Salivary glands come to the pathology lab in three contexts.
- They may be the main specimen in a resection for a benign indication
- They may come up as a resection for a tumor. When a salivary gland is the main specimen, it may potentially be accompanied by other smaller specimens, including neck nodes or a dissection. When salivary glands are removed for benign or malignant tumors, the goal is always to achieve complete resection to avoid local recurrences. Some salivary gland tumors (benign mixed tumor) are famous for being locally aggressive. Therefore, margin evaluation is very important in these specimens.
- There is also a major salivary gland (the submandibular gland) present in level II of the neck, so that gland is usually included in neck dissections performed for other indications (e.g., thyroid cancer). When you gross these specimens, do not mistake the submandibular gland for a lymph node with metastatic disease!
- If unoriented—can ink one color.
- If oriented—ink using six-color code.
- Superior blue, inferior green, lateral yellow, medial violet, anterior red, posterior black.
- If specimen is larger than a few cm, make at least one cut to aid fixation.
- Consider tumor banking if size permits.
- Fix in formalin.
- Describe size in three dimensions, shape (round/ovoid/irregular/distorted), color (pink/tan/hemorrhagic) and firmness (firm/soft/heterogeneous).
- Ink the specimen and maintain any orientation provided by surgeon.
- Section by breadloafing specimen and pay close attention for closeness to margins.
- Note size (3 dimensions), color, texture and relation between mass lesions and margins.
- Identify and describe any landmarks idenitifed by surgeon (facial nerve, etc.)
- Note the presence or absence of the usual parenchyma which is composed of distinct, uniform, coarse, yellowish-tan lobules.
- Note any dilatation of the salivary ducts is noted as well as the presence of lesions within the ducts.
- Note in all cases of tumor whether the tumor is confined to the gland or is extending beyond it to invade adjacent tissues.
- In cases of extracapsular spread, sections should be cut to show the relationship of the tumor to the surrounding tissue, and especially to the inked margins of resection.
- If the tumor is less than 3 cm, submit entirely, otherwise can submit one section per 0.5 centimeter of tumor, including any areas suspicious for invasion, necrosis, or other unusual features.
- For known Warthin’s tumor, 3-4 total sections are sufficient.
- Remember to take tissue from the center of the lesion for tumor banking.
- Handle any accompanying neck dissection as described in the neck dissection description
Glands received as part of a neck dissectionEdit
- Describe size of the gland.
- State whether gland is grossly involved by tumor and whether the tumor extends outside the gland.
- One section of the uninvolved gland, or one section demonstrating involvement by tumor, is sufficient.
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