How can I differentiate between benign and malignant lesions based on histopathology reports?

To differentiate between benign and malignant lesions based on histopathology reports, key microscopic features must be assessed. Benign lesions typically show well-differentiated cells with uniform nuclei, low mitotic activity, and an organized tissue architecture without invasion into surrounding tissues. In contrast, malignant lesions demonstrate cellular atypia, pleomorphism, increased and abnormal mitoses, loss of normal tissue architecture, and evidence of invasion beyond the basement membrane into adjacent structures or stroma. Additionally, malignant lesions may show necrosis and a desmoplastic stromal response. The presence of these features supports a diagnosis of malignancy, whereas their absence favors benign pathology.

Histopathology reports often describe these features explicitly, highlighting nuclear abnormalities, mitotic figures, and invasion patterns. Immunohistochemical staining and molecular markers may also assist in difficult cases but are adjuncts to the morphological assessment. This approach aligns with UK clinical guidelines emphasizing the importance of cellular atypia and invasion in cancer diagnosis ¹. Recent literature on oral lesions in children and adolescents further supports these criteria, noting that benign oral mucosal lesions maintain normal epithelial stratification and lack invasive growth, while malignant lesions disrupt normal architecture and show marked cytological atypia (Yuhan et al., 2018; Maymone et al., 2019).