Prevalence of synchronous bilateral tonsil squamous cell carcinoma: A retrospective study

Abstract

Objectives The prevalence of synchronous bilateral tonsil cancer remains unexplored. To date, only 38 cases have been described in the literature. With an aim to substantiate the Danish recommendation of performing bilateral tonsillectomy in patients with suspected or proven tonsil cancer and in patients with cervical carcinoma metastasis from an unknown primary tumour, this study was undertaken to determine the prevalence of synchronous bilateral tonsil cancer. Design A retrospective review of all patients diagnosed with tonsil cancer in the period 2000‐2015, Aarhus University Hospital, Denmark, was performed. Results Seven of 211 (3.3%) consecutive patients with tonsil cancer, who had undergone bilateral tonsillectomy (n = 180) or unilateral tonsillectomy (clinically normal side) combined with contralateral tonsil biopsy (side with suspected cancer) (n = 31), had synchronous bilateral tonsil cancer. Furthermore, dysplasia was found in the contralateral tonsil in two patients with unilateral tonsil cancer. Four of 171 (2.3%) patients with suspected unilateral tonsillar cancer had additional contralateral tonsil cancer. Three of 34 (8.8%) patients without clinical signs of tonsillar malignancy on any side (32 patients with carcinoma of unknown primary) had synchronous bilateral tonsil cancer. In none of the patients were bilateral tonsil cancer suspected. Patients with unilateral vs synchronous bilateral tonsil cancer had similar clinical and tumour characteristics. Conclusion Knowledge on additional contralateral synchronous tonsil cancer is crucial for avoidance of early recurrence of oropharyngeal cancer in patients with tonsil cancer. Based on our findings, we recommend bilateral tonsillectomy in all patients with suspected or proven tonsil cancer and carcinoma of unknown primary.

In Reference to Should the Contralateral Tonsil Be Removed in Cases of HPV‐Positive Squamous Cell Carcinoma of the Tonsil?

“…In the Rokkjaer and Klug study, when contralateral tonsillectomy was routinely performed for all patients with known or suspected tonsillar cancer, 2.3% had contralateral disease. 5 Finally, it is not evident that subclinical contralateral tonsil cancer would ultimately have clinical impact. A majority of patients receive adjuvant radiation and close post-treatment surveillance.…”

Should the Contralateral Tonsil Be Removed in Cases of HPV‐Positive Squamous Cell Carcinoma of the Tonsil?

“…To determine the prevalence of SBTC, Rokkjaer et al performed a retrospective review of all patients diagnosed with TSCC between 2000 and 2015 at Aarhus University Hospital, Denmark. They found that seven of 211 (3.3%) consecutive patients with tonsil cancer who had either undergone bilateral tonsillectomy (n = 180) or unilateral tonsillectomy (clinically normal side) combined with contralateral tonsil biopsy (clinically suspicious side) (n = 31) had SBTC.…”

“…These recommendations are based on three case reports (level 4 evidence) and two retrospective chart reviews (level 3 evidence).…”

“…Human papillomavirus‐positive (HPV+) head and neck squamous cell carcinomas (SCC) are increasing in incidence worldwide. The palatine tonsils are the most commonly involved anatomical subsite, followed by the base of tongue and then the soft palate . Secondary primary malignancy (SPM) is a well‐established phenomenon among patients with head and neck SCC and can present in up to 36% of patients within 20 years of their original diagnosis .…”

Viral Integration Analysis Reveals Likely Common Clonal Origin of Bilateral HPV16-Positive, p16-Positive Tonsil Tumors

“…Very few patients with tonsillar carcinoma present with bilateral HPV+ tumors, and the literature on this phenomenon is somewhat limited [ 16 – 20 ]. A recent retrospective study reported that in a cohort of Danish patients, only 3.3% had synchronous bilateral tonsil cancer [ 21 ]. There are multiple hypotheses on the mechanism of this event.…”