submittedfor processing include all lymph nodes (by level), thesubmandibular gland, the sternocleidomastoid muscle,and the internal jugular vein. If the neck dissection isof the extended type, sections of all extra lymph nodegroups and non-lymphatic structures that were removedshould be submitted for tissue processing.9.7.3 Histologic Evaluationof Neck DissectionThe major aim of the histologic evaluation of the statusof lymph nodes in cases of carcinoma of the headand neck is to provide information required for stagingdisease, planning further treatment and predictingpatient outcome. The histologic evaluation alsodocuments and confirms the pathologist’s own grossevaluation of the dissected specimen. More importantly,increasingly important histologic parameters,such as number, sizes and levels of positive nodes, thepresence or absence of extracapsular spread, the presenceof desmoplastic reaction, the presence of gross residualtumour and the presence of tumour emboli inintervening lymphatics, among others, can be assessedby a thorough histologic evaluation. These histologicfindings by themselves and in combination with otherhistologic parameters have been increasingly identifiedas important prognostic factors in disease controland survival, recurrence of neck disease and distantmetastasis. The five factors that are currently indicatorsfor adjuvant postoperative therapy can be reliablyprovided only by histologic evaluation; they are:1. Extranodal spread of disease,2. Number of lymph nodes involved,3. Number of lymph node regions involved,4. Size of metastases,5. Presence of desmoplastic reaction in metastatic disease[42].References1. Agaton-Bonilla FC, Gay-Escola C (1996) Diagnosis andtreatment of branchial cleft cysts and fistulae. A retrospectivestudy of 183 patients. Oral Maxillofac Surg 25:449–4452. Aguacil-Garcia A (1992) Intranodal myofibroblastoma in asubmandibular lymph node. A case report. Am J Clin Pathol978:69–723. Al-Dousary S (1997) Current management of thyroglossalductremnant. J Otolaryngol 126:259–2654. 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