Head and neck small biopsies and teeth
Background
Malignancies of the oral mucosa and are most commonly squamous cell carcinomas but adenocarcinomas, salivary gland neoplasms and neuroendocrine epithelial neoplasms can also occur.1 Specimens from the nasopharynx and sinuses may also be received. Small biopsies are commonly undertaken to diagnose lesions to determine appropriate treatment.
This protocol is applicable to small biopsy specimens. See oral resection protocol for larger specimens.
Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.
| LP |
Lichen planus |
| MMP |
Mucous membrane pemphigoid |
| SCC |
Squamous cell carcinoma |
| CHC |
Chronic hyperplastic candidosis |
| MRG |
Median rhomboid glossitis |
| FEP |
Fibroepithelial polyp |
Courtesy of Prof Michael Aldred
- No
- Non-routine fixation (not formalin), describe.
- Yes
- Special studies required, describe.
- Ensure samples are taken prior to fixation.
Follow best practice procedures to minimise cross-over contamination of small fragments to other specimens.2
See general information for more detail on specimen handling procedures.
Inspect the specimen and dictate a macroscopic description.
External Inspection
Orientate and identify the anatomical features of the specimen.
Record additional orientation or designation provided by operating clinician:
- Absent
- Present
- Method of designation (e.g. suture, incision)
- Featured denoted
Describe the following features of the specimen:
Procedure
Record as stated by the clinician.
- Incisional biopsy
- Excisional biopsy
- Other, describe
Specimen size (mm)
- Total specimen in three dimensions, length x width x thickness1,3,4
Specimen site
Record the specimen site as stated by the clinician.
| NP |
Nasopharynx |
| FOR |
Fossa of Rosenmuller |
| RBM |
Right buccal mucosa |
| LBM |
Left buccal mucosa |
| R comm |
Right commissure |
| L comm |
Left commissure |
| R tongue |
Right side of tongue |
| L tongue |
Left side of tongue |
| FOM |
Floor of mouth |
| Q_| |
Right maxilla |
| |_Q |
Left maxilla |
| Q¯| |
Right mandible |
| |¯Q |
Left mandible |
Courtesy of Prof Michael Aldred
Specimen description
- Identifiable lesion
- Absent
- Present, describe
- Ulceration
- Scar
- Thickening
- Nodule
- Polyp
- Bone, if present
If received, record the following:
- Number, if more than one, designate and describe each separately
- Fédération Dentaire Internationale (FDI) designation4
- Mobility
- Periodontal ligament involvement
- Root resorption
- Note the presence of any fillings
- Note the presence of soft tissue attached and record location
- Root apex
- Side of root
- Around crown
- Attached at amelo-cemental junction
Permanent teeth are recorded as 1-8 in four quadrants with a two digit numbering system. The first number designates the quadrant and the second number designates the tooth. Quadrants are read clockwise (1. right maxilla, 2. left maxilla, 3. left mandible and 4. right mandible).
e.g. the mandibular left third molar may be recorded as tooth 38 or |¯8.
See also the illustration in general information on anatomical terms.
Dissection
- Mucosal biopsies usually do not require dissection.
- Excisional biopsies are usually best sectioned transversely (across the short axis) to demonstrate the closest margins.
- Incisional biopsies are usually bisected through the long axis. Note that many biopsies of lichen planus are incisional and should not be sliced transversely. Instructions for tissue to be embedded on edge should be communicated to embedding staff.
- Hard tissue, bone and teeth should be decalcified before dissection.4,6
- Cysts =<10mm, bisect and submit all tissue for processing.
- Cysts >10mm, section transversely at 4-5mm intervals.
Bisect or section transversely across the specimen to the closest margins at 3-4mm intervals.
A photo or diagram is required.
- Larger excision biopsies (>10mm) should be dissected to demonstrate representative margins according to the diagram provided.
- Note the position of any orientating sutures.
- Fragments <5mm, submit whole for processing after decalcification.
- Fragments >5mm, section transversely at 3-4mm intervals after decalcification.
- Note the position of any orientating sutures.
- Slice off outer surfaces to obtain a section through the middle of the tooth.
Internal Inspection
If applicable, describe the cut surface appearance including the following items:
Tumour/lesion
- Absent
- Present
- Number; if more than one, designate and describe each separately
Tumour size (mm)
- In three dimensions, length x width x thickness1
- Macroscopic depth of invasion (mm)*
*This is the depth of invasion below luminal surface not thickness of tumour. Ulcerated tumours should be measured from an estimate of the reconstructed surface.1
Photograph the dissected specimen, if required.
Note photographs taken, diagrams recorded and markings used for identification
Processing
- Submit whole for processing. Instructions for tissue to be embedded on edge should be communicated to embedding staff.
- If <10mm, submit whole for processing.
- If >10mm, submit all sections for processing.
- Submit all sections for processing.
- If <10mm, submit all sections for processing.
- If >10mm, submit representative sections demonstrating the relationship of lesion to margins.
- <5mm, submit whole for processing (after decalcification).
- >5mm, submit all sections (after decalcification).
- Submit representative sections through the middle of the tooth for processing (after decalcification) if microscopic examination is required.
Record details of each cassette.
An illustrated block key similar to the one provided may be useful.
Block allocation key
Specimens <10mm
|
Cassette id
|
Site
|
No. of pieces
|
|
A+
|
All tissue, whole or all sections
|
|
Specimens >10mm
|
Cassette id
|
Site
|
No. of pieces
|
|
A+
|
Representative sections demonstrating relationship of lesion to margins
|
|
Acknowledgements
Prof Richard Logan and Prof John Nicholls for their contribution in reviewing and editing this protocol.
References
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Lester SC. Extraneous Tissue. In: Manual of Surgical Pathology, Saunders Elsevier, Philadelphia, 2010;33-34.
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