IntroductionTonsillitis is a very common disease in children. Understanding the microbiology and pathology of chronic tonsillitis is an important step in its management. The aim of the study was to describe the microbiological profile of core tonsillar tissue in chronic tonsillitis in children.Materials and methodsChildren under 16 years of age with chronic tonsillitis were recruited in the descriptive study. Children with recurrent tonsillitis and recurrent tonsillitis with obstructive symptoms were included. Children who underwent tonsillectomy for obstructive symptoms alone and those who received antibiotics for at least one month prior to surgery were excluded from the study. Dissection and the snare method of tonsillectomy were done on all children. The operated specimen was cut into two halves in a sterile container. The core of the tonsillar tissue was swabbed with two sterile cotton-tipped swabs and sent for the microbiological evaluation of aerobes and anaerobes. The tonsillar tissue was sent for a histopathological examination.ResultsA total of 106 children were operated for chronic tonsillitis in one year. The mean age of children included in this study was 9.4 years. The duration of symptoms due to tonsillar disease ranged from four weeks to 28 months. There were 48 males and 58 females. Recurrent tonsillitis was the most common indication for tonsillectomy in all children. A total of 301 aerobes and 171 anaerobic microorganisms were isolated from 106 children with chronic tonsillitis. The aerobic bacterial species most often isolated was Streptococcus viridans, which was present in 83 children followed by Group A, β-hemolytic Streptococci in 67 children. The anaerobic bacterial most often isolated was Peptococcus species in 49 children. Polymicrobial aerobic and anaerobic flora were present in all tonsillar specimens, yielding an average of 4.1 isolates per specimen. The histopathological examination revealed chronic tonsillitis with reactive follicular hyperplasia in all (100%) children. Actinomycosis was associated with non-specific reactive follicular hyperplasia in four specimens.ConclusionPolymicrobial aerobic and anaerobic flora are identified in deep tonsillar tissue in children with tonsillitis. The identification of bacterial isolates from the core tissue in recurrent tonsillitis could dictate the management of chronic tonsillitis. The histopathological examination of the core tissues of the tonsils helps in an accurate identification of organisms that are difficult to culture.
Hepatoblastoma (HB) constitutes less than 1% of all pediatric malignancies and is the most common malignant tumor of liver in children. The fine‐needle aspiration cytological (FNAC) diagnosis and sub‐typing of this tumor is challenging, which is of critical importance from its treatment point of view. All cases with a clinicoradiological impression of “HB” during the study period of 1 year were subjected to ultrasound‐guided (USG) FNAC and cell blocks were prepared in all cases. Detailed cytopathological examination was carried out based on the cytomorphological pattern and the cell blocks were used to correlate the findings and the final diagnoses were confirmed with the histopathological findings. Four cases were included during this study period. All were children, whose age ranged from 3 months to 10 years. All of them presented with mass per abdomen and increased serum alfa‐feto protein (AFP) levels. On a detailed cytological examination, the clinical impression of HB was confirmed in all four cases with a subsequent histological correlation. Based on their distinct cytomorphological pattern, three of them were accurately sub‐typed as“fetal type,” wile the fourth was an “embryonal type of HB.” All four cases had the evidence of extramedullary hematopoeisis. We conclude that a precise preoperative FNAC diagnosis with accurate sub‐typing of HB is possible purely on cytomorphologic basis which has prognostic and therapeutic implications. Cell blocks are of great use for ancillary studies. Extramedullary hematopoiesis serves as an important “clue” in diagnosis.
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