Time to Rethink Pathology Reporting in Adenoid Cystic Carcinoma

PURPOSE: To propose a practical, biologically informed pathology reporting framework for adenoid cystic carcinoma (AdCC) that integrates conventional morphology with selective biomarker assessment. METHODS: A narrative review of current pathological reporting standards, emerging proteogenomic evidence, and clinically relevant biomarkers was performed. Based on available evidence, a stepwise reporting strategy was developed in which routine histopathological evaluation remains the foundation, while additional immunohistochemical and molecular analyses are selectively recommended for high-risk or clinically relevant cases. FINDINGS: Conventional morphology accurately establishes the diagnosis but does not fully capture the biological heterogeneity and complexity of AdCC. A selective biological addendum including MYC, p63, B7-H4, TROP2, Nectin-4, and selected molecular analyses may improve biological stratification, optimize tissue stewardship, and identify patients eligible for biomarker-driven therapeutic trials. CONCLUSION: Morphology should remain the cornerstone of AdCC pathology reporting while guiding selective biological characterization to support precision oncology and future clinical trial enrollment.