There is a large body of evidence in the European and US literature which argues forcefully that the presence of metastatic deposits within cervical lymph nodes is the single most significant independent adverse prognostic factor in patients with squamous-cell carcinomas of the head and neck. When all head and neck cancers are considered, ipsilateral lymph node metastases appear to decrease patient survival by as much as 50%; moreover, the presence of contralateral or bilateral cervical metastases reduces prognosis by an additional 50%. Patients with cervical metastases seem to be more likely to develop both distant metastases and local recurrences at the primary site.

Cancer of the larynx is a common problem in a head and neck oncological surgical practice; as such, pathology departments supporting such surgical practices will examine cervical lymph node dissection specimens with some frequency. Issues to be settled among pathologists and surgeons include – How precise an anatomic dissection of the specimen is called for? What histological features of the specimen will be of most use to the clinicians who are devising a course of postoperative therapy for the patient? What sorts of methods are needed to identify the maximum number of micrometastases which may be lurking within the lymph nodes of the specimen? Is there a role for routine application of special techniques – such as immunohistochemistry or molecular biology – in the analysis of these specimens? While the answers to these questions are likely to vary somewhat from one center to another, patients are best served when these questions are discussed amongst the respective physicians before surgical procedures are undertaken, rather than after the fact.

Squamous carcinomas of the head and neck region are exceedingly common problems in the routine practice of head and neck tumour surgery. Well-defined treatment protocols have evolved to manage patients afflicted with such tumours. This article explores the role of the hospital pathologist in the detection of occult metastases. The conventional approach to evaluation of cervical nodes from a neck dissection is reviewed, and then the potential utility of more recently developed diagnostic approaches (such as immunohistochemistry and polymerase chain reaction) is explored.

Current routine histopathologic methods may fail in detecting lymph node micrometastases, while the introduction of newer, sensitive techniques, such as immunohistochemistry and molecular analysis, can improve their detection. The literature reveals that the presence of micrometastases has clinical and prognostic implications.

Current routine histopathologic methods may fail in detecting lymph node micrometastases, while the introduction of newer, sensitive techniques, such as immunohistochemistry and molecular analysis, can improve their detection. The literature reveals that the presence of micrometastases has clinical and prognostic implications.

An overview of the impact of the phenotype malignancies is presented.

Among the more puzzling non-neoplastic necrotizing lesions of the head and neck area is Wegener's granulomatosis. This is a condition of unknown cause that may present (in the head and neck area) with ulceration of the nasal septum, sinus mucosa, oral mucosa, or external ear canal, or even destruction of the vocal cord. Diagnosis depends on the pathologic finding of a characteristic inflammatory reaction pattern (which, in its best-developed form, includes necrosis, granulomatous inflammation, and vasculitis) and the serum finding of an elevated antinuclear cytoplasmic antigen. Treatment is principally medical, with the use of powerful immunosuppressive agents. Distinction from other conditions that may mimic Wegener's granulomatosis (such as malignant lymphoma and infections) is of critical importance in constructing an appropriate treatment strategy.

This paper, based on a literature review, deals with the occasional development of a head and neck neoplasm in the pregnant woman. This rare event makes for some challenging problems in patient management, insofar as the otolaryngologist is actually responsible for taking care of 2 patients - the mother and her unborn child. In particular, 4 tumor types have figured prominently among those head and neck tumors arising in pregnant women: cancer of the larynx, cancer of the thyroid, malignant melanomas, and malignant lymphomas of the head and neck. Of these, the most common appear to be melanomas, followed by lymphomas, thyroid carcinomas, and, finally, laryngeal carcinomas. The thyroid tumors, lymphomas, and laryngeal carcinomas do not appear to behave more aggressively in pregnant than in nonpregnant patients; there is, however, some anecdotal evidence to suggest that melanomas in pregnant women may be more aggressive neoplasms than similar-stage tumors in nonpregnant women. One difficulty in treating any of these tumor types in this clinical setting is the limitation that may be imposed on the use of adjuvant therapy by the presence of the unborn child, which may put the attending physicians in the difficult position of balancing less aggressive therapy for the mother against the potential for harming the baby through use of toxic systemic therapy.