Jump To

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.

Fresh tissue received

No
- Non-routine fixation (not formalin), describe.

Yes
- Special studies required, describe.
  - Describe and ensure samples are taken prior to fixation.

Intraoperative consultation performed

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.

Record additional orientation or designation provided by operating clinician:

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

Options

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

Tonsillectomy tumour specimens

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

More detail

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

Tonsillectomy clinically benign/routine specimens

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.

Options

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.

Tonsillectomy for tumour

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

Tonsillectomy non-tumour

One representative section from both tonsils

Adenoidectomy

One representative section

Record details of each cassette.

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

Block allocation key