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    Pharynx

    Background

    This protocol is applicable to surgical specimens of the pharynx including oropharynx, tonsil, adenoid, hypopharynx anc nasopharynx.

    Most malignancies of the nasopharynx are squamous cell carcinomas. However adenocarcinomas, malignant melanoma, undifferentiated carcinomas and neuroendocrine tumours may also occur.1

    Tonsils and adenoids are usually removed due to chronic inflammation and are sometimes processed for histological examination. Rarely these tissues are involved by malignancies such as lymphoma or carcinoma and require microscopic examination.


    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.

    • No
      • Non-routine fixation (not formalin), describe.
    • Yes
      • Special studies required, describe.
        • Describe and ensure samples are taken prior to fixation.
    • Not performed
    • Performed
      • Type, describe
        • Frozen section
        • Imprints

    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.

    • Absent
    • Present
      • Method of designation (e.g. suture, incision)
      • Featured denoted

    Orientate and identify anatomical features. Complex specimens should be examined and orientated together with the responsible surgeon, if possible. Alternatively the surgeon should orientate the specimen with the use of ties or pin the specimen out and label the cork board.2

    Photograph the intact specimen if required.

    Describe the following features of the specimen:

    Specimen laterality

    • Left
    • Right
    • Midline
    • Not specified

    Specimen site

    • Oropharynx
    • Nasopharynx
    • Hypopharynx
    • Other, specify

    Procedure

    • Incisional/endoscopic biopsy
    • Excisional biopsy
    • Resection
      • Tonsillectomy
      • Adenoidectomy
    • Other, describe

    Specimen integrity

    • Intact
    • Disrupted

    Anatomical components included (more than one may apply) and dimensions (mm)

    Describe and measure the anatomical components present.

    • Tonsil, three dimensions
    • Adenoid, three dimensions
    • Oral mucosa, three dimensions
    • Bone, specify and record measurements in three dimensions
    • Other, describe and measure according to relevant tissue protocol

    Mucosal surface abnormalities/lesion

    • Absent
    • Present
      • Ulceration
        • Measure in three dimensions
      • Polyp
        • Measure in three dimensions
      • Other, specify

    Dissection

    Paint the specimen according to any surgical orientation.

    These specimens are usually composed of the tonsillar fossa in addition to other affected mucosal regions such as base of tongue, soft palate and uvula. The specimen is usually serially sectioned cranio-caudally at 3mm intervals.

    All tonsillar tissue is usually submitted for processing because macroscopic examination of tumour depth can be difficult given the fibrotic nature of the specimen and microscopic anatomy of the tonsil.3

    Where no tumour is apparent but neck lymph nodes have possible metastatic tumour, serially section the tonsil and submit all tissue for processing.3

    Primary lesions of the tonsil may not be apparent macroscopically. The ipsilateral tonsil is often the primary site of metastatic squamous cell carcinoma found in the neck, particularly cystic metastases that resemble branchial cysts. Where there is proven or suspected metastasis to neck lymph nodes, the entire tonsil should be examined microscopically.3

    Serially sectioning through the specimen at 3mm intervals.

    Where bone is present, decalcification may be required prior to sectioning.

    After opening the specimen may require longer fixation in larger quantity of formalin.


    Internal Inspection

    Describe the internal or cut surface appearance including the following items:

    Tumour

    • Absent
    • Present
      • Number; if more than one tumour, designate and describe each tumour separately

    Tumour size (mm)

    • In three dimensions

    Tumour site (more than one may apply)

    Record as stated by the clinician.

    Oropharynx

    • Palatine tonsil
    • Base of tongue including lingual tonsil
    • Soft palate
    • Uvula
    • Pharyngeal wall (posterior)
    • Other, specify

    Nasopharynx

    • Nasopharyngeal tonsils (adenoids)

    Hypopharynx

    • Pharyngeal wall (posterior and/or lateral)
    • Other, specify
    • Not specified

    Oropharyngeal tumours

    • Macroscopic depth of invasion (mm)

    Record the depth of invasion below luminal surface (not the thickness of tumour). Ulcerated tumours should be measured from an estimate of the reconstructed surface2

    Tumour description

    • Exophytic
    • Endophytic
    • Ulcerated
    • Polypoid
    • Nodular

    Distance to margins (mm)

    • Distance of tumour to closest surgical margin
    • Specify margin

    Processing

    Dissect the specimen further and submit sections for processing according to the diagram provided.

    Submit representative sections according to the illustrations provided:

    • Surgical margins
    • Representative section of tumour including deepest point of invasion and entire tonsil
    • Tumour with adjacent normal mucosa or residual polyp
    • If bone is present, take sections of margins and a section from any suspicious areas of bone infiltration
    • One representative section from both tonsils
    • One representative section

    Record details of each cassette.

    An illustrated block key similar to those provided below may be useful.

    Block allocation key

    Cassette id
    Site
    No. of pieces
    A
    Surgical margins
     
    B
    Representative section of tumour including deepest point of invasion and entire tonsil
     
    C
    Tumour with adjacent normal mucosa or residual polyp
     
    D
    Bone margins, if present
     
    Cassette id
    Site
    No. of pieces
    A-B
    Representative section from each tonsil
     
    Cassette id Site No. of pieces
    A Adenoid, representative section  
    Cassette id
    Site
    No. of pieces
    A-D
    All serial sections of tissue
     

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    Acknowledgement

    Prof Alfed Lam for his contribution in reviewing and editing this protocol.


    References

    1. Helliwell T and Woolgar J. Dataset for histopathology reporting of mucosal malignancies of the pharynx, The Royal College of Pathologists, London, 2013.
    2. Dahlstrom J, Coleman H, Johnson N, Salisbury E, Veness M and Morgan G. Oral structured reporting protocol, The Royal College of Pathologists of Australasia, Surry Hills, NSW, 2012.
    3. Speight P, Jones A, Napier S, Helliwell T. Tissue pathways for head and neck pathology, The Royal College of Pathologists, London, 2008.

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    26-Mar-2019
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