[1178] 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%.

Table 1: Final Pathologic Diagnoses in Adult Bilateral Tonsillectomy Specimens

Benign	1682
No evidence of malignancy/Benign tonsillar tissue	52
Gross Diagnosis Only	8
Squamous Cell Carcinoma	2
Lymphoproliferative Disorder	2

Conclusions: Our data is consistent with data from a number of studies regarding the malignancy and occult malignancy rate in tonsil specimens. Based on this data, a gross diagnosis for adult bilateral tonsillectomy specimens removed for a clinical indication of tonsillitis or sleep apnea appears appropriate. However, consensus-derived practice guidelines regarding the triaging of adult tonsillectomy specimens will be needed prior to a change of practice.
Category: Head & Neck

Monday, February 28, 2011 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 147, Monday Morning