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Mughal Z, Jangan A, Ahmad A, Turner N, Mughal F. Assessing asymmetrical tonsils in children: an evidence-based review for primary care. Br J Gen Pract 2024; 74:93-94. [PMID: 38272689 PMCID: PMC10824352 DOI: 10.3399/bjgp24x736377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
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2
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Ottinger AM, Singh R, Chen D, Parham K. Unilateral Tonsillar Enlargement as Initial Presentation of Bilateral Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. EAR, NOSE & THROAT JOURNAL 2023:1455613231214634. [PMID: 37997620 DOI: 10.1177/01455613231214634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
Unilateral tonsillar enlargement is a common indication for tonsillectomy, but there are varying rates of malignancy among tonsils removed for asymmetry and a lack of clear guidelines for management within the literature. Lymphoma of the palatine tonsils is among the concerns leading to tonsillectomy, but chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) of the tonsil is rare. We report a case of primary CLL/SLL of the palatine tonsil in a 51-year-old gentleman who presented with tonsillar asymmetry and obstructive sleep apnea (OSA) but lacked signs and symptoms suspicious for malignancy, including lymphadenopathy and "B-symptoms." To our knowledge, only 7 cases of CLL/SLL of the palatine tonsil have been reported in the English literature, with the tonsil being the primary site of involvement in only 4 of those cases. Our unique case highlights the importance of thorough physical exam, family history, and tissue biopsy in patients presenting to the otolaryngologist with OSA and asymmetric tonsils.
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Affiliation(s)
- Allie M Ottinger
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Roshansa Singh
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Dong Chen
- Department of Pathology and Laboratory Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Kourosh Parham
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, USA
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3
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Edwards D, Sheehan S, Ingrams D. Unilateral tonsil enlargement in children and adults: is routine histology tonsillectomy warranted? A multi-centre series of 323 patients. J Laryngol Otol 2023; 137:1022-1026. [PMID: 36167605 DOI: 10.1017/s002221512200216x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study aimed to establish whether histology tonsillectomy is justified for unilateral tonsil enlargement. METHODS A retrospective review was conducted of histology tonsillectomies in three health organisations over five years, with strict exclusion criteria, focusing on benign-appearing unilateral tonsil enlargement. RESULTS Ninety paediatric and 233 adult cases were included. No paediatric cases and five adult cases of malignancy were detected. All malignant cases presented with other symptoms. Using binary logistic regression, a history of rapid unilateral tonsil enlargement was the only factor found to be significantly associated with malignant outcome. Thirty-three per cent of subjectively larger tonsils were smaller on post-operative histological measurement. Of the cases, 12.1 per cent re-presented with post-tonsillectomy bleeding. CONCLUSION The authors recommend avoiding histology tonsillectomy for unilateral tonsil enlargement unless 'red flag' signs of malignancy are present, with particular attention to rapid unilateral tonsil enlargement. This study demonstrated discrepancy between clinical examination findings and true tonsil asymmetry; there may be a role for cross-sectional imaging prior to histology tonsillectomy in high-risk patients.
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Affiliation(s)
- D Edwards
- Department of ENT Surgery, University Hospital of Wales, Cardiff, UK
| | - S Sheehan
- Department of ENT Surgery, Aneurin Bevan University Health Board, Newport, Wales, UK
| | - D Ingrams
- Department of ENT Surgery, Aneurin Bevan University Health Board, Newport, Wales, UK
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4
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Soylu E, Harrison R, Taylor M, Yuen HM, Sproson E. Establishing the relationship between MRI and histological tonsil size measurement in patients undergoing tonsillectomy: Our experience in 11 patients. Clin Otolaryngol 2022; 47:546-551. [PMID: 35397135 DOI: 10.1111/coa.13935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/21/2022] [Accepted: 03/20/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Erdinc Soylu
- Department of Otolaryngology, Queen Alexandra Hospital, Cosham, Portsmouth
| | - Rachael Harrison
- Department of Radiology, Queen Alexandra Hospital, Cosham, Portsmouth
| | - Matthew Taylor
- Department of Radiology, Queen Alexandra Hospital, Cosham, Portsmouth
| | - Ho Ming Yuen
- School of Primary Care, Population Sciences and Medical Education, South Academic Block, Southampton General Hospital, SO16 6YD
| | - Eleanor Sproson
- Department of Otolaryngology, Queen Alexandra Hospital, Cosham, Portsmouth
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Kurch L, Mauz-Körholz C, Fosså A, Georgi TW, Kluge R, Bartelt JM, Kunze C, Wohlgemuth WA, Pelz T, Vordermark D, Plößl S, Hasenclever D, Sabri O, Landman-Parker J, Wallace WH, Karlen J, Fernández-Teijeiro A, Cepelova M, Klekawka T, Løndalen AM, Steiner D, Krombach G, Attarbaschi A, Hoffmann M, Ceppi F, Pears J, Hraskova A, Uyttebroeck A, Beishuizen A, Dieckmann K, Leblanc T, Daw S, Körholz D, Stoevesandt D. Assessment of Waldeyer's ring in pediatric and adolescent Hodgkin lymphoma patients-Importance of multimodality imaging: Results from the EuroNet-PHL-C1 trial. Pediatr Blood Cancer 2021; 68:e28903. [PMID: 33538093 DOI: 10.1002/pbc.28903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND In the EuroNet Pediatric Hodgkin Lymphoma (EuroNet-PHL) trials, decision on Waldeyer's ring (WR) involvement is usually based on clinical assessment, that is, physical examination and/or nasopharyngoscopy. However, clinical assessment only evaluates mucosal surface and is prone to interobserver variability. Modern cross-sectional imaging technology may provide valuable information beyond mucosal surface, which may lead to a more accurate WR staging. PATIENTS, MATERIALS, AND METHODS The EuroNet-PHL-C1 trial recruited 2102 patients, of which 1752 underwent central review including reference reading of their cross-sectional imaging data. In 14 of 1752 patients, WR was considered involved according to clinical assessment. In these 14 patients, the WR was re-assessed by applying an imaging-based algorithm considering information from 18 F-fluorodeoxyglucose positron emission tomography, contrast-enhanced computed tomography, and/or magnetic resonance imaging. For verification purposes, the imaging-based algorithm was applied to 100 consecutive patients whose WR was inconspicuous on clinical assessment. RESULTS The imaging-based algorithm confirmed WR involvement only in four of the 14 patients. Of the remaining 10 patients, four had retropharyngeal lymph node involvement and six an inconspicuous WR. Applying the imaging-based algorithm to 100 consecutive patients with physiological appearance of their WR on clinical assessment, absence of WR involvement could be confirmed in 99. However, suspicion of WR involvement was raised in one patient. CONCLUSIONS The imaging-based algorithm was feasible and easily applicable at initial staging of young patients with Hodgkin lymphoma. It increased the accuracy of WR staging, which may contribute to a more individualized treatment in the future.
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Affiliation(s)
- Lars Kurch
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Christine Mauz-Körholz
- Department of Pediatric Hematology and Oncology, Justus-Liebig University, Gießen, Germany.,Medical Faculty of the Martin-Luther-University, Halle (Saale), Germany
| | - Alexander Fosså
- Department of Medical Oncology and Radiotherapy, Oslo University Hospital, Oslo, Norway
| | | | - Regine Kluge
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Jörg Martin Bartelt
- Department of Radiology, Medical Faculty of the Martin-Luther-University, Halle (Saale), Germany
| | - Christian Kunze
- Department of Radiology, Medical Faculty of the Martin-Luther-University, Halle (Saale), Germany
| | | | - Tanja Pelz
- Department of Radiation Oncology, Medical Faculty of the Martin-Luther-University, Halle (Saale), Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, Medical Faculty of the Martin-Luther-University, Halle (Saale), Germany
| | - Sebastian Plößl
- Department of Ear, Nose and Throat Medicine, Hospital Martha-Maria Halle, Halle (Saale), Germany
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | | | - William Hamish Wallace
- Department of Paediatric Oncology, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, UK
| | - Jonas Karlen
- Karolinska University Hospital, Astrid Lindgrens Childrens Hospital, Stockholm, Sweden
| | | | - Michaela Cepelova
- Department of Pediatric Hematology and Oncology, University Hospital Motol and, Second Medical Faculty of Charles University, Prague, Czech Republic
| | - Tomasz Klekawka
- Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | | | - Dagmar Steiner
- Department of Nuclear Medicine, Justus-Liebig University Giessen, Giessen, Germany
| | - Gabriele Krombach
- Department of Radiology, Justus-Liebig University Giessen, Giessen, Germany
| | - Andishe Attarbaschi
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | | | - Francesco Ceppi
- Division of Pediatrics, Department of Woman-, Mother-Child, Pediatric Hematology-Oncology Unit, University Hospital of Lausanne, Lausanne, Switzerland
| | - Jane Pears
- Department of Pediatric Hematology and Oncology, Our Lady's Children's Hospital, Dublin, Ireland
| | - Andrea Hraskova
- Department of Pediatric Hematology and Oncology, University Children's Hospital, Bratislava, Slovakia
| | - Anne Uyttebroeck
- Department of Pediatric Hematology and Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Auke Beishuizen
- Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Princess Màxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Karin Dieckmann
- Department of Radiation Oncology, University Hospital Vienna, Vienna, Austria
| | - Thierry Leblanc
- Service d'Hématologie Pédiatrique, Hôpital Robert-Debré, Paris, France
| | - Stephen Daw
- Department of Pediatric Hematology and Oncology, University College London Hospitals, London, UK
| | - Dieter Körholz
- Department of Pediatric Hematology and Oncology, Justus-Liebig University, Gießen, Germany
| | - Dietrich Stoevesandt
- Department of Radiology, Medical Faculty of the Martin-Luther-University, Halle (Saale), Germany
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Kurtoğlu E, Göçer M. Clinical Significance of Increased FDG Uptake in the Waldeyer Ring and the Nasopharynx Region Identified by PET-CT in Postchemotherapy Follow-up in Patients With Lymphoma: When Should We Perform Biopsy? CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:830-835. [PMID: 32917575 DOI: 10.1016/j.clml.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE To identify whether fluorodeoxyglucose (FDG) uptake in the Waldeyer ring (WR)/nasopharyngeal (NP) region by positron emission tomography-computed tomography (PET-CT) was physiologic or pathologic in the follow-up of lymphoma patients receiving postchemotherapy treatment. PATIENTS AND METHODS We retrospectively examined FDG uptake in the WR/NP region in 534 patients with lymphoma as assessed by PET-CT used for both diagnosis and follow-up. RESULTS Forty-nine patients had FDG uptake in the WR/NP region by PET-CT performed after completion of a chemotherapy regimen. Biopsy was performed for 11 of these patients in whom the uptake was considered to be pathologic, and results indicated the presence of reactive follicular hyperplasia. It was considered to be physiologic in 38 patients. PET-CT was repeated after 1 year, and no significant difference was identified between the standardized maximum uptake values (SUVmax; P = .107). The initial diagnosis of 20 patients was made via biopsy performed in the WR/NP region. The SUVmax for the FDG uptake in these patients, asymmetry, SUVmax of the coexisting lymphadenopathies in the neck, and FDG uptake with a counterpart finding by CT were significantly higher than other groups (P = .047, .001, and .005). CONCLUSION When deciding whether to resample after treatment completion, it should be taken into account that, in addition to the SUVmax of the lesion, asymmetry, and the SUVmax of the coexisting lymphadenopathy in the neck, a crucial criterion is whether the FDG uptake has a counterpart finding by CT.
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Affiliation(s)
- Erdal Kurtoğlu
- Division of Hematology, Department of Internal Medicine, Antalya Training and Research Hospital, Antalya, Turkey.
| | - Mesut Göçer
- Division of Hematology, Department of Internal Medicine, Antalya Training and Research Hospital, Antalya, Turkey
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7
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Kinealy BP, Harding BC, Vazmitsel MA, Laziuk K, Gov-Ari E. Atypical lymphoid hyperplasia in a patient undergoing tonsillectomy for severe obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2020; 134:110066. [PMID: 32361254 DOI: 10.1016/j.ijporl.2020.110066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 11/17/2022]
Abstract
Tonsillectomy is a common procedure in the pediatric population, with subsequent microscopic examination of the specimen for cancer and other rare diagnoses occurring routinely. A 17 year-old female with a history of autoimmune vasculitis underwent adenotonsillectomy for severe obstructive sleep apnea. Pathology demonstrated small, medium and large lymphocytes and plasma cells obscuring the lymphoid follicles and germinal centers, with few Epstein-Barr virus positive lymphocytes. Tingible body macrophages were seen in the vaguely nodular areas. This reactive histologic pattern represents an atypical lymphoproliferative disorder never before documented in tonsils. Histopathologic images will be shown.
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Affiliation(s)
- Brian P Kinealy
- University of Missouri School of Medicine, Columbia, MO, USA
| | - Brette C Harding
- Department Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Maryna A Vazmitsel
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, USA
| | - Katsiaryna Laziuk
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, USA
| | - Eliav Gov-Ari
- Department Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA.
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8
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Fellner A, Gavriel H, Pitaro J, Muallem Kalmovich L. Clinical parameters predicting tonsillar malignancy. Eur Arch Otorhinolaryngol 2020; 277:1779-1783. [PMID: 32130510 DOI: 10.1007/s00405-020-05873-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Tonsillectomy is indicated in unilateral tonsillar enlargement (UTE) to rule out malignancy, which eventually is found in about 1.4% of the patients. The aim of this study was to evaluate the presenting symptoms of patients who underwent tonsillectomy for UTE and identify parameters that are associated with an increased risk for malignancy, for better assessment and refinement of current management protocols. METHODS A retrospective chart review of adult patients with UTE who underwent tonsillectomy between 1/1/2006 and 31/12/2016 was conducted. RESULTS Forty-one patients with a median age of 53 years were included. There were 20 (49%) females and 21 (51%) males. Sixteen (39%) patients were diagnosed as having tonsillar malignancy. Patients with malignancy were older than those in the benign group (p = 0.001), had a previous malignancy (p = 0.006), and were less likely to present as an incidental finding (p < 0.001). Lymphadenopathy, throat pain, suspicious appearance of tonsillar mucosa, and hard consistency were also found to be statistically significant findings in the malignancy group (p = 0.017, p = 0.001, p = 0.01 and p = 0.018, respectively). Multivariable regression showed age, appearance and adjacent tissue involvement to be independently with malignancy. CONCLUSIONS UTE alone, as an incidental finding, should not be regarded as an indication for tonsillectomy, as the risk for malignancy is low and the morbidity is significant. We suggest integrating the above-mentioned clinical parameters in the decision-making process, which were found to be significantly more frequent in the malignant group.
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Affiliation(s)
- Avital Fellner
- Department of Otolaryngology-Head and Neck Surgery, Shamir (Assaf Harofeh) Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300, Zerifin, Israel.
| | - Haim Gavriel
- Department of Otolaryngology-Head and Neck Surgery, Shamir (Assaf Harofeh) Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300, Zerifin, Israel
| | - Jacob Pitaro
- Department of Otolaryngology-Head and Neck Surgery, Shamir (Assaf Harofeh) Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300, Zerifin, Israel
| | - Limor Muallem Kalmovich
- Department of Otolaryngology-Head and Neck Surgery, Shamir (Assaf Harofeh) Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300, Zerifin, Israel
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9
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Kay-Rivest E, Saint-Martin C, Daniel SJ. High-Frequency Ultrasound: A Novel Diagnostic Tool to Measure Pediatric Tonsils in 3 Dimensions. Otolaryngol Head Neck Surg 2019; 161:856-861. [DOI: 10.1177/0194599819850139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective A wide variety of pathologies can affect the palatine tonsils. Ultrasound is a commonly used modality for assessing head and neck masses in children; however, its use in tonsillar evaluation has not been widely explored. The objective of this study was to measure 3-dimensional tonsillar size with ultrasound, in centimeters, and correlate these measurements with actual ex vivo dimensions on pathology specimens. Study Design We performed a prospective cohort study. Setting The study was set in a tertiary care children’s hospital. Subjects and Methods Children undergoing tonsillectomy were included in the study. Transcervical high-frequency ultrasonography (HFU) was performed prior to surgery to obtain 3-dimensional measurements of the right and left palatine tonsils. Mean sizes were compared to ex vivo tonsil measurements and correlations were obtained. Results Seventy-five consecutive children underwent a transcervical HFU, with a total of 150 tonsils analyzed. The mean differences between HFU and pathology measurements were −0.08 cm and −0.24 cm for the right and left craniocaudal axes, −0.19 cm and −0.18 cm for the right and left mediolateral axes, and 0.05 cm and 0.03 cm for the right and left anteroposterior axes. Correlation coefficients between ultrasound and pathology measurements were all above 0.5. Conclusion HFU can accurately measure the size of pediatric tonsils in 3 dimensions.
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Affiliation(s)
- Emily Kay-Rivest
- Department of Pediatric Otolaryngology–Head and Neck Surgery, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Christine Saint-Martin
- Department of Medical Imaging, Division of Pediatric Radiology, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Sam J. Daniel
- Department of Pediatric Otolaryngology–Head and Neck Surgery, Montreal Children’s Hospital, Montreal, Quebec, Canada
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Jones GH, Burnside G, McPartland J, Markey A, Fallon M, De S. Is tonsillectomy mandatory for asymmetric tonsils in children? A review of our diagnostic tonsillectomy practice and the literature. Int J Pediatr Otorhinolaryngol 2018; 110:57-60. [PMID: 29859588 DOI: 10.1016/j.ijporl.2018.04.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Diagnostic tonsillectomy is performed to exclude malignancy. It is associated with a post-operative hemorrhage rate of 3.5%, (1) which is more dangerous in small children. No previous case series for asymmetrical tonsils have detected tonsil lymphoma.(2-6) We aimed to review our local diagnostic tonsillectomy practice. METHOD The authors reviewed the clinical notes and histological results for all diagnostic tonsillectomies carried out from June 2013 to June 2016. RESULTS We recorded data for 168 patients. There were four post-operative bleeds and one return to theatre. Bilateral tonsillectomies accounted for 152 operations (90.5%). Lymphoid hyperplasia accounted for 95% of histological diagnosis with no malignancies found. Pre-operative tonsil grading demonstrated no statistically significant association with histological tonsil weight difference (ANOVA p = 0.10). Actinomyces colonisation had little affect on tonsil weight difference when we compared patients with bilateral colonisation and no colonisation (t-test p = 0.540) and between tonsils in patients with unilateral tonsil Actinomyces colonisation (paired t-test p = 0.448). Recurrent tonsillitis was more prevalent in patients with Actinomyces colonisation than OSA/sleep disordered breathing (39% vs 15%). CONCLUSION A literature search yielded five smaller case series of palatine tonsil asymmetry in children with no malignancy found.(2-6) Case-control studies report tonsillar asymmetry as the most common presenting symptom (73%) in tonsillar lymphoma.(7) This enlargement usually occurs rapidly within 6 weeks with new obstructive or systemic B-type symptoms.(3) A Turkish epidemiological study found asymmetrical tonsils in 1.7% of the healthy paediatric population.(8) We therefore estimate there to be over 210,000 children with asymmetrical tonsils in the UK. With an unreliable grading system, we believe asymmetrical tonsils in isolation, unchanged for over 6 weeks may not warrant tonsillectomy.
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Affiliation(s)
- Gareth Huw Jones
- Otolaryngology Department, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK.
| | - Girvan Burnside
- Department of Biostatistics, University of Liverpool, Waterhouse Building, Brownlow Street, L69 3GL, UK
| | - Jo McPartland
- Otolaryngology Department, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK
| | - Anne Markey
- Otolaryngology Department, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK
| | - Michael Fallon
- Otolaryngology Department, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK
| | - Sujata De
- Otolaryngology Department, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK
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Pediatric Tonsil Cancer: A National and Institutional Perspective. J Pediatr 2018; 197:255-261.e1. [PMID: 29571929 DOI: 10.1016/j.jpeds.2018.01.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/13/2017] [Accepted: 01/10/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To evaluate childhood and adolescent tonsil cancer incidence and to identify the clinical characteristics indicative of those patients who would benefit from urgent operative intervention. STUDY DESIGN The Surveillance, Epidemiology and End Results 18 database, inclusive of national cancer statistics from 1973 to 2013, provided quantitative tonsil cancer incidence data. An institutional retrospective chart review of pediatric patients diagnosed with tonsil malignancy from January 2013 to January 2017 identified supplementary qualitative clinical presentation information. RESULTS The Surveillance, Epidemiology and End Results 18 database included 138 pediatric patients with tonsil cancer with an age-adjusted incidence rate of 0.021/100 000 patients per year. The majority of cases were unilateral (79.7%), and there was both a male and Caucasian predominance. Non-Hodgkin lymphoma (84.1%) was the most common malignancy, of which Burkitt lymphoma (31.1%), diffuse large B-cell lymphoma (26.8%), and follicular lymphoma (10.1%) were the most common subtypes. Five tonsillar malignancy patients were identified upon institutional chart review. The majority likewise had non-Hodgkin lymphoma and all shared a history of rapid tonsillar enlargement over ≤12 weeks. Significant tonsillar asymmetry was present in 4 patients. Four patients additionally exhibited prominent cervical lymphadenopathy. CONCLUSIONS Pediatric tonsil cancer is rare, with non-Hodgkin lymphoma accounting for the majority of pediatric tonsillar malignancies. A high index of suspicion is appropriate in children who present with relatively rapid tonsil enlargement, tonsillar asymmetry characterized by a difference in tonsillar size of ≥2 degrees on the Brodsky scale, or concurrent prominent cervical lymphadenopathy.
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Hwang MS, Kaye KE, Waxman JA, Friedman M. What is the best management of asymptomatic unilateral tonsillar enlargement? Laryngoscope 2015; 125:2438-40. [DOI: 10.1002/lary.25477] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Michelle S. Hwang
- Advanced Center for Specialty Care; Advocate Illinois Masonic Medical Center; Chicago Illinois U.S.A
| | - Kathryn E. Kaye
- Advanced Center for Specialty Care; Advocate Illinois Masonic Medical Center; Chicago Illinois U.S.A
| | - Jonathan A. Waxman
- Advanced Center for Specialty Care; Advocate Illinois Masonic Medical Center; Chicago Illinois U.S.A
| | - Michael Friedman
- Department of Otorhinolaryngology; Rush University Medical Center; Chicago Illinois
- Advanced Center for Specialty Care; Advocate Illinois Masonic Medical Center; Chicago Illinois U.S.A
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Operative Management of OSAS in a Complex Case of Proteus Syndrome. Case Rep Otolaryngol 2015. [PMID: 26199778 PMCID: PMC4493299 DOI: 10.1155/2015/137589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a common disorder in childhood with high prevalence in syndromic subjects with craniofacial malformations. Proteus Syndrome (PS) is a rare hamartoneoplastic disorder associated with disproportionate and asymmetric overgrowth of body parts and hypertrophy or malformation of lymphatic tissues, such as palatine tonsils. We report a case of a 12-year-old boy diagnosed with Proteus Syndrome (PS) and suffering from OSAS due to asymmetric palatine tonsillar hypertrophy, treated with partial resection of left tonsil. To avoid the risk of a general anesthesia and remove only the obstructive portion of the palatine tonsil bipolar radiofrequency-induced thermotherapy (RFITT) under local anesthesia was performed. Recovery of the obstructive respiratory disease was obtained. To our knowledge, this is the first case reported in the literature of partial tonsillar resection performed in a patient with PS suffering from OSAS under local anesthesia.
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