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

Abstract

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.

Hospital discharge survey on 4,199 peritonsillar abscesses in the Veneto region: what is the risk of recurrence and complications without tonsillectomy?

“…Clinicians should be aware that in rare cases PTA may masquerade a malignant tumor of the tonsil: most often squamous cell carcinoma or, more rarely, lymphoma. As far as we know, 14 cases of tonsillar malignancy with PTA as initial manifestation have been reported in the literature [23,24].…”

Indications for tonsillectomy stratified by the level of evidence

“…Arguments for abscesstonsillectomy include: definitive removal of the abscess focus, removal of an occult contralateral abscess, only one inpatient treatment, diagnosis of a previously undetected malign disease, avoiding painful secondary drainage, needle aspiration and treatment of retrotonsillar spreading of the abscess [345], [350]. Occult malignomas are very rare (0.3%), the diagnosis depends on histopathologic examination [351], [352], [353], [354], [355] and is therefore impossible after NA or ID. First reports of ID date back to Paulus from Aegina (625–690 A.C.) and Guy de Chauliac in 1362 [356].…”

Cranial tonsillotomy for peritonsillar abscess: what a relief!

“…This approach should combine (1) the low risk of bleeding complications associated with ID, (2) secure a patent drainage, and (3) finally, offer the opportunity to collect material for histologic examination. Rare cases of malignant diseases mimicking a PTA have been described in the literature [11,[15][16][17][18][19] and cannot be discovered by ID and NA. However, a malignant tumor was not identified in our study, most likely due to the small population size.…”