Histopathologic Retrospective Analysis of Tonsillectomy Specimens

Öz

Aim: Tonsillectomy is a frequent surgical operation in every otolaryngology clinic, especially in the pediatric age group. Pathologic examination of tonsillectomy specimens routinely remains a controversial issue. In this study, we investigated the histopathologic distribution of tonsillectomy materials and the necessity of routine pathologic examination in adult patients who underwent tonsillectomy operation in our clinic for the last 5,5 years

Material and Methods: The tonsillectomy materials of 856 patients (452 males, 404 females, mean age: 34.6 years, range of age: 12-92 years) who underwent tonsillectomy operations between January 2013 and July 2018 in our otolaryngology clinic were examined histopathologically.

Results: Malignancy was observed in 50(6%) of 856 adult patients and malignancy distribution in these patients is like this; 36(%4) patients with lymphoma, 11(%1) patients with squamous cell carcinoma (SCC), 2(%0.2) patients with adenocarcinoma metastasis (lung and pancreatic adenocarcinoma), 1(%0.1) patient with neuroendocrine tumor metastasis

Conclusion: The most common cause of tonsillar malignancies in literature, is squamous cell carcinoma (SCC) and the second most common cause is lymphoma. In our study we found some information contrary to literature as the most common tonsillar malignancy was lymphoma with 72% and squamous cell carcinoma (SCC) is the second most common malignancy with frequent rate of % 22. Diffuse Large B Cell Lymphoma (DBBHL) was the most common malignancy with 19 patients (52%) in patients with lymphoma and this information is consistent with the literature. All patients with malignancy were clinically diagnosed with a malignancy risk factor such as asymmetric enlarged, ulcerated or obstructive tonsillar tissue, swelling in the neck or swallowing difficulty etc. And none of the 856 patients had malignancy. As a result, routine histopathologic examination may not be necessary in patients with tonsillectomy, but histopathologic examination should be performed in patients with have preoperative risk factors. 

Anahtar Kelimeler

• Histopathology
• Lymphoma
• Malignancy
• Tonsillectomy

Tonsillektomi spesmenlerinin Histopatolojik Retrospektif Analizi

Öz

Amaç: Tonsillektomi, özellikle pediyatrik yaş grubunda sıkça yapılan bir ameliyattır. Tonsillektomi spesmenlerinin rutin histopatolojik incelemesinin gerekliliği ise hala tartışmalı bir konudur. Çalışmamızda kliniğimizde son 5,5 yılda tonsillektomi operasyonu olmuş 12 yaş ve üstü hastaların tonsil materyallerinin histopatolojik dağılımını ve rutin patolojik incelemenin gerekliliği sorgulanmaktadır.

Gereç ve Yöntem: Hastanemiz kulak burun boğaz kliniğinde 2013 ocak ayı ve 2018 temmuz ayı tarihleri arasında çeşitli endikasyonlar ile tonsillektomi operasyonu olmuş 856 hastanın (452 erkek, 404 kadın; ortalama yaş: 34.6, yaş aralığı: 12-92 yaş) anamnezi, şikayetleri, fizik muayene sonuçları ve patolojik sonuçları incelenmiştir.

Bulgular: 856 hastanın patoloji sonuçları değerlendirildiğinde; 50 hastada (%6) malignite saptanmış olup bu hastaların 36’sında (%4) lenfoma, 11’inde (%1) skuamoz hücreli karsinom (SCC), 2’sinde (%0.2) adenokarsinom metastazı (akciğer ve pankreas adenokarsinomu metastazı), 1’inde (%0.1) malign melanom, 1’inde (%0.1) nöroendokrin tümör metastazı olduğu görülmüştür. Çalışmaya dahil edilen hastaların hiçbirinde rastlantısal malignite saptanmamıştır.

Sonuç: Literatürdeki çoğu çalışmada en sık görülen tonsil malignitesi skuamoz hücreli karsinom ikinci en sık görülen tonsil malignitesi ise lenfoma olarak belirtilmiştir. Çalışmamızda bu bilginin aksine %72’lik bir oranla en sık görülen tonsil malignitesi lenfoma, ikinci en sık görülen tonsil malignitesi ise skuamoz hücreli karsinom (SCC) olarak bulunmuştur. Lenfoma saptanan 36 hastanın 19’unda (%52) ise Diffüz Büyük B Hücreli Lenfoma (DBBHL) alt tipi görülmüş olup bu oran literatür verileri ile uyumlu bulunmuştur. Malignite saptanmış olan hastaların hepsinde malignite risk faktörü (asimetrik büyümüş, ülsere olmuş veya obsturiktif boyutlara ulaşmış tonsil dokusu, boyunda şişlik, yutma güçlüğü vs) olduğu görülmüş olup ve 856 hastanın hiçbirinde rastlantısal malignite saptanmamıştır. Sonuç olarak tonsillektomi spesmenlerinin rutin histopatolojik incelenmesi gerekli olmayabilir ancak risk faktörü taşıyan hastalarda mutlaka histopatolojik inceleme yapılmalıdır. 

Anahtar Kelimeler

• Histopatoloj
• lenfoma
• malignite
• Tonsillektomi

Kaynakça

1. Chow W Rotenberg BW Discontinuing routine histopathological analysis after adult tonsillectomy for benign indication. Laryngoscope. 2015 Jul;125 (7) :1595-9
2. Koskenkorva T, Koivunen P Short-term outcomes of tonsillectomy in adult patients with recurrent pharyngitis: a randomized controlled trial CMAJ. 2013 May 14;185 (8) :E331-6.
3. Mustafa K , Selçuk Y. Current approach to adenotonsillectomy in children Balıkesir Sağlık Bilimleri Dergisi 2015:2146-9601
4. Booth CL, Wang J. hematologic malignancy in routine tonsillectomy specimens: a single institutional experience and review of the literature. Am J Clin Pathol. 2013 Dec;140 (6) :807-12
5. Jamie Glancy Bizzell ,Gresham T. Richter Routine pathologic examination of tonsillectomy specimens: A 10-year experience at a tertiary care children’s hospital International Journal of Pediatric Otorhinolaryngology2017-11-01,
6. Koç S, Uysal IO, Histopathologic examination of routine tonsil and adenoid specimens: is it a necessary approach? Kulak Burun Bogaz Ihtis Derg. 2012 Mar-Apr;22 (2) :87-90.
7. Courville EL, Lew M, Sadow PM. Routine evaluation of adult tonsillectomy specimens: toward establishing a new standard of care. Int J Surg Pathol. 2011 Aug;19 (4) :469-75.
8. Dewil B, Jorissen M, Lemkens P. Routine pathological evaluation after tonsillectomy: is it necessary?B-ENT. 2006;2 (3) :103-8.

9. Kalcioglu MT, Gurses I, Erdem T. Is the pathological examination of routine tonsillectomy and adenoidectomy specimens necessary? A retrospective study of 559 adenoidectomy and 1132 tonsillectomy specimens and a literature review. B-ENT. 2010;6 (2) :91-5.
10. S Syrjanen HPV infections and tonsillar carcinoma Clin Pathol 2004;57:449–455.
11. Anil K. Chaturvedi, Eric A. Engels Incidence Trends for Human Papillomavirus–Related and –Unrelated Oral Squamous Cell Carcinomas in the United States Journal of Clinical Oncology 2008 26:4, 612-619
12. Iyengar P, Mazloom A, Shihadeh F, et al. Hodgkin lymphoma involving extra-nodal and nodal head and neck sites: characteristics and outcomes. Cancer2010;116 (16) :3825–9.
13. Chi H-S, Lee K-W, Chiang F-Y, et al. Head and neck extranodal lymphomain a single institute: a 17-year retrospective analysis. Kaohsiung J Med Sci2012;28 (8) :435–41.
14. Etemad-Moghadam S, Tirgary F, Keshavarz S, et al. Head and neck non-Hodgkin’s lymphoma: a 20-year demographic study of 381 cases. Int J oralmaxillofac Surg 2010;39 (9) :869–72.
15. A. Faramarzi, M.J. Ashraf, B. Hashemi Histopathological screening of tonsillectomy and/or adenoidectomy specimens: A report from southern Iran International Journal of Pediatric Otorhinolaryngology, 2009-11-01,7;1576-1579
16. Rokkjaer MS, Klug TE. Malignancy in routine tonsillectomy specimens: a systematic literature review. Eur Arch Otorhinolaryngol. 2014 Nov;271 (11) :2851-61.
17. Reiter ER, Randolph GW, Pilch BZ. Microscopic detection Of malignancy in the adult tonsil.Otolaryngol Head Neck Surg. 1999;120:190-4.