Salivary glands

Background

Parotid and submandibular glands may be resected after fine needle aspiration (FNA) investigation due to the presence of a benign tumour, such as a pleomorphic adenoma or Warthin’s tumour.

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Malignant neoplasms are rare but primary salivary gland tumours such as mucoepidermoid, acinic cell, adenoid cystic, squamous cell and salivary duct carcinomas do occur.1-8

The resection procedure may be a superficial parotidectomy (superficial lobe not including the facial nerve), total parotidectomy (superficial and deep lobes, including the facial nerve) or a submandibulectomy (total excision of the submandibular gland). Radical neck dissections may be required for treatment of head and neck malignancies.See the neck dissection protocol for more detail.

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.

Fresh tissue received
  • No
    • Non-routine fixation (not formalin), describe.
  • Yes
    • Special studies required, describe.
    • Ensure samples are taken prior to fixation.
Intraoperative consultation
  • Not performed
  • Performed, describe type and result
    • Frozen section
    • Imprints
    • Other, describe

See general information for more detail on specimen handling procedures.

Inspect the specimen and dictate a macroscopic description.

External InspectionBack to top


Orientate and identify the anatomical features of the specimen.

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

Orientation markers

Record additional orientation or designation provided by operating clinician:

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

Photograph the intact specimen if required.

Describe the following features of the specimen:

Specimen integrity

  • Intact
  • Fragmented, describe

Specimen laterality

  • Left
  • Right
  • Unoriented

Procedure

Record as stated by the clinician.1

Options
  • Incisional biopsy
  • Excisional biopsy of minor gland
  • Resection of submandibular gland
  • Extended resection of submandibular gland (surgeon to indicate extent of anatomical resection)
  • Resection of sublingual gland
  • Superficial parotidectomy +/- facial nerve sacrifice
  • Total parotidectomy
    • Facial nerve preservation
    • Facial nerve sacrifice
    • Extended radical total parotidectomy (includes resection of parotid gland, facial nerve, masseter muscle, zygoma and mandible)
  • Other, describe

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

  • Total specimen, in three dimensions1,2,6
More detail

If multiple fragments are received, the collective size of all tissue is measured in three dimensions2

Describe and measure the anatomical components present.

  • Minor salivary gland
  • Parotid
  • Submandibular gland
  • Sublingual gland
  • Skin, note any skin lesions and refer to the skin protocol for more information.
  • Other, describe

DissectionBack to top


Minor salivary glands may be small specimens <15mm in maximum dimension. Bisect the gland transversely.

Resection specimens may be orientated by the clinician. Paint the deep and superficial surgical margins2 (if known) with ink, in addition to any other designated margins & record the colours applied.

Section the specimen at sequential intervals to best demonstrate the relationship of the lesion to the margins.2 This is usually along the transverse axis.

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

Internal InspectionBack to top


Describe the internal or cut surface appearance including the following items:1,6

Tumour

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

Tumour size (mm)1

  • In three dimensions
More detail

Tumour size is an important prognostic factor for treatment outcome and survival.1,5-8

Tumour site1

  • Describe if relevant, or record with an annotated photograph.

Tumour appearance1,2,6

  • Solid
  • Cystic
  • Gelatinous

Distance of tumour to margins (mm)

  • Distance of tumour to the surgical resection margins
  • Specify each margin

Macroscopic extraparenchymal extension1

  • No
  • Yes, specify tissues involved
    • Surrounding fat
    • Skeletal muscle
    • Skin
    • Nerve
    • Other, specify

Other abnormalities present

  • Cysts
  • Stones
  • Other, describe
Lymph nodes

Retrieved from resection specimen

  • Describe site(s)
  • Number retrieved

Separately submitted

  • For each specimen container, record specimen number and designation
  • Collective size of tissue in three dimensions (mm)
  • Number of grossly identified lymph nodes submitted
  • Maximum diameter of each (mm)

Sentinel, left and right neck dissection1

  • Level
    • Submental (IA)
    • Submandibular (IB)
    • Upper jugular (IIA and IIB)
    • Middle jugular (III)
    • Lower jugular (IV)
    • Posterior triangle (VA and VB)
    • Anterior triangle (VI)

See neck dissection protocol for more detail.

Photograph the dissected specimen if required.

Note photographs taken, diagrams recorded & markings used for identification.

ProcessingBack to top


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

Submit representative sections of:1,6

  • Surgical resection margins
  • Tumour or lesion
    • If <30mm, it may be appropriate to submit all the tumour
    • If >30mm, at least one section per 10mm of tumour
  • All macroscopically different areas particularly at the edge of the tumour
  • Tumour interface with non-lesional tissue
  • Surgical resection margins of any large nerves included

Submit all lymph nodes & identify the site of each.

Record details of each cassette.

An illustrated block key similar to the one provided may be useful.

Block allocation key 

Cassette id
Site
No. of pieces
A-B
Surgical resection margins
 
C-D
Tumour, representative sections including any macroscopically different areas
 
E
Tumour demonstrating interface with normal tissue
 
F
Nerve resection margins
 
G+
Lymph nodes
 

Acknowledgements

Prof Richard Logan for his contribution in reviewing and editing this protocol.

ReferencesBack to top


  1. Logan RM, Dahlstrom J, Otto S, Nguyen B, Coleman HG and Chong G. Malignant salivary gland neoplasms structured reporting protocol, Royal College of Pathologists Australasia, Surry Hills, NSW, 2013.
  2. Speight P, Jones A, Napier S, Helliwell T. Tissue pathways for head and neck pathology. The Royal College of Pathologists, London, 2008.
  3. Guzzo M, Locati LD, Prott FJ, Gatta G, McGurk M and Licitra L. Major and minor salivary gland tumors. Crit Rev Oncol Hematol 2010;74(2):134-148.
  4. Wahlberg P, Anderson H, Biorklund A, Moller T and Perfekt R. Carcinoma of the parotid and submandibular glands--a study of survival in 2465 patients. Oral Oncol 2002;38(7):706-713.
  5. Zarbo RJ. Salivary Gland Neoplasia: A Review for the Practicing Pathologist. Mod Pathol 2002;15(3):298-323.
  6. Helliwell T and Woolgar J. Dataset for histopathology reporting of salivary gland neoplasms, The Royal College of Pathologists, London, 2013.
  7. Speight PM and Barrett AW. Prognostic factors in malignant tumours of the salivary glands. Br J Oral Maxillofac Surg 2009;47(8):587-593.
  8. Harbo G, Bundgaard T, Pedersen D, Sogaard H and Overgaard J. Prognostic indicators for malignant tumours of the parotid gland. Clin Otolaryngol Allied Sci 2002;27(6):512-516.