Histopathology report

Final reports of pharyngectomy specimens should include details on:

• the type of tumour present:

- squamous cell carcinoma NOS.

- SCC variants include basaloid, adenosquamous, spindle cell, verrucous adenocarcinoma (salivary gland types).

• the grade of tumour assessed at the invasive front.

• cohesive or non-cohesive patterns (more metastasis with non-cohesive).

• the extent of local spread.

• the distance of tumour from the nearest mucosal margin.

• the distance of the tumour from the nearest deep margin.

• intravascular and/or perineural spread.

• involvement of peripharyngeal lymph nodes.

• other pathology such as dysplasia or radiation injury.

If other specimens are attached as an in-continuity dissection (e.g., neck dissection, thyroid gland, oesophagus, skin, etc.), these can be cut separately in the usual fashion.

• TNM classification of tumour spread larynx: pTis carcinoma in situ.

pT1* tumour confined to one subsite*, normal cord mobility. pT2* tumour invades more than one subsite*, impaired cord mobility. pT3 tumour confined to larynx, fixation of 1 or 2 cords.

pT4 tumour through thyroid cartilage and/or extends beyond larynx to, e.g., trachea, soft tissues of neck, thyroid, oesophagus.

* Exact details depends on whether tumour site is supraglottic, glottic or subglottic.

Regional lymph nodes:

pN0 no regional lymph nodes involved.

pN1 metastasis in ipsilateral single node < 3 cm diameter.

pN2 metastasis in:

a. ipsilateral single >3 to 6 cm.

b. ipsilateral multiple < 6 cm.

c. bilateral, contralateral < 6 cm.

pN3 metastasis in a lymph node > 6 cm diameter.

TNM classification of tumour spread pharynx Oro-(hypopharynx):

pT1 tumour < 2 cm in greatest dimension (hypopharynx - and limited to one subsite). pT2 2 cm < tumour < 4 cm in greatest dimension (hypopharynx - and more than one subsite).

pT3 tumour > 4 cm in greatest dimension (hypopharynx - or with fixation of hemilarynx). pT4 tumour invades adjacent structures, e.g., pterygoid muscles, mandible, hard palate, deep muscle of tongue, larynx (hypopharynx - thyroid/cricoid cartilage, carotid artery, soft tissues of neck, pre-vertebral fascia/muscles, thyroid and/or oesophagus).

Nasopharynx:

pT1 tumour confined to nasopharynx.

pT2 tumour into oropharynx and/or nasal fossa.

pT3 tumour into bone and/or nasal sinuses.

pT4 intracranial extension and/or cranial nerves, hypopharynx, orbit.

Regional lymph nodes Oro- and hypopharynx:

pN0 no regional lymph nodes involved.

pN1 metastasis in ipsilateral single node < 3 cm diameter.

pN2 metastasis in:

a. ipsilateral single > 3 to 6 cm.

b. ipsilateral multiple < 6 cm.

c. bilateral, contralateral < 6 cm.

pN3 metastasis in a lymph node > 6 cm diameter.

Nasopharynx:

pN1 unilateral nodal metastasis < 6 cm, above supraclavicular fossa. pN2 bilateral nodal metastasis < 6 cm, above supraclavicular fossa. pN3 metastasis in nodes > 6 cm or in supraclavicular fossa.

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