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ORIGINAL ARTICLE Table of Contents   
Year : 2011  |  Volume : 8  |  Issue : 3  |  Page : 283-285
Is routine histopathology of tonsil specimen necessary?


1 Department of Otorhinolaryngology, Jos University Teaching Hospital, Nigeria
2 Department of Anaesthesia, Jos University Teaching Hospital, Nigeria

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Date of Web Publication11-Jan-2012
 

   Abstract 

Background: Tonsillar diseases are common in paediatric and adult otolaryngological practice. These diseases require tonsillectomy. Specimens are subjected to histopathology routinely in my institution for fear of infections and tumour without consideration for risk factors. The financial burden is on the patients and waste of histopathologist's man hour because other specimens are left un-attended. This study aims to find out the necessity of routine histopathology of tonsil specimens. Materials and Methods : A 2 year retrospective review of the histopathological results of two (paediatric and adult) groups of 61 patients managed for tonsillar diseases at the ENT UNIT of Jos University Teaching Hospital from July 2005 to June, 2007. Data extracted included biodata, clinical features and histopathological diagnosis. Result : The 61 patients comprise 35 children and 26 adults. The youngest and oldest paediatric patients were 1 year and 3 months and 16 years respectively, a range of 1 year 3 months to 16 years. The youngest and oldest adults were 17 and 50 years with a range of 17-50 years. Groups mean ages were 5.1 and 28.5 years. The gender ratios were 1:2.7 and 1:1.9 respectively. One adult was HIV positive. The histopathological diagnosis were chronic nonspecific tonsillitis in 10(16.6%), follicular tonsillitis in 23(38.3%), chronic suppurative tonsillitis in 10(16.6%), lymphoid hyperplasia in 18(30.0%) and lymphoma in 1(1.0%) respectively. Conclusion : Histopathologic request for tonsillectomy specimens should be based on certain risk factors with consideration of the cost to patients and to spare the histopathologist's man hour.

Keywords: Histopathology, risk factor, routine, specimen, tonsil

How to cite this article:
Adoga AS, Ma`an DN, Nuhu SI. Is routine histopathology of tonsil specimen necessary?. Afr J Paediatr Surg 2011;8:283-5

How to cite this URL:
Adoga AS, Ma`an DN, Nuhu SI. Is routine histopathology of tonsil specimen necessary?. Afr J Paediatr Surg [serial online] 2011 [cited 2019 Dec 13];8:283-5. Available from: http://www.afrjpaedsurg.org/text.asp?2011/8/3/283/91666

   Introduction Top


Tonsillar diseases are common in paediatric and adult otolaryngological practice. [1] Wide varieties of diseases affect this tissue often requiring tonsillectomy. [2] These specimens are often subjected to histology routinely in my institution for fear of harbouring infections and more so tumour without consideration for risk factors in other to escape medicolegal actions. [3],[4],[5] This routine throws the financial burden on the patients and waste of the histopathologist's man hour to the detriment of other numerous specimens needing attention. [6],[7] This study therefore aims to find out the necessity of routine histopathology of tonsil specimens.


   Materials and Methods Top


A 2 year retrospective review of the histopathological results of two (paediatric and adult) groups of 61 patients managed for tonsillar diseases at the ENT UNIT of the Jos University Teaching Hospital from July 2005 to June, 2007. Data extracted included biodata, clinical features and histopathological diagnosis.


   Results Top


Sixty-one patients comprise 35 children and 26 adults. Four patients had adenotonsillectomy. The youngest patient was 1 year and 3 months while the oldest was 16 years, a range of 1 year 3 months to 16 years. The adult youngest age was 17, while the oldest was 50 years. The age ranges from 17 to 50 years. The mean age for both groups was 5.1 years and 28.5 years. There were 10 paediatric males to 27 female with a ratio of 1:2.7, whereas there were 9 adult males and 17 adult females with a ratio of 1:1.9. Only one adult person had the risk factor of being HIV positive. The clinical features are shown in [Table 1]. The histological diagnosis were chronic nonspecific tonsillitis in 10(16.6%), follicular tonsillitis in 23(38.3%), chronic suppurative tonsillitis in 10(16.6%), lymphoid hyperplasia in 18(30.0%) and lymphoma in 1(1.0%) respectively.
Table 1: The clinical features of all the patients who had
tonsillectomy


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   Discussion Top


Histopathological request for tonsil specimen differs in various centres across the globe. These are age, risk factors and cost, respectively. [8],[9],[10] In our centre, we routinely request or to rule out malignancy as is the case by Williams, [8] Beaty et al., [9] respectively but in contrast, cost was not considered by us as done by Younis. [10]

Few centres have criteria but many routinely request. [3],[11],[12] In our study all the 61 patients comprising 35 children (10 males to 27 females) and 26 adults (9 males and 17 females) with a ratio of 1:2.7 and 1:1.9 respectively were all routinely subjected to histopathological examination. Tonsillar disease appears predominantly a female disease as shown by the higher incidence in the result of the two groups. This is dissimilar to the work of Ikram et al., [3] where males predominate but similar to Ekirlie, [11] Garavello [12] and co-workers respectively where routine histology was requested.

The most common age groups were under 5 years constituting 24 patients (68.6%) in paediatric and second to third decade (20-40 years) in the adult groups. This result shows that tonsillectomy was frequently performed in the paediatric age group. This agrees with the findings of Hellier [13] and co-workers in United Kingdom and Wadoux [14] but in contrast to our study where we carried out routine tonsillectomy whilst theirs were day case tonsillectomies.

The indications for tonsillectomy in our study were recurrent tonsillitis, obstructive sleep apnoea and snoring, peritonsillar abscess and suspected tumour cases. Risk factors include tonsil asymmetry, visible tonsillar lesion, a neck mass, history of cancer, constitutional symptoms and social history. Five (8.3%) of our patients had neck swelling but only one had lymphoma. Benign enlarged tonsil might produce neck swelling and not necessarily a malignancy. The histological diagnosis is consistent with the clinical features as shown in [Table 1]. This is similar to the findings of Ikram, [2] Leif [15] and co-workers.

The histological diagnoses were chronic nonspecific tonsillitis in 10(16.6%), follicular tonsillitis in 23(38.3%), chronic suppurative tonsillitis (quinsy) in 10(16.6%), lymphoid hyperplasia in 18(30.0%) and lymphoma in 1(1.0%) respectively. This is similar to the findings of Ikram et al., [2] except that the proportion varies.

The above result proved that the chances of harbouring malignancies were very small particularly in children and in patients without risk factors. The only case of lymphoma was found in adult male with retroviral disease.

Limitations

Some patients do not have the finances to foot the bill for histology, therefore accounting for less number of analyzed histology reports.


   Conclusion Top


Request for tonsillectomy specimens should be based on certain risk factors with consideration of the cost to patients and to spare the histopathologist's man hour.

 
   References Top

1.Guerra MM, Garcia E, Pilan RR, Rapoport PB, Campanholo CB, Martinelli EO. Antibiotic use in post-adenotonsillectomy morbidity: A randomized prospective study. Braz J Otorhinolaryngol 2008;74:337-41.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Ikram M, Khan M, Ahmed M, Siddiqui T, Mian MV. The Histopathology of routine tonsillectomy specimens. Results of a study and review of literature. Ear Nose Throat J 2000;79:880-2.  Back to cited text no. 2
    
3.Anim J, Dawlaty E. Tuberculosis of the tonsil revisited. West Afr J Med 1991;10:194-7.  Back to cited text no. 3
    
4.Selimoglu MD, Sutbeyaz Y, Ciftcioglu MA, Parlak M, Esrefoglu M, Ozturk A. Primary Tonsillar Tuberculosis: A case report. J Laryngol Otol 1995;109:880-2.  Back to cited text no. 4
    
5.Berkowitz R, Manhandevan M. Unilateral tonsillar enlargement and tonsillar lymphoma in children. Ann Otol Rhinol Laryngol 1999;108:876-9.  Back to cited text no. 5
    
6.Randall DA, Martin PJ, Thompson LD. Routine histologic examination is unnecessary for tonsillectomy and adenoidectomy. Laryngoscope 2007;117:1600-4.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Nester J, Robinson R, Smith R, Raab SS. A cost benefit analysis examination of routine and non routine tonsil and adenoid specimens. Anat Pathol 1997;108:158-65.   Back to cited text no. 7
    
8.Williams M, Brown H. The adequacy of gross pathological examination of routine tonsils and adenoids in patients 21 years old and younger. Hum Pathol 2003;34:1053-7.  Back to cited text no. 8
    
9.Beaty MM, Funk GF, Karnell LH, Graham SM, McCulloch TM, Hoffman HT, et al. Risk factors for malignancy in adult tonsils. Head Neck 1998;20:399-403.  Back to cited text no. 9
[PUBMED]  [FULLTEXT]  
10.Younis R, Hesse S, Anand V. Evaluation of the Utility and cost-effectiveness of obtaining histopathologic diagnosis on all routine tonsillectomy specimens. Laryngoscope 2001;111:2166-9.  Back to cited text no. 10
    
11.Ekirlie S, Aydin A, Kocer E. Histologic features in routine tonsillectomy specimens: The presence and proportions of seromucus glands. J Laryngol Otol 2002;116:911-3.  Back to cited text no. 11
    
12.Garavello W, Romagnoli M, Sordo L, Spreafico R, Gaini RM. Incidence of unexpected malignancies in routine tonsillectomy specimens in children. Laryngoscopes 2004;114:1103-5.  Back to cited text no. 12
    
13.Hellier WP, Knight J, Hern J, Waddell T. Day case paediatric tonsillectomy: A review of three years experience in a dedicated day case unit. Clin Otolaryngol Allied Sci 1999;24:208-12.  Back to cited text no. 13
[PUBMED]    
14.Wadoux JF, Pendeville PE, Dort JP, Von Montigny S. Analgesia after day-case tonsillectomy in children: A comparison of tramadol with propacetamol followed by paracetamol. Eur J Anaesthesiol 2000;17:149.  Back to cited text no. 14
    
15.Leif B, Markku P, Jukka Y. Traditional tonsillectomy compared with traditional radiofrequency thermal ablation tonsillectomy in adults. Arch Otolaryngol Head Neck Surg 2001;127:1106-12.  Back to cited text no. 15
    

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Correspondence Address:
Agida S Adoga
Department of Otorhinolaryngology, Jos University Teaching Hospital
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0189-6725.91666

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    Tables

  [Table 1]

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