Abstract
Objective: To determine the incidence of carcinoma in patients with asymmetrical tonsillar enlargement. Study Design: A clinical retrospective case series based on medical records of our medical complex. Results: During a two-year period, 990 patients underwent tonsillectomy at Salmaniya Medical Complex (SMC). 59 (5.9%) of those patients had asymmetrical enlargement of their tonsils, three of whom had suspicious clinical findings at presentation. The latter were found to have tonsillar malignancy on histopathological testing. Malignancy was excluded in all other specimen. Conclusions: Since the incidence of malignancy in asymmetrical tonsils is negligible in the absence of other associated risk factors, watchful waiting may be appropriate prior to any surgical intervention. Diagnostic tonsillectomy is indicated in patients with asymmetrical tonsillar enlargement with associated suspicious clinical findings, including cervical lymphadenopathy and rapid tonsillar enlargement.
Highlights
Tonsils are lymphoid tissue collections located at either side of the oropharynx
Since the incidence of malignancy in asymmetrical tonsils is negligible in the absence of other associated risk factors, watchful waiting may be appropriate prior to any surgical intervention
Diagnostic tonsillectomy is indicated in patients with asymmetrical tonsillar enlargement with associated suspicious clinical findings, including cervical lymphadenopathy and rapid tonsillar enlargement
Summary
Tonsils are lymphoid tissue collections located at either side of the oropharynx. They are primarily made of B lymphocytes and are lined by stratified squamous epithelium. Their main function is to production antibodies, lymphokines and gamma interferon. There are several etiologies behind unilateral tonsillar enlargement, including tuberculosis, actinomycoses, syphilis and sarcoidosis [1], chronic inflammatory response, papilloma [2], reactive immunological response to a nearby primary tumor in cervical lymph node and malignancy. Asymmetric tonsils could be a normal variant due to varying depth of tonsillar fossa or asymmetry in anterior pillars
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