1. Boston Children’s Hospital, Department of Otolaryngology Summer 2016
Genevieve Medina ‘18
Boston Children’s Hospital, Department of Otolaryngology
Summer 2016

2. Inflamed tonsils [Drawing]
Inflamed tonsils [Drawing]. Mayo Foundation for Medical Education and Research
Grading of palatine tonsils hypertrophy proposed by L. Brodsky [Drawing]. Dell’Aringa AR, Antonio JCJ, de Melo, C, Nardi, JC, Kobari K, Perches Filho RM. Histological analysis of tonsillectomy and adenoidectomy specimens -January 2001 to May Brazilian Journal of Otorhinolaryngology. 2005;71:2-113.

3. Current Literature Year Author Patient Population Number UTE Patients
Number of Malignant Cases %
1999
Berkowitz et al. 1
Pediatric 46
2000
Syms et al.2
Non- pediatric 48 2
4.1
2002
Spinou et al.3 47
Harley et al.4 57
2004
Cinar et al.5
Non- Pediatric 53
2006
Oluwasanmi et al.6 87
2.3
2007
Van Lierop et al.7 13
Total
351 4
1.1%

4. Methods Literature Review National Data: Institutional Data
Surveillance, Epidemiology and End Results Program, data collection
Institutional Data
Comprehensive Retrospective Chart Review, case series.

5. National Results Cancer Type Subtype n % Bilateral
Non-Hodgkin Lymphoma
Burkitt lymphoma/leukemia 43
31.2 4
Diffuse Large
B-cell Lymphoma, NOS 37
26.8
Follicular lymphoma 14
10.1 5
Non-Hodgkin lymphoma, NOS, unknown lineage 8
5.8
Lymphoid neoplasm, NOS
3.6 3
Precursor Non-Hodgkin lymphoma, T-cell
2.9 1
Chronic/Small lymphocytic leukemia/lymphoma 2
1.4
Extranodal MZL, MALT type
Non-Hodgkin lymphoma, B-cell, NOS
Lymphoplasmacytic lymphoma
0.7
NK/T-cell lymph, nasal-type/aggressive NK leukemia
Non-Hodgkin lymphoma, NOS, T-cell
Sarcoma
Rhabdomyosarcoma
Synovial sarcoma
Liposarcoma
Kaposi's sarcoma
Plasma Cell Neoplasms
Plasmacytoma
2.2
Hodgkin Lymphoma
Nodular Sclerosis
Unclassified Carcinomas
 Total
138
100 22

6. Instutional Data Case Age Gender Chief Complaint Other Signs/Symptoms
Preoperative Suspicion for Malignancy
Duration of Symptoms
Time Before Office Visit
Final Pathology
Laterality
Left Tonsil Size (Brodsky)
Right Tonsil Size (Brodsky) 1 3
Male
Obstructive Sleep Disordered Breathing
Bilateral cervical lymphadenopathy, abnormal labs
Yes
8+ weeks
6 weeks
Acute Lymphoblastic Leukemia (ALL), T-cell
Bilateral 4+ 2 4
Obstructive sleep disordered breathing, tonsillitis, enlarged right tonsil
Bilateral cervical lymphadenopathy
3 weeks
Burkitt lymphoma
Right 1+ 7
Neck pain, enlarged right tonsil
12 weeks
“barely detectable” (0) 9
Recurrent tonsillitis, enlarged right tonsil No
4 weeks 2+

7. Conclusions Limitations: Conclusions SEER reach: 28% US Population
Retrospective chart review for institutional data
Conclusions
Marked tonsillar asymmetry and rapid enlargement, especially in a unilateral fashion, are harbingers of malignanacy.
Pediatric tonsillar malignancies: primarily non-Hodgkin lymphomas, less frequently sarcomas, plasma cell neoplasms and Hodgkin lymphomas.

8. References
1. Berkowitz RG, Mahadevan M. Unilateral tonsillar enlargement and tonsillar lymphoma in children. The Annals of otology, rhinology, and laryngology. Sep 1999;108(9):
2. Syms MJ, Birkmire-Peters DP, Holtel MR. Incidence of carcinoma in incidental tonsil asymmetry. The Laryngoscope. Nov 2000;110(11):
3. Spinou E, Kubba H, Konstantinidis I, Johnston A. Tonsillectomy for biopsy in children with unilateral tonsillar enlargement. International journal of pediatric otorhinolaryngology. Mar ;63(1):15-17.
4. Harley EH. Asymmetric tonsil size in children. Archives of otolaryngology--head & neck surgery. Jul 2002;128(7):
5. Cinar F. Significance of asymptomatic tonsil asymmetry. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. Jul 2004;131(1):
6. Oluwasanmi AF, Wood SJ, Baldwin DL, Sipaul F. Malignancy in asymmetrical but otherwise normal palatine tonsils. Ear, nose, & throat journal. Oct 2006;85(10):
7. van Lierop A, AJ. PC, Fagan J, Sinclair-Smith C. Is diagnostic tonsillectomy indicated in all children with asymetrically enlarged tonsils? South African Medical Journal. 2007;97(5).