Major Salivary Glands
gross appearance of some salivary gland neoplasms is so characteristic that one
can come close to establishing the diagnosis on the gross findings alone. Yet, all
too often, salivary glands are simply inked, bread-loafed, and thrown into
tissue cassettes. Take time to describe the appearance of any lesions
the external surface of the specimen after it has been weighed and measured.
Without help from the surgeon, it is usually not possible to distinguish the
superficial from the deep lobe of the parotid. The surgeon sometimes uses a
suture or tag to designate one or both lobes in total parotidectomy specimens.
Carefully look for and tag with safety pins any large nerves that may have been
resected with the gland. It is important to sample these nerves for histology,
but they will not be identifiable after the specimen has been inked. After it
has been oriented and inked, palpate the specimen and identify the tumor. Next,
section the gland at 2- to 3-mm intervals. Measure the size of the tumor and
describe its gross appearance. Is it well demarcated and en-capsulated or
poorly demarcated and infiltrative? Is the tumor solid or cystic? Are areas of
cartilagi-nous differentiation appreciable grossly? How close is the tumor to
the margins? Carefully exam-ine the salivary gland parenchyma, keeping in mind
that salivary gland tumors may be multi-nodular (e.g., recurrent pleomorphic
adenomas) or multicentric (e.g., Warthin’s tumor).
gland neoplasms should be thor-oughly if not entirely sampled for microscopic
examination. Sampling that is too limited runs the risk of: (1) missing focal
areas of malignant transformation in a pre-existing adenoma; and
an incomplete representation of the overall microscopic appearance of these
morpho-logically diverse neoplasms. Do not just scoop out the center of the
tumor; instead, carefully submit sections showing the relationship of the tumor
to the inked soft tissue margin, the tumor to the adjacent uninvolved gland,
and, as noted, the tumor to any grossly identifiable nerves. Once the tumor has
been described and submitted for histology, the rest of the gland can be
examined and described. The parotid gland is unique among the major salivary
glands in that it harbors a number of intraparenchymal lymph nodes. Thus, your
search for lymph nodes should include the parotid parenchyma itself in addition
to the peri-parotid soft tissues. These lymph nodes should be entirely
submitted for histologic evaluation. Are any calculi present, and are the ducts
of the salivary gland dilated? Submit representative sections of grossly
uninvolved salivary gland.
procedure was performed, and what structures/organs are present? For parotid
resections, which lobes have been removed?
· Is a
· What are
the type, size, and degree of differentiation of the tumor?
· Does the
tumor infiltrate small or large nerves?
· Does the
tumor involve any of the margins?
· If lymph
nodes are present, how many are pres-ent, and how many are involved by tumor?
Does the non-neoplastic portion of the salivary
gland show any pathology?