- In general, done for visually identifiable lesion
- Rarely done blind when searching for squamous cell carcinoma of unknown origin.
- Most malignant lesions will be squamous cell carcinomas
- Most benign lesions will be vocal cord polyps and papillomas
- Other lesions are very rare: sarcoma, lymphoma…
- Occasionally these specimens will be sent up as “rule out lymphoma”, in which case immediately process for hematopathology before fixing.
- Fix in formalin.
- Describe size, number of fragments, color and texture.
- If polypoid, ink base, bisect and submit to maintain orientation on slide.
- For most ENT biopsies, request three H&E levels.
- Occasionally, small resections such as partial laryngectomies may get misaccessioned as biopsies. As a rule, a single H&E level suffices for these: the patient already has a diagnosis and the lesion will be present on any given level.
- Specimens taken as margins as part of a large resection require a single H&E level.
Review and SignoutEdit
The main tasks when reviewing these biopsies are to classify the lesion (usually squamous dysplasia/carcinoma, but need to exclude reactive changes, lymphoid hyperplasia, infection), determine and its severity (grading of dysplasia; in situ or invasive carcinoma).
1. Larynx, subsite, biopsy:
2. Tongue, subsite, biopsy:
3. Oropharynx, subsite, biopsy:
- Squamous mucosa, no tumor seen.
- Mild squamous dysplasia, no in situ or invasive carcinoma seen.
- Squamous cell carcinoma, (non-)keratinizing, (well, moderately, poorly) differentiated, (in situ vs. invasive), in background of squamous dysplasia and squamous carcinoma in situ.
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