Unexpected occult malignancy diagnosed during tonsillectomy surgery for obstructive sleep apnea

Abstract

Rationale: Many previous studies have investigated the necessity of routine histopathological analysis of tonsillectomy specimen, and most recent studies have suggested that such an analysis is not justified in asymptomatic patients or those with no risk factors for malignancy. Patient concerns: A 59-year-old man diagnosed with obstructive sleep apnea underwent surgery, including tonsillectomy; a tonsil specimen was sent to the department of pathology. Diagnosis: Although the patient did not exhibit any tonsil-related signs or symptoms, nor did the appearance of the tonsil appear to be pathological, the right tonsil specimen was diagnosed with squamous cell carcinoma, with detection of human papilloma virus 16. Interventions: Chemotherapy and radiotherapy were used to treat the tonsil cancer. Outcomes: No recurrence was observed during the 4-year follow-up. Lessons: In the future, it may be necessary to reinvestigate the necessity of routine histopathological analysis of tonsillectomy specimens in asymptomatic patients, considering the drastically increased rate of detection of human papilloma virus-related oropharyngeal squamous cell carcinomas in these patients.

Oropharynx cancer after sleep apnea surgery

“…26 It may be necessary to weigh the previous low incidence of oropharynx SCC against the disadvantages of missing a cancer in the currently rising HPV population and the cost of caring for them. 27 The literature and our experience suggest that most tonsillar malignancies present with suspicious clinical or gross findings; however, occult malignancies do occur. Although the incidence is very low, recognition of occult malignancy in tonsillectomy specimens may facilitate early diagnosis and treatment.…”

“… 26 It may be necessary to weigh the previous low incidence of oropharynx SCC against the disadvantages of missing a cancer in the currently rising HPV population and the cost of caring for them. 27 …”

“…Even though the current yield in screening seemingly benign tonsil specimens for carcinoma is remarkably low, over time, this may increase due to the rising incidence of HPV‐related oropharyngeal SCC 26 . It may be necessary to weigh the previous low incidence of oropharynx SCC against the disadvantages of missing a cancer in the currently rising HPV population and the cost of caring for them 27 …”