Tonsillar Carcinoma in the Contralateral Tonsil

Smith, Raymond O.; Pokala, Krishna; Medina, Jesús E.; Krempl, Greg A.

doi:10.1002/lary.21640

Cited by 5 publications

(7 citation statements)

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“…Moreover, given that other 3 cases of bilateral synchronous tonsillar cancer in patients with SCCUP have been reported in studies that did not meet the inclusion criteria, we believe that the true incidence of bilateral/contralateral tumors is underestimated. 11,35,64 Bilateral tonsillar resection is further supported by this review, mainly for oncological reasons, but also by the fact that of 204 bilateral tonsillectomies performed (on a total of 416) only 2 bleeding episodes are reported in one 60 of the included articles, which did not specify if the source site was the tonsillar fossa or the base of tongue. Therefore, it seems clear that the advantage of finding the primary tumor largely outweighs the very minimal risks associated with the bilateral tonsillectomy procedure.…”

Section: Discussionmentioning

confidence: 92%

“…Literature search identified 1035 studies (Figure ); after scrutinizing titles and abstracts, 1003 were excluded as non‐relevant, concerning other diseases, duplicates, non‐original studies, or non‐English studies. Forty‐two articles, which included palatine tonsillectomy in the diagnostic approach of SCCUP, were screened in full‐text: 4 studies were from the same institution, more precisely 2 from the University of Florida College of Medicine and 1 from The Johns Hopkins Hospital, and another 1 from the University of Pittsburgh Medical Center, which subsequently published 3 updated series included in the review; 4 studies contained non‐SCC histopathology; 6 studies have not reported enough information about the negativity of the physical examination and/or conventional cross‐sectional imaging carried out before tonsillectomy; 3 studies using TLM as surgical approach to the palatine tonsil were lacking data on the state of conventional imaging before EUA or on tonsillectomies performed; 7 studies did not specify the number of tonsillectomies performed; 2 studies had suspicious findings on physical examination and/or conventional cross‐sectional imaging carried out before TORS tonsillectomy; 1 was an anatomopathological study without any clinical information on patients involved; and 1 study conducted palatine tonsillectomy before conventional imaging. Excluded studies and respective reasons of exclusion are summarized in Table .…”

Section: Resultsmentioning

confidence: 99%

“…In this review, 14 (10%) synchronous bilateral and 2 (1%) contralateral tumors were identified on 140 occult tonsillar malignancies. Moreover, given that other 3 cases of bilateral synchronous tonsillar cancer in patients with SCCUP have been reported in studies that did not meet the inclusion criteria, we believe that the true incidence of bilateral/contralateral tumors is underestimated …”

Section: Discussionmentioning

confidence: 99%

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Role of palatine tonsillectomy in the diagnostic workup of head and neck squamous cell carcinoma of unknown primary origin: A systematic review and meta‐analysis

Maio

Iocca²,

Virgilio³

et al. 2018

Head & Neck

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Background This systematic review and meta‐analysis aims to evaluate the effectiveness of palatine tonsillectomy in patients with cervical metastasis from squamous cell carcinoma of unknown primary (SCCUP) origin. Methods A systematic review including studies that encompassed palatine tonsillectomy in the SSCUP diagnostic evaluation was conducted. A single arm meta‐analysis was then made to obtain the overall identification rate of tonsillectomy. Results Fourteen studies were included, comprising 673 patients who underwent 416 palatine tonsillectomies, 338 preformed during examination under anesthesia (EUA) and 78 managed with transoral robotic surgery (TORS). A total of 140 occult tonsillar malignancies were identified; of these, 124 (89%) were ipsilateral, 2 (1%) contralateral, and 14 (10%) synchronous bilateral. Meta‐analysis of 11 studies showed an overall detection rate of tonsillectomy of 0.34 (99% confidence interval 0.23‐0.46). Conclusion Palatine tonsillectomy is a valuable diagnostic tool in the management of patients with head and neck SCCUP. Bilaterality of tonsillectomy should be taken into consideration.

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Section: Discussionmentioning

confidence: 92%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Role of palatine tonsillectomy in the diagnostic workup of head and neck squamous cell carcinoma of unknown primary origin: A systematic review and meta‐analysis

Maio

Iocca²,

Virgilio³

et al. 2018

Head & Neck

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“…Knowledge on additional contralateral synchronous tonsillar malignancy is crucial for avoidance of early recurrence of oropharyngeal cancer in patients with TC. Furthermore, radical treatment of such recurrences is commonly impossible, and five‐year survival rates are dramatically decreased in these patients . In Denmark, TCs are treated with radiotherapy or chemo‐radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

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

Rokkjær

Klug

2017

Clinical Otolaryngology

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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.

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“…However, the contralateral palatine and lingual tonsils can be the culprit in less the 10%. [2][3][4] Human papilloma virus (HPV) related oropharyngeal squamous cell carcinoma (OPSCC) comprises about 70% of all OPSCC cases and therefore the majority of the carcinoma of unknown primary (CUP) cases. 5 Primary site identification is important to focus therapy and limit morbidity.…”

Section: Introductionmentioning

confidence: 99%

Transoral robotic surgery for the identification of unknown primary head and neck squamous cell carcinomas: Its effect on the wait and the weight

et al. 2022

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Background Neck carcinoma of unknown primary (CUP) is a frequent scenario. Transoral robotic mucosectomies (TORM) of pharynx have increased rate of primary identification, but come with cost of treatment delay. Methods We reviewed patients who underwent CUP protocol from 2014 to 2020. Patients with cervical nodes carcinoma and failure to localize a primary source were classified as CUP. We determined primary identification rate and postoperative complications. Results We included 65 patients underwent TORM. Surgical approach consisted of lingual and/or palatine tonsillectomies. The primary detection rate was 49.2%. Average weight reduction was 2.5 ± 4.3 kg. The average number of days from consultation to definitive treatment was 52.2 ± 18.3. Conclusion A systematic approach to patients with CUP showed a promising primary identification rate compared to panendoscopy alone. TORM carries a small risk of complications. The benefits of primary identification must be weighed with the morbidity and delay to definitive treatment.

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Tonsillar Carcinoma in the Contralateral Tonsil

Cited by 5 publications

References 0 publications

Role of palatine tonsillectomy in the diagnostic workup of head and neck squamous cell carcinoma of unknown primary origin: A systematic review and meta‐analysis

Role of palatine tonsillectomy in the diagnostic workup of head and neck squamous cell carcinoma of unknown primary origin: A systematic review and meta‐analysis

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

Transoral robotic surgery for the identification of unknown primary head and neck squamous cell carcinomas: Its effect on the wait and the weight

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