Abstract
We report herein a case of isolated Rosai-Dorfman disease (Sinus Histiocytosis with Massive Lymphadenopathy) diagnosed upon routine microscopic examination of tonsils in a child. The patient is a 4 year old girl who had a history of sleep apnea, but no other significant medical history or other findings on physical examination. In this report, we discuss the various approaches to handling of tonsillectomy specimens. We also discuss the value of routine microscopic examination, providing a list of case examples of incidental, clinically important, findings that can be missed if a microscopic examination of tonsils was not performed. We finally discuss the clinical significance of finding histologic evidence of Rosai-Dorfman disease in a child.
Highlights
The value of routine submission of tonsillectomy tissue for microscopic examination is often brought into question, as a cost saving measure, given the low yield of clinically significant findings
Some advocate limiting pathologic examination to gross inspection, with submission of sections for microscopy reserved for tonsils that appear grossly abnormal or if the patient has a significant or unusual medical history [1]
While there is an obvious cost saving by not performing routine microscopic examination on tonsils in the above two approaches, this is only achieved at the risk of missing potentially important findings
Summary
The value of routine submission of tonsillectomy tissue for microscopic examination is often brought into question, as a cost saving measure, given the low yield of clinically significant findings. Some advocate limiting pathologic examination to gross inspection, with submission of sections for microscopy reserved for tonsils that appear grossly abnormal or if the patient has a significant or unusual medical history [1]. Performing no examination at all of tissue has been proposed by some authors [2]. While there is an obvious cost saving by not performing routine microscopic examination on tonsils in the above two approaches, this is only achieved at the risk of missing potentially important findings. A recent example is our case described below
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