Malignancy in routine tonsillectomy specimens: a systematic literature review

Rokkjær, Malene Sine; Klug, Tejs Ehlers

doi:10.1007/s00405-014-2902-0

Cited by 23 publications

(45 citation statements)

References 43 publications

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“…In a recent review, unsuspected tonsillar malignancy was found in three out of 6,434 adult patients (prevalence 0.05 %) because of routine histological examination of the tonsils. One of these patients presented with PTA and another had a history of recurrent PTA [3]. In agreement with other researchers, the possibility of PTA as an independent risk factor for tonsillar malignancy was questioned [1,3,10].…”

Section: Introductionmentioning

confidence: 72%

“…Unsuspected tonsillar malignancy, diagnosed by coincidence because of routine histological examination, is infrequently found in patients presenting with peritonsillar abscess (PTA) [3,[5][6][7][8][9][10][11]. In a recent review, unsuspected tonsillar malignancy was found in three out of 6,434 adult patients (prevalence 0.05 %) because of routine histological examination of the tonsils.…”

Section: Introductionmentioning

confidence: 95%

“…The prevalence of unsuspected tonsillar malignancy in routine tonsillectomy specimens (adults and children) is low (0.011-0.015 %) [1][2][3]. Clinical risk factors, which indicate histological examination of tonsillectomy specimens, have been defined and discussed in previous publications [1][2][3][4].…”

Section: Introductionmentioning

confidence: 98%

“…Clinical risk factors, which indicate histological examination of tonsillectomy specimens, have been defined and discussed in previous publications [1][2][3][4]. These risk factors include: (1) history or diagnosis of cancer, (2) tonsillar asymmetry, (3) palpable firmness or visible lesions of the tonsils, (4) concomitant neck adenopathy, (5) unexpected weight loss and (6) constitutional symptoms (fatigue, night sweats, fever and anorexia).…”

Section: Introductionmentioning

confidence: 99%

“…These risk factors include: (1) history or diagnosis of cancer, (2) tonsillar asymmetry, (3) palpable firmness or visible lesions of the tonsils, (4) concomitant neck adenopathy, (5) unexpected weight loss and (6) constitutional symptoms (fatigue, night sweats, fever and anorexia). Many researchers add post-transplant patients and immunodeficiency as risk factors because of the risk of lymphoproliferative disorders [3].…”

Section: Introductionmentioning

confidence: 99%

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Tonsillar malignancy in adult patients with peritonsillar abscess: retrospective study of 275 patients and review of the literature

Rokkjær

Klug

2014

Eur Arch Otorhinolaryngol

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Unsuspected tonsillar malignancy in routine tonsillectomy specimens is rare. A potentially increased risk of unsuspected tonsillar malignancy in adult patients presenting with peritonsillar abscess (PTA) was noted in a recent review. Furthermore, a literature search revealed several case reports concerning tonsillar malignancy presenting as PTA. Thus, the aim of the current study was to explore the prevalence of tonsillar malignancy in adult patients with PTA. A retrospective review of all adult patients undergoing tonsillectomy due to PTA from January 2001 to December 2012 at the Ear-Nose-Throat Department was performed. In 275 consecutive adult patients with PTA (median age 40 years, range 30-89 years), we identified one patient with unsuspected tonsillar malignancy (prevalence 0.3 %); a 40-year-old, previously healthy, male was diagnosed with acute myeloid leukaemia. Reviewing the literature, we identified 13 cases of tonsillar malignancy presenting as PTA (median age 49 years, range 2-66 years). Our data represents the only series of histological examined tonsillectomy specimens from PTA patients reported in the literature. We identified one case of unsuspected tonsillar malignancy in this relatively small series. We find it important to stress, that we had no knowledge of this patient before designing the study. Hence, the prevalence of 0.3 % is unbiased in this respect. More, and preferably, larger studies are needed to determine the prevalence with greater certainty. At present, no definitive conclusions can be made, but clinicians should be aware that PTA infrequently masquerade tonsillar malignancy.

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Section: Introductionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Tonsillar malignancy in adult patients with peritonsillar abscess: retrospective study of 275 patients and review of the literature

Rokkjær

Klug

2014

Eur Arch Otorhinolaryngol

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Oropharynx, Hypopharynx, and Parapharyngeal Space: Anatomy, Histology, Benign and Malignant Neoplasia

Brandwein‐Weber

2018

Textbook of Head and Neck Pathology

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Routine Histopathology of Tonsillectomy Specimens, Is It Necessary? A Prospective Observational Study

Mestry,

Sardesai,

Sonawale

et al. 2024

Indian J Otolaryngol Head Neck Surg

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Routine histopathology of tonsillectomy specimens is not standard practice due to cost and resource constraints. This study aimed to evaluate the prevalence of abnormal histopathologies in tonsillectomy specimens to determine the necessity of routine histopathology. A prospective observational study was conducted from January 2014 to August 2016 at a general tertiary care center after approval of Institutional Ethics Committee (IEC). Patients scheduled for tonsillectomy surgery as per the AAOHNS 2011 criteria were included in the study. All tonsillectomy specimens were sent for histopathology, and abnormal findings were documented. Statistical analysis was performed. A total of 111 patients were enrolled in this study, and 222 tonsillectomy specimens were analyzed. The most common finding was chronic tonsillitis, which justified the selection criteria in 91.89% of patients. Two patients with chronic tonsillitis were also found to have actinomycosis present on the surface without parenchymal tissue reaction. Abnormal histopathological findings were observed in 9 (8.10%) of patients, leading to further investigations or treatment in 8 cases. These abnormalities included chronic granuloma, non-Hodgkin's lymphoma, early squamous cell carcinoma, and one choristoma. Tonsillar asymmetry, recent onset of symptoms and older age were found to be significantly correlated with abnormal histopathology and malignancy. Routine histopathology in tonsillectomy specimens helps to identify important findings that may require additional treatment. Based on the study we strongly recommend routine histopathology of tonsillectomy specimen. When significant cost constraints exist, risk-based approach can be adopted. Factors such as older age, asymmetry of tonsils, referred otalgia, duration of symptoms (recent onset) and a history of addiction should be considered for proceeding with histopathology.

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Malignancy in routine tonsillectomy specimens: a systematic literature review

Cited by 23 publications

References 43 publications

Tonsillar malignancy in adult patients with peritonsillar abscess: retrospective study of 275 patients and review of the literature

Tonsillar malignancy in adult patients with peritonsillar abscess: retrospective study of 275 patients and review of the literature

Oropharynx, Hypopharynx, and Parapharyngeal Space: Anatomy, Histology, Benign and Malignant Neoplasia

Routine Histopathology of Tonsillectomy Specimens, Is It Necessary? A Prospective Observational Study

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