There is more than meet the eyes in head and neck cytopathology.

This issue of Diagnostic Cytopathology is dedicated to cytopathology of the head and neck region, which begs a question and several definitions. What do clinicians, pathologists and patients mean when they say: “head and neck”. More pertinently, do cytopathologists think mainly of “head and neck lumps” when thinking of cytopathology of the head and neck? The truth is, somewhat arbitrarily, we have gradually come to think mainly of lumps, located in the thyroid and the parathyroid glands, the major salivary glands, the cervical lymph nodes, and the soft tissue tumors of the region above the clavicle as the usual territory of head and neck cytopathology. Our selection of papers is intended as food for thought in 1) expanding the way we view cytopathology of the head and neck, not only as diagnostic and prognostic, but also as capable of impacting treatment and enabling the recognition of novel targets of molecular therapies 2) extending it beyond just lumps and bumps, by refocusing attention on the use of exfoliative cytology for the study of mucosal abnormalities 3) re-emphasizing that the eyes, the pituitary and the pineal gland as well as the leptomeninges can be evaluated cytologically and are part of the head and neck; and 4) recognizing that a wider range of lesions, to include tumors originating in the skin, subcutaneous, nerve, lymphoid, bone and soft tissues as well as metastatic lesions can occur anywhere in head and neck region. Such an amplified view extends also to remembering that any structure of the head and neck can be the site of lesions of varied histogenesis, be it metabolic, inflammatory, infectious, allergic, immunologic or neoplastic in nature. As the articles in this issue demonstrate, one of the most complex regions of the human body, the head and neck includes a myriad of interrelated but uniquely different organs, each with its own scientific field of study and clinical specialty, or group of specialties. Otolaryngology, commonly called ENT for “ear, nose and throat” is the oldest medical specialty in the US, but is far from being clearly defined. Practiced by surgical as well as nonsurgical specialists, ENT uses countless procedures to maximize diagnosis and treatment of head and neck lesions. In fact, one of the earliest papers on the cytology of the ear, nose and throat was published in the Journal of Laryngology & Otology, at a time when exfoliative cytology was the norm. In case you are wondering, yes, there is a journal of Rhinology, founded in 1963, which represents at least four Rhinology societies: respectively, the International, the European, the American and the Japanese Society of Rhinology. There are at least three dozen additional scientific journals dedicated to clinical aspects of conditions affecting the head and neck. These publications cover both neoplastic and non-neoplastic conditions, described by clinicians, surgeons, pathologists and other specialists, with emphasis on histopathology and a smattering of cytology oriented papers. The vast majority of the cytopathology-centered literature tends to be focused mainly to the use of FNA and other biopsy procedures for ruling out cancer or characterizing the exact nature of various neoplasms Could it be that amplifying the scope of studies based on cytological techniques would succeed in expanding the horizons of our sub-specialty and making it more clinically relevant in the 21 century? The same goal could be enhanced by examining cytological specimens with an ever expanding repertoire of newly developed antibodies as well as the latest tools for the cytogenetic and molecular characterization of various neoplasms of the head and neck. According to current terminology, ENT is both a medical and surgical specialty concerned with the diagnosis, management, and treatment of diseases and disorders of at least four or five related structures of the head and neck, besides the ear, the nose and the throat. These regions, comprising the para-nasal sinuses, the larynx, the DOI: 10.1002/dc.23089 Published online in Wiley Online Library (wileyonlinelibrary.com).