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Diagnostic Considerations in Head and Neck Pathology

Richardson, Mary S. MD

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doi: 10.1097/PCR.0000000000000144
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This issue of the American Journal of Surgical Pathology Reviews and Reports focuses on a few of the unique, as well as common, problem areas within head and neck pathology. Just as in other subspecialty areas of pathology, molecular information has enlightened the classification of various lesions; some of these will be discussed. Diagnostic challenges in head and neck pathology can be posed merely by the array of tissue types present, compounded by complicated anatomic interfaces. Integrating all these facets into the possible types of diseases and tumors that may be encountered during a patient's lifetime from this region is fairly onerous, particularly given limited biopsy tissue. The less commonly encountered lesions of any region are problematic for the surgical pathologist and the head and neck is no exception.

Identifying the source of a presumed metastatic tumor is part of the daily practice of surgical pathology. Clear cell carcinomas are particularly taxing when the primary is uncertain. Dr. Kelly Magliocca and Dr. Angela Chi highlight the challenges of encountering a clear cell tumor presenting in the jaws and discuss the various entities that enter the current differential diagnosis. In some scenarios, the use of molecular markers may be necessary to render the correct diagnosis and these are discussed.

Soft tissue and bone neoplasms may be particularly difficult on a small core biopsy. Dr. Evelyn Bruner and Dr. Ashley Cross discuss the subtle and diverse histologic features of these lesions in a practical presentation of some unusual entities. The location of a lesion, molecular findings, and radiologic presentation are necessary in formulating the differential diagnosis for many of these entities.

A number of lymphoproliferative lesions are unique to the head and neck. Dr. Angie Duong and Dr. Michael Stump provide a vivid case series presentation of lymphoproliferative lesions. Each case provides helpful discussion of ancillary studies used to make the correct diagnosis, thus enabling selection of the appropriate therapeutic intervention.

The skull base biopsy requires attention to the potential hazards of a “crossover zone” with numerous foramina, structures, and diverse tissue types. This location is one that qualifies as an especially complicated anatomic interface. A neuropathologist's perspective of this area is presented by Dr. Cynthia Welsh with attention to difficult diagnostic challenges, especially with endoscopic biopsy material.

Pigmented lesions of mucosal surfaces of the head and neck are problematic for a number of reasons. Coauthors Dr. Jonathan Ralston, Dr. Thomas Soike, and Dr. Ashley Hamstra discuss the differential diagnosis for a wide variety of pigmented lesions seen in the head and neck. Prognostic indicators for mucosal melanoma, including an approach for diagnostic challenges, are presented.

Receiving a biopsy specimen of a potential malignant or premalignant lesion from the oral cavity is becoming more common in general surgical pathology services. This group of lesions is difficult because the interobserver reproducibility of thresholds for dysplasia is highly variable by report, yet clinical management is reliant on clear communication of findings. A unique potentially malignant disorder of the oral cavity is proliferative verrucous leukoplakia. The current knowledge and understanding of this spectrum of disease is discussed and illustrated by Dr. Mary Richardson, Dr. Laura Spruill, and Dr. Brad Neville.

We hope you will find this issue of American Journal of Surgical Pathology Reviews and Reports interesting and informative.

© 2016 Lippincott Williams & Wilkins, Inc.