JAPANESE JOURNAL OF ORAL & MAXILLOFACIAL SURGERY

Vol. 54 No. 6       2008

ISSN: 0021-5163      UBIC: 151-J

ABSTRACT

The dissection of surgical specimen from the neck is often difficult due to the anatomically complicated nature of this area. A neck dissection consists of a tissue mass containing the cervical lymphatics extending from the submandibular to the supraclavicular tissue, bordered latellary by platysma and medially by the internal jugular vein. The lymph nodes in this area are divided into six compartments, the so-called levels as proposed by American Academy of Otolaryngology´s Committee for Head and Neck Surgery and Oncology, and as same as other guidelines provided by several committees in Japan. Practical methods for pathological examination should be established and designed by pathologist based on each institutional environment, for example, a specifically designed record chart for pathological examination of neck dissection. Adequate investigation of surgical specimens requires knowledge of the various types of surgical procedures used and preoperatively performed diagnostic imaging. The histological examination on lymph nodes should be performed by a definite procedure such as start from the hilum along with the peripheral sinus by low magnification. It seems to easily define a relatively large focus of metastatic carcinoma by low magnification, however metastatic micro foci are difficult to define and confused with reactively proliferated histiocytes that have large cytoplasm and nucleus resemble to epithelial cells. A precise histological preparation with adequate staining, especially Eosin staining is essential for precise histological examination and to avoid miss individual carcinoma cells as micro metastasis in the lymph node. There are several reactive changes that should be avoided to confuse from metastatic foci in the lymph nodes received after a radiation therapy. The reactive changes in lymph node are massive proliferation of histiocytes, sinus histiocytosis, cicatrized fibrous hyperplasia with melanin pigmentation. Moreover, a metastatic carcinoma often shows a different histological type from that of original focus, such as metaplastic mucous-laden cells and cystic change. Although there is several issues should be settled of the centinel lymph node examination, it is useful for determination of surgical procedure of neck dissection and for improvement of qualify of life. It is required for improvement of sensitivity and accurate detection for micro metastasis in lymph nodes, and standardization of methods. Key words: neck dissection, lymph node metastasis, histopathological examination, reactive changes, centinel lymph node.

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