Routine Evaluation of Adult Tonsillectomy Specimens

Abstract

Tonsil excision is a common surgery for both children and adults. Prior studies have consistently shown that the rate of malignancy in tonsil specimens is low and that the possibility of true, occult malignancy is remote. Practice trends accept triage of pediatric tonsillectomies for exemption or gross exam only. However, for adults, despite a low malignancy rate, routine histological evaluation of tonsillectomy specimens is standard of care at most health care facilities. The authors performed a retrospective review of all tonsil specimens received in their department over 45 months with categorization of pathological diagnosis and surgical indication. Of 1746 adult tonsillectomy specimens removed during this time, there were no incidental/occult malignancies. These data indicate that gross examination of adult tonsillectomy specimens excised for chronic tonsillitis or sleep apnea is sound practice, and this, taken together with other published data, provides a basis for consensus-derived practice guidelines.

Tonsil histopathology in HIV-infected versus HIV-uninfected adults

“…Courville et al tested 1093 adult patients, and of these, 75 (7%) had SCC. 21 Malignancies were suspected prior to the confirmatory histology in all of their patients. Four of our patients had SCC on pathological evaluation; three patients were HIV-uninfected and one patient had HIV infection.…”

“…Their occurrence ranges from 0% to 1.74%. 1,13,14,15,21,22 Ikram et al studied 200 patients between the ages of 4 and 49 years. They detected lymphoma in only one patient (0.5%).…”