Pathological Spectrum and a Few Surprises in Craniofacial Resections: Analysis of 8 Years

Objective: To analyze all cases received in the Department of Pathology from craniofacial resections and to find out incidence of different pathological entities among our population. Cases with differing histology between initial biopsy and final excision specimen were taken out separately and analyzed for the pitfalls in reporting.

Design: Retrospective.

Patients/Materials and Methods: The histology reports and slides of all patients who underwent craniofacial resections in the Department of Head and Neck Surgery from October 2003 to 2011 were reviewed with special emphasis on cases where the histopathology of the initial biopsy differed from the final excision specimen.

Results: A total of 64 cases underwent craniofacial resection in the Department of Head and Neck Surgery over a period of 8 years. Of these, 44 cases had an initial biopsy. The histology reports were discordant in 12 biopsy specimens. Esthesioneuroblastomas were the most common (25%) tumors among our samples, closely followed by squamous cell carcinomas (23.4%) and adenoid cystic carcinomas (15.6%). The reasons for differing histology between the initial sample and final excision biopsy are multifactorial, and primarily related to sampling issues. In some cases, morphological mimickers were the reason for mistaken diagnosis. In addition, a few, rare entities that we encountered were not accurate in the initial histology.

Conclusions: Tumor heterogeneity and morphologic mimics were the most common reasons for a differing histology. In the majority of the cases, the treatment protocol followed did not differ, but the prognostic implications did. This probably could be corrected by an initial extensive sampling.