Palatine Tonsil Asymmetry - Results from the Otorhinolaryngology Department of a Tertiary Hospital

Authors

  • Ana Isabel Gonçalves Hospital Pedro Hispano
  • Diogo Abreu Pereira Hospital Pedro Hispano
  • Delfim Duarte Hospital Pedro Hispano
  • Gustavo Lopes Hospital Pedro Hispano
  • Ditza Vilhena Hospital Pedro Hispano

DOI:

https://doi.org/10.34631/sporl.787

Keywords:

tonsillar asymmetry, malignancy, tonsillectomy, oropharyngeal cancer

Abstract

OBJECTIVES:To evaluate the incidence of malignancy in patients with tonsillar asymmetry who underwent tonsillectomy at our hospital. Characterize the clinical profile of patients with malignant disease.

MATERIAL AND METHODS:The clinical records of 1268 patients undergoing tonsillectomy between January 2012 and January 2019 inclusive were retrospectively analyzed. We selected the cases in which the anatomopathological exam of the removed tonsils was requested because of tonsillar asymmetry. A total of 48 patients were included in the study.

RESULTS:The incidence of malignancy was 8.3% and the most frequent malignancy was squamous cell carcinoma (n = 2). A statistically significant positive correlation was found between the tonsillar asymmetry quantified by the Brosdky classification and the weight difference between the tonsils in the histological evaluation (p = 0.009). There were no differences in tonsil weight between groups with and without Actynomices colonization (p = 0.631). A statistically significant correlation was demonstrated between the perceived tonsillar asymmetry on the objective examination and the histological result of malignancy (p = 0.033).

CONCLUSIONS:All patients diagnosed with malignant disease underwent surgery only due to the presence of tonsillar asymmetry. Thus, although tonsillar asymmetry is more often associated with benign changes, a statistically significant correlation was found between asymmetry and malignant disease.

References

- Adil EA, Medina G, Cunningham MJ. Differentiating Tonsil Cancer from Benign Tonsillar Hypertrophy. J Pediatr. 2018 Jun;197:309-309.e1. doi: 10.1016/j.jpeds.2018.02.048.

– Rokkjaer MS, Klug TE. Malignancy in routine tonsillectomy specimens: a systematic literature review. Eur Arch Otorhinolaryngol. 2014 Nov;271(11):2851-61. doi: 10.1007/s00405-014-2902-0.

- Berkowitz RG, Mahadevan M. Unilateral tonsillar enlargement and tonsillar lymphoma in children. Ann Otol Rhinol Laryngol. 1999 Sep;108(9):876-9. Doi: 10.1177/000348949910800910.

- Cohan DM, Popat S, Kaplan SE, Rigual N et al. Oropharyngeal cancer: current understanding and management. Curr Opin Otolaryngol Head Neck Surg. 2009 Apr;17(2):88-94. Doi: 10.1097/moo.0b013e32832984c0.

- Papouliakos S, Karkos PD, Korres G, Karatzias G et al. Comparison of clinical and histopathological evaluation of tonsils in pediatric and adult patients. Eur Arch Otorhinolaryngol. 2009 Aug;266(8):1309-13. doi: 10.1007/s00405-008-0869-4.

- Younis RT, Hesse SV, Anand VK. Evaluation of the utility and cost-efectiveness of obtaining histopathologic diagnosis on all routine tonsillectomy specimens. Laryngoscope. 2001 Dec;111(12):2166-9. doi: 10.1097/00005537-200112000-00017.

- Harley EH. Asymmetric tonsil size in children. Arch Otolaryngol Head Neck Surg. 2002 Jul;128(7):767-9. Doi: 10.1001/archotol.128.7.767.

- Alvi A, Vartanian AJ. Microscopic examination of routine tonsillectomy specimens: is it necessary? Otolaryngol Head Neck Surg. 1998 Oct;119(4):361-3. Doi: 10.1016/S0194-5998(98)70079-8.

- Garavello W, Romagnoli M, Sordo L, Spreafico R et al. Incidence of unexpected malignancies in routine tonsillectomy specimens in children. Laryngoscope. 2004 Jun;114(6):1103-5.doi: 10.1097/00005537-200406000-00027.

- Starry AC. XXIX Pathology of the Tonsil with Statistical Report and Microscopic Study. Annals of Otology, Rhinology & Laryngology. 1939; 48(2): 346–358. doi: 10.1177/000348943904800204

- Syms MJ, Birkmire-Peters DP, Holtel MR. Incidence of carcinoma in incidental tonsil asymmetry. Laryngoscope. 2000 Nov;110(11):1807-10. doi: 10.1097/00005537-200011000-00006.

- Kutluhan A, Salviz M, Yalçiner G, Kandemir O et al. The role of the actinomyces in obstructive tonsillar hypertrophy and recurrent tonsillitis in pediatric population. Int J Pediatr Otorhinolaryngol. 2011 Mar;75(3):391-4. doi: 10.1016/j.ijporl.2010.12.014.

- Bhargava D, Bhusnurmath B, Sundaram KR, Raman R et al. Tonsillar actinomycosis: a clinicopathological study. Acta Trop. 2001 Oct 22;80(2):163-8. doi: 10.1016/s0001-706x(01)00172-3.

Published

2020-03-11

How to Cite

Gonçalves, A. I., Abreu Pereira , D. ., Duarte, D. ., Lopes, G. ., & Vilhena, D. (2020). Palatine Tonsil Asymmetry - Results from the Otorhinolaryngology Department of a Tertiary Hospital. Portuguese Journal of Otorhinolaryngology and Head and Neck Surgery, 57(3), 95–99. https://doi.org/10.34631/sporl.787