Retrospective Review of Tonsil Specimens: Experiential Assessment of a Clinical Practice.
Elizabeth L Courville, Madelyn Lew, Peter M Sadow. Massachusetts General Hospital, Boston; Massachusetts Eye and Ear Infirmary, Boston
Background: Tonsil excision is a common surgical procedure performed in adults, primarily for recurrent infections and sleep apnea. Prior publications describe a low rate of malignancy in tonsil specimens, and the possibility of true occult malignancy is remote. At our institution, all tonsillectomy specimens from pts ≥18 yo are examined microscopically, while those from pts <18 yo are examined as gross only, and microscopy performed only with an abnormal gross finding or clinical suspicion for malignancy. The objective of our study was to provide institutional data regarding the prevalence of malignancy in adult bilateral tonsillectomy specimens and to promote discussion of best practices in pathology for tonsillectomy specimens based upon indication for surgery.
Design: In this retrospective study approved by our internal review board (2009P002643), we used our electronic medical record to obtain pathological diagnoses and clinical information for all adult tonsillectomy specimens processed in our pathology department over 45 consecutive months.
Results: Our department accessioned 1095 tonsil cases from adults, 80% of which consisted of bilateral excision specimens. Clinical indications for surgery included tonsillitis (72%), sleep apnea (12.5%), no clinical history available (11.5%), suspicion for malignancy (2.3%), asymmetry (1.7%), and mass (0.3%). Classification of the final pathology diagnoses for the 1746 specimens from bilateral excisions in adults is listed in Table 1. Of those specimens examined by histology, 1734 (99.8%) had a benign histopathologic diagnosis. The malignancy rate in bilateral adult tonsillectomy specimens at our institution over 45 months was 0.2% (two cases of squamous cell carcinoma and one case of follicular lymphoma). None of the malignant diagnoses were unexpected; therefore, our occult malignancy rate was 0%.
|No evidence of malignancy/Benign tonsillar tissue||52|
|Gross Diagnosis Only||8|
|Squamous Cell Carcinoma||2|