Synchronous Bilateral Tonsil Squamous Cell Carcinoma

Roeser, Michelle M.; Alon, Eran E.; Olsen, Kerry D.; Moore, Eric J.; Manduch, Marosh; Wismayer, David J. Schembri

doi:10.1002/lary.21645

Cited by 24 publications

(20 citation statements)

References 17 publications

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“…Moreover, given that other 3 cases of bilateral synchronous tonsillar cancer in patients with SCCUP have been reported in studies that did not meet the inclusion criteria, we believe that the true incidence of bilateral/contralateral tumors is underestimated. 11,35,64 Bilateral tonsillar resection is further supported by this review, mainly for oncological reasons, but also by the fact that of 204 bilateral tonsillectomies performed (on a total of 416) only 2 bleeding episodes are reported in one 60 of the included articles, which did not specify if the source site was the tonsillar fossa or the base of tongue. Therefore, it seems clear that the advantage of finding the primary tumor largely outweighs the very minimal risks associated with the bilateral tonsillectomy procedure.…”

Section: Discussionmentioning

confidence: 92%

“…In this review, 14 (10%) synchronous bilateral and 2 (1%) contralateral tumors were identified on 140 occult tonsillar malignancies. Moreover, given that other 3 cases of bilateral synchronous tonsillar cancer in patients with SCCUP have been reported in studies that did not meet the inclusion criteria, we believe that the true incidence of bilateral/contralateral tumors is underestimated …”

Section: Discussionmentioning

confidence: 99%

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Role of palatine tonsillectomy in the diagnostic workup of head and neck squamous cell carcinoma of unknown primary origin: A systematic review and meta‐analysis

Maio

Iocca²,

Virgilio³

et al. 2018

Head & Neck

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Background This systematic review and meta‐analysis aims to evaluate the effectiveness of palatine tonsillectomy in patients with cervical metastasis from squamous cell carcinoma of unknown primary (SCCUP) origin. Methods A systematic review including studies that encompassed palatine tonsillectomy in the SSCUP diagnostic evaluation was conducted. A single arm meta‐analysis was then made to obtain the overall identification rate of tonsillectomy. Results Fourteen studies were included, comprising 673 patients who underwent 416 palatine tonsillectomies, 338 preformed during examination under anesthesia (EUA) and 78 managed with transoral robotic surgery (TORS). A total of 140 occult tonsillar malignancies were identified; of these, 124 (89%) were ipsilateral, 2 (1%) contralateral, and 14 (10%) synchronous bilateral. Meta‐analysis of 11 studies showed an overall detection rate of tonsillectomy of 0.34 (99% confidence interval 0.23‐0.46). Conclusion Palatine tonsillectomy is a valuable diagnostic tool in the management of patients with head and neck SCCUP. Bilaterality of tonsillectomy should be taken into consideration.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Role of palatine tonsillectomy in the diagnostic workup of head and neck squamous cell carcinoma of unknown primary origin: A systematic review and meta‐analysis

Maio

Iocca²,

Virgilio³

et al. 2018

Head & Neck

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“…Squamous cell carcinoma of the head and neck presents with a biopsy proven metastatic cervical lymph node without an identifiable primary tumor site in approximately 2% to 4% of all cases . To identify the primary tumor, the typical diagnostic workup consists of a thorough physical examination, flexible endoscopy, and radiological imaging including positron emission tomography (PET)/CT.…”

Section: Introductionmentioning

confidence: 99%

Transoral robotic approach to carcinoma of unknown primary

et al. 2013

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Background The management of carcinoma of unknown primary (CUP) is one of the challenging conditions in head and neck oncologic surgery. Despite various diagnostic tools, the primary tumor site in more than half of cases remains unidentified. The purpose of this study was to assess the feasibility and efficiency of utilizing transoral robotic surgery (TORS) for the diagnosis and treatment of CUP in the head and neck. Methods In this prospective, single-institutional, clinical TORS trial, 22 of 181 patients were treated for CUP between 2008 and 2012. Results Among all those 22 patients, primary tumor site identification and complete tumor removal was achieved in 17 patients (77.3%) with TORS. Tonsil (59.1%) and base of tongue (18.1%) were identified as the most common tumor locations. Conclusion Together with panendoscopy, directed biopsies, and positron emission tomography (PET)/CT, TORS is a valuable option in the identification and treatment of primary tumor sites.

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“…3-6 These same patients, however, may be at an elevated risk of developing other HPV-associated carcinomas. Men with HPV-associated oropharyngeal carcinoma are at increased risk for developing HPV-associated anogenital carcinoma, and several recent reports have described patients diagnosed with HPV-HNSCCs who subsequently developed second primary cancers of the head and neck: McGovern et al described a 46 year-old patient with three synchronous HPV-associated carcinomas of Waldeyer’s ring, 7 Roeser et al described a case of synchronous HPV-associated tonsillar carcinomas, 8 and Singhi et al observed 3 patients with HPV-associated oropharyngeal carcinomas in their series of patients with HPV-associated nasopharyngeal carcinomas. 9 …”

Section: Introductionmentioning

confidence: 99%

Molecular etiology of second primary tumors in contralateral tonsils of human papillomavirus-associated index tonsillar carcinomas

et al. 2013

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Objectives For patients with tobacco-related head and neck squamous cell carcinoma (HNSCC), the occurrence of a second primary tumor (SPT) is an ominous development that is attributed to a field cancerization effect and portends a poor clinical outcome. The goal of this study was to determine whether patients with human papillomavirus (HPV)-related index tonsillar carcinomas can also develop SPTs in the contralateral tonsil, and to discern the molecular etiology of HPV-related tumor multifocality. Materials and Methods The surgical pathology archives of The Johns Hopkins Hospital were searched for all patients with primary HPV-related tonsillar squamous cell carcinoma who developed a synchronous or metachronous carcinoma in the contralateral tonsil. The HPV-16 E6 exon was sequenced from each independent cancer site to determine whether the tumor pairs harbored the same or a different HPV-16 variant. Results Four patients with bilateral HPV-related tonsillar carcinomas were identified. In every case, the HPV DNA sequences derived from the index tumor and corresponding SPT were 100% concordant, indicating that the index and SPTs were caused by the same HPV-16 variant. Conclusion For the small subset of patients with tonsillar carcinomas who develop SPTs in the contralateral tonsil, the index case and the SPT consistently harbored the same HPV variant. This finding suggests that HPV-related tumor multi-focality can be attributed either to independent inoculation events by the same virus, or by migration of HPV-infected cells from a single inoculation site to other regions of Waldeyer’s ring.

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Synchronous Bilateral Tonsil Squamous Cell Carcinoma

Abstract: We describe an exceedingly rare case of bilateral simultaneous metastatic palatine tonsil SCCA. This finding raises the question regarding the need for bilateral tonsillectomy in the case of the unknown primary or proven tonsil carcinoma with HPV positivity.

Cited by 24 publications

References 17 publications

Role of palatine tonsillectomy in the diagnostic workup of head and neck squamous cell carcinoma of unknown primary origin: A systematic review and meta‐analysis

Role of palatine tonsillectomy in the diagnostic workup of head and neck squamous cell carcinoma of unknown primary origin: A systematic review and meta‐analysis

Transoral robotic approach to carcinoma of unknown primary

Molecular etiology of second primary tumors in contralateral tonsils of human papillomavirus-associated index tonsillar carcinomas

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