Bilateral synchronous tonsillar carcinoma: a case series and review of the literature

Abstract

We present the first dedicated case series of bilateral synchronous tonsillar carcinoma and discuss the role of bilateral tonsillectomy as a diagnostic tool. The occurrence of multiple head and neck tumours is well recognised; however, reports of bilateral synchronous tonsillar carcinoma are rare. A literature review reveals only 12 cases of bilateral synchronous tonsillar carcinoma described in the international literature in the past 15 years. We present a further three cases confirmed following bilateral tonsillectomy. In conclusion, bilateral tonsillectomy has in many centres been established as a standard diagnostic and therapeutic procedure for patients who have cervical metastases from a head and neck cancer of unknown primary site. It is likely the true incidence of bilateral synchronous tonsillar carcinoma is underestimated and under-reported. We recommend bilateral tonsillectomy for patients with suspected or proven unilateral tonsillar carcinoma as well as those with cervical metastases from unknown primary site.

Synchronous bilateral tonsil carcinoma: case presentation and review of the literature

“…Nevertheless, in our case described above no reliance on the imaging technique was given. In conclusion, an imaging technique, particularly PET-CT, is necessary for reasons described above and can assist in work-up and diagnosis of CUP-syndrome [18], but a bilateral tonsillectomy with histopathological tissue examination, is more reliable for detection of a tonsillar primary [3] and should not be replaced.…”

“…The new German guidelines recommend a unilateral tonsillectomy in the case of a unilateral peritonsillar abscess except for patients with a positive history of recurrent acute tonsillitis, where a bilateral tonsillectomy could be justified. However, the morbidity of a bilateral tonsillectomy does not seem to be significantly greater [3, 10]. Anatomical reasons can be the normal architecture of the contralateral tonsil, compared to the increased vascularization of a pathologically changed tonsil.…”

“…Primary tonsillar carcinoma is the third most common malignancy in H&N area, after thyroid and larynx carcinoma [3]. About 50% of patients are diagnosed with lymphatic metastazation, occurring on the contralateral cervical side in 10–15% [4].…”

Synchronous HPV-Positive Squamous Cell Carcinoma of the Bilateral Base of the Tongue

“…Several reports have described patients diagnosed with HPV-HNSCCs who subsequently developed SPTs of the head and neck; however, the SPTs in these reports developed in the tonsils or nasopharynx [7][8][9]. Our review of the literature suggests that this is the first report of synchronous HPV-positive SCCs of the bilateral BOT.…”

“…Although there have been a number of recent reports of synchronous HPV-associated tonsillar carcinomas, there have been no reports of synchronous HPV-associated BOT carcinoma. Here we report the case of a 59-year-old man with synchronous HPV-positive SCCs of the bilateral BOT [7][8][9].…”