Cryosurgical treatment of the lymphoid tissue of Waldeyer's ring

The role of cryosurgery in the treatment of tonsil disease is an unresolved issue. Initial favorable reports failed to provide the necessary incentives for larger well-controlled studies. Bacteriologic and immunologic response to the cryosurgical treatment of tonsils remains unclear. Without appropriate studies, cryosurgery has been relegated to a backup status for conventional tonsil surgery. At present, cryogenic treatment of lymphoid tissue is generally limited to tonsillectomy in patients with blood dyscrasias; elimination of palatine tonsil regrowth and posterior pharyngeal lymphoid hyperplasia; and occasional laryngeal and lingual tonsillectomy.     

Tonsil amyloidosis revealing a Waldenstr?m macroglobulinemia

Localized amyloidosis of the tonsil is rare and its management depends on the etiology. We report a case of tonsil amyloidosis and review the characteristics of this exceptional pathology. A 74-year-old man consulted for odynophagia, upper dysphagia and deteriorated general health status, which have been evolving for 1 year. Clinical examination found a smooth swelling of the right palatine tonsil. No further abnormalities were noted. The biopsy findings were consistent with amyloidosis. Etiological assessment pointed to Waldenstrom macroglobulinemia. Tonsillectomy was performed. The patient was managed by chemotherapy associating chlorambucil, vincristine and prednisone. The progress after chemotherapy was good. Localized amyloidosis is a rare lesion of the superior aerodigestive tract, predominating in the larynx and tonsil involvement is exceptional. Its diagnosis is histological and its management depends on the etiology. Continued regular follow-up is necessary to look for recurrence.     

Cryosurgical treatment of tonsillar hypertrophy in children

Eighteen children with tonsillar hypertrophy and signs of upper respiratory obstruction during sleep have been treated by cryosurgery. Nitrous oxide has been used as the refrigerent and the freezing time has been 3 minutes X 2 on each tonsil, with spontaneous thawing in between. All the children had earlier undergone adenoidectomy without relief on their symptoms. Fourteen children are free of obstruction two years after treatment, 12 after one treatment and two after two treatments. The treatment has been found to be free from complications. Cryosurgery represents an alternative to conventional tonsillectomy in the treatment of upper respiratory obstruction caused by enlarged tonsils in children.     

Secondary syphilis of the tonsil

Summary An 18-year-old man with an ulceration of his right tonsil and cervical lymphadenopathy was examined. The patient also had a papular eruption in his face, chest, abdomen, and upper extremities. There were no signs of genital involvement. Routine serological tests for syphilis were reactive and histological findings of a cervical lymph node biopsy were characteristic for syphilitic lymphadenitis. Spirochetes were also identified in the tissue sections. A diagnosis of secondary syphilis of the tonsil with cervical syphilitic lymphadenitis was made. In recent years, the number of new cases of syphilis has increased in Japan. Since the oral cavity is the most common extragenital site of syphilis, clinicians should bear in mind that oral lesions from an unknown cause might possibly be syphilitic.     

Secondary syphilis of the tonsil

An 18-year-old man with an ulceration of his right tonsil and cervical lymphadenopathy was examined. The patient also had a papular eruption in his face, chest, abdomen, and upper extremities. There were no signs of genital involvement. Routine serological tests for syphilis were reactive and histological findings of a cervical lymph node biopsy were characteristic for syphilitic lymphadenitis. Spirochetes were also identified in the tissue sections. A diagnosis of secondary syphilis of the tonsil with cervical syphilitic lymphadenitis was made. In recent years, the number of new cases of syphilis has increased in Japan. Since the oral cavity is the most common extragenital site of syphilis, clinicians should bear in mind that oral lesions from an unknown cause might possibly be syphilitic.     

Fine-needle aspiration in recurrent tonsillitis

The incidence of tonsillitis that is unresponsive to penicillin therapy is leading to concern. This phenomenon has been linked to a change in the core tonsil bacteria, in particular beta-lactamase production. To date, the only way to identify the presence of these resistant microbes is at tonsillectomy. In this prospective study, we performed fine-needle tonsil aspiration in 34 patients (mean age, 7.6 years) before tonsillectomy. The bacteriologic nature of the aspirate was compared with that obtained from culturing the tonsillar surface (in situ) and core of the resected tonsils. The bacteriologic findings of the aspirate corresponded closely with those of the tonsil core (qualitative and quantitative comparison), while the superficial swab was of limited value in predicting the core bacteria. Based on this study, tonsil fine-needle aspiration may have a place in the treatment of recurrent tonsillitis.     

Ectopic salivary tissue of the tonsil: a case report

To report one patient with an ectopic salivary tissue tag on the tonsil, and review the embryology, management, and implications of this benign disorder. Case report with literature review. Ectopic salivary tissue presented on the tonsil of a child as a painless, growing, unilateral pale exophytic mass. Tonsillectomy was performed to provide diagnosis, and was curative. Ectopic salivary tissue of the tonsil is a rare finding. Tonsillectomy allows for definitive diagnosis and treatment.     

Absceso parafaríngeo secundario a un absceso periamigdalino en la infancia

We report a case of parapharyngeal abscess in a five-years-old girl, secondary to a local extension of a peritonsillar abscess. The typical signs of peritonsillar abscess, medially displaced tonsil and displacement of the uvula toward the oposite side, were either less pronunced than usual. In this case, with parapharyngeal involvement, the treatment was abscess tonsillectomy under intravenous anti     

Metastasis in the palatine tonsil as the first sign of a gastric adenocarcinoma

Gastric adenocarcinomas rarely give rise to metastases in the palatine tonsils; twelve such cases have been published. In two of them the tonsillar tumour was the first sign of the disease. We present a patient with a tumour of the palatine tonsil and cervical lymph node involvement who was diagnosed as having an adenocarcinoma of "signet ring" cells in the histopathology and cytology studies. Finding such cells directed us to the stomach in our search for the primary.     

Follicular dendritic cell sarcoma of the tonsil: a case report

Follicular dendritic cell sarcomas of the tonsil are very rare tumors. Only 10 cases have been published in the English-language medical literature. We present an additional case that occurred in a 27-year-old woman. She presented with a tumor of the right tonsil. Histological sections of tonsillar biopsies and tonsillectomy suggested that this tumor was a nerve sheath tumor or a malignant melanoma. Histological examination and immunohistochemical study were reviewed. The final diagnosis was follicular dendritic cell sarcoma. She underwent a transoral resection of the right oropharynx with ipsilateral selective neck dissection and postoperative irradiation. We emphasize the difficulties in diagnosing this type of tumor. The use of monoclonal specific markers is required to avoid misdiagnosis. We discuss therapeutic methods for this rare tumor for which optimal treatment has not yet been defined.     

The Prognostic Role of p16 Expression in Tonsil Cancer Treated by Either Surgery or Radiation

Objectives

Although human papillomavirus (HPV) infection is considered as a favorable prognostic factor in oropharyngeal cancer, the prognosis of HPV-associated tonsil cancer has rarely been studied especially when surgery was the main treatment. In this study, the authors investigated the effect of p16 over-expression (HPV infection) on tonsil cancer prognosis according to the type of treatment, HPV presence by PCR, and expression of p53 and epidermal growth factor receptor (EGFR) by immunohistochemistry (IHC).

Methods

Medical records of 33 tonsil cancer patients were reviewed. Using formalin-fixed and paraffin-embedded tumor specimens, PCR-based genotyping of HPV and IHC of p16, p53 and EGFR were performed. The effects of HPV presence and the expression of IHC markers were analyzed on the recurrence-free survival. Five-year disease-free survival (DFS) rates were evaluated according to p16 expression status.

Results

An over-expression of p16 was observed in 27 (81.9%) out of 33 cases. Surgery-based treatment was provided for 21 (63.6%) patients. There was no association between p16 immunoreactivity and HPV presence, nor with p53 and EGFR expression. Regardless of main treatment modalities, five-year DFS did not differ by p16 expression status (P=0.051). However, over-expression of p16 was associated with a lower recurrence in multivariable analyses (P=0.046).

Conclusion

Regardless of main treatment modalities, an over-expression of p16 (HPV infection) is associated with a lower recurrence in tonsil cancers. However it is not associated with simple HPV presence or p53 and EGFR over-expression.     

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

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.     

Peritonsillar abscess with parapharyngeal involvement: incidence and treatment

In 2.3% of 217 patients with peritonsillar abscess, the clinical picture was atypical, with inflammatory swelling of the pharyngeal wall below and behind the tonsil, oedema of the epiglottis and a diffuse swelling on the side of the neck. The typical signs of peritonsillar abscess, i.e. trismus, a medially displaced tonsil and displacement of the uvula toward the opposite side, were either completely lacking or less pronounced than usual. The abscesses were all located in the peritonsillar space at the lower pole or behind the tonsil. To ensure rapid, uncomplicated recovery in such cases with parapharyngeal involvement, it is essential that abscess tonsillectomy under antibiotic cover with penicillin is not postponed.     

Tonsillar metastasis of oesophageal adenocarcinoma

In the literature less than 100 cases of metastatic carcinoma of the palatine tonsil have been reported. Tonsillar metastasis of adenocarcinoma of the oesophagus has not been reported previously. We report a case of a 57-year-old male with a primary adenocarcinoma of the distal esophagus with a metastasis in the right palatine tonsil. Metastatic tumour involving the palatine tonsil is rare. The route of dissemination remains unclear. Hypothetically the dissemination of tumour cells could be lymphogenic or secondary by transportation due to vomiting or at the time of endoscopy, but most likely represents haematogenous spread.     

Carcinoma of the tonsil

One hundred and twenty-two cases with squamous cell carcinoma of the tonsil have been reviewed, 101 of which were treated with radiotherapy; the five-year survival rate in these cases was significantly better in early-stage tumours. Surgical treatment in this series was too small to draw any firm conclusion but, from reports in a large series, surgical treatment has been highly recommended in selected cases of advanced tumour, this result could also be improved with a pre-operative course of radiotherapy.     

原发局限性扁桃体淀粉样变1例并文献复习

目的 探讨原发局限性扁桃体淀粉样变的临床表现、诊断思维、治疗方法及预后,以便对其进行早期诊断。 方法 回顾性分析1例原发局限性扁桃体淀粉样变患者的临床资料并复习相关文献进行总结。 结果 原发局限性扁桃体淀粉样变早期缺乏特异性症状,疾病进展常较快,临床表现常为双侧扁桃体不对称增长或双侧迅速增大导致的咽部异物感为主,其余包括扁桃体赘生物、溃疡、咽干、咽痒、咽痛、吞咽困难等非特异性表现。对无痛性扁桃体肥大且无炎症症状患者,如若病程较短、双侧扁桃体明显不对称、表面溃疡和质地硬等,都应先行病理活检。 结论 原发局限性扁桃体淀粉样变临床及影像表现无特异性,因而详细病史采集、全身系统检查、病理活检等有效手段对于早期诊断疾病非常重要。     

Tonsillar suppressors of killer cells in tonsillitis

The authors studied the effect of tonsil cells obtained from intact and inflamed tonsils on spontaneous cytotoxicity of autologous blood leucocytes. It has been shown that addition of tonsil cells of patients with chronic tonsillitis and those of animals with experimental tonsillitis to blood cells with a high cytotoxic potential did not augment cytolysis of heteroerythrocytes but inhibited it. Meanwhile in the joint cultivation of tonsil cells of intact animals and children with tonsillar hypertrophy with autologous blood leucocytes the killer effect exceeded that seen in a separate use of these cells. The data presented in this article indicate that non-specific suppressors capable of inhibiting spontaneous killing may appear in tonsils in the course of inflammation.     

Temperature-controlled radiofrequency tonsil reduction in children

OBJECTIVE: To evaluate the safety and efficacy of temperature-controlled radiofrequency tonsil reduction in the treatment of children with a sleep-related breathing disorder associated with tonsillar obstructive hypertrophy. DESIGN: Prospective, nonrandomized, case series feasibility study of children meeting the criteria for tonsillectomy or adenotonsillectomy for the treatment of an obstructive sleep-related breathing disorder. SETTING: Community-based hospital.Patients Ten children, aged 4 to 13 years, presenting consecutively to a community-based otolaryngology practice with tonsillar or adenotonsillar obstructive hypertrophy implicated clinically in causing a sleep-related breathing disorder; their parents consenting to temperature-controlled radiofrequency tonsil reduction instead of surgical tonsillectomy.Intervention Temperature-controlled radiofrequency tonsil reduction, along with surgical adenoidectomy, if adenoids were present, under general anesthesia. MAIN OUTCOME MEASURES: Tonsil size reduction, treatment morbidity, and symptom improvement with follow-up to 1 year. Baseline and 3-month posttreatment polysomnographic data were used. RESULTS: There was a reduction in tonsil size at 1 year of 75.0% on average, without evidence of regrowth during the 1-year follow-up. All children were drinking liquids in the recovery room, and most were eating soft diets within 6 hours; 8 of the 10 children were eating a normal diet by day 5. On average, the return to normal activity was 3.9 days, with 2.9 days of parental loss of work time. Quality-of-life variables all improved. Snore indexes decreased by 88.6%. Polysomnography at 3 months revealed an 84.2% reduction in the apnea index and a 52.3% reduction in the apnea/hypopnea index. There were no complications. CONCLUSION: Temperature-controlled radiofrequency tonsil reduction seems to be a safe, effective, and minimally morbid treatment for tonsil hypertrophy in children with obstructive sleep-related breathing disorders.     

Fine needle aspiration in chronic tonsillitis: reliable and valid diagnostic test

Fine needle aspiration (FNA) of the tonsil as a diagnostic tool in evaluating the microflora in chronic tonsillitis has not been popularized. A prospective study of 30 patients with chronic tonsillitis undergoing tonsillectomy was undertaken. FNA of the tonsil core was done under local/general anaesthesia. The reliability of the culture by FNA of the tonsil core was then validated with the reference (gold) standard which is the dissected tonsil core. The sensitivity of FNA culture as compared to core culture was 100 per cent and 93 per cent under general and local anaesthesia respectively. The positive predictive value of FNA culture as compared to core culture was 92 per cent and 82 per cent for general and local anaesthesia respectively. These factors indicate that FNA of the tonsil core is reliable and valid. It can safely be performed as an out-patient procedure under local anaesthesia. This is reported for the first time. Identifying the bacterial organism within the infected tonsil for appropriate antibiotic therapy could revolutionize the management of chronic tonsillitis.