The Implications of Malignancy for Adult Patients with Asymmetrical Tonsils

Abstract

BACKGROUND: The presence of asymmetrical tonsils may create not only significant anxiety for the patient but also a diagnostic challenge to the clinician. The aim of this study is to investigate the possibility of malignancy for adult patients with asymmetrical tonsils. METHODS: Asymmetrical tonsils were defined according to Mackenzie's criteria or different appearances due to a tonsillar lesion, excluding peritonsillar abscess or other acute infection. Ninety-two adult patients over the age of 20 years who had never undergone tonsillectomy or tonsillar biopsy for asymmetrical tonsils were retrospect-tively analyzed between July 1988 and February 2003 at an academic tertiary medical center. RESULTS: The malignant rate for adult asymmetrical tonsils was 40.2% (37/92) in this series. The rate of tonsillar malignancy proved by tonsillar biopsy and tonsillectomy was 57% (16/28) and 33% (21/64), respectively. In addition, there was a statistically significant relationship between malignant tumors in adult asymmetrical tonsils and age or the presence of a neck mass (p＜0.05). CONCLUSIONS: It is noteworthy that the presence of asymmetrical tonsils in adults really represents a clinical warning sign of a potentially serious disease. In addition to traditional tonsillectomy, tonsillar biopsy may be used as an alternative procedure to examine the characteristics of suspicious asymmetrical tonsils in adults.