Tonsillitis

Tonsillitis is common and a reason the tonsils are removed (tonsillectomy).

Malignancy in tonsils is rare if not suspected; thus, tonsils can be considered a ditzel.

General

Commonly removed (tonsillectomy) when enlarged.
Very low probability of malignancy (<0.2%) in tonsilectomies in individuals <19 years old if no clinical suspicion.^[1]

Gross

Symmetrical and equal size.

Note:

Gross exam is considered sufficient if there is no asymmetry if individual younger than 21 years of age.^[2]

Image=

Tonsils at cut-up. (WC/Katotomichelakis et al.)

Microscopic

Features:

Follicular hyperplasia - see lymph node pathology.
+/-Colonies (clusters) of actinomycetes in the tonsillar crypts.

DDx:

Non-Hodgkin lymphoma.^[3]
Others - see tonsil.

IHC

If there is a clinical suspicion - a panel to exclude (small cell) non-Hodgkin lymphomas:

CD3.
CD20.
CD5.
CD10.
CD23.
Cyclin D1.

Sign out

A. Tonsil, Left, Tonsillectomy:
- Reactive follicular hyperplasia.
- Reactive squamous mucosa.

B. Tonsil, Right, Tonsillectomy:
- Reactive follicular hyperplasia.
- Reactive squamous mucosa.

Block letters

A. TONSIL, LEFT, TONSILLECTOMY:
- REACTIVE FOLLICULAR HYPERPLASIA.
- REACTIVE SQUAMOUS MUCOSA.

B. TONSIL, RIGHT, TONSILLECTOMY:
- REACTIVE FOLLICULAR HYPERPLASIA.
- REACTIVE SQUAMOUS MUCOSA.

Without squamous mucosa

A. TONSIL, LEFT, TONSILLECTOMY:
- REACTIVE FOLLICULAR HYPERPLASIA.

B. TONSIL, RIGHT, TONSILLECTOMY:
- REACTIVE FOLLICULAR HYPERPLASIA.

References

↑ Erdag, TK.; Ecevit, MC.; Guneri, EA.; Dogan, E.; Ikiz, AO.; Sutay, S. (Oct 2005). "Pathologic evaluation of routine tonsillectomy and adenoidectomy specimens in the pediatric population: is it really necessary?". Int J Pediatr Otorhinolaryngol 69 (10): 1321-5. doi:10.1016/j.ijporl.2005.05.005. PMID 15963574.
↑ Williams, MD.; Brown, HM. (Oct 2003). "The adequacy of gross pathological examination of routine tonsils and adenoids in patients 21 years old and younger.". Hum Pathol 34 (10): 1053-7. PMID 14608541.
↑ Wang, XY.; Wu, N.; Zhu, Z.; Zhao, YF. (May 2010). "Computed tomography features of enlarged tonsils as a first symptom of non-Hodgkin's lymphoma.". Chin J Cancer 29 (5): 556-60. PMID 20426908.

[pmid15963574-1] Erdag, TK.; Ecevit, MC.; Guneri, EA.; Dogan, E.; Ikiz, AO.; Sutay, S. (Oct 2005). "Pathologic evaluation of routine tonsillectomy and adenoidectomy specimens in the pediatric population: is it really necessary?". Int J Pediatr Otorhinolaryngol 69 (10): 1321-5. doi:10.1016/j.ijporl.2005.05.005. PMID 15963574.

[pmid14608541-2] Williams, MD.; Brown, HM. (Oct 2003). "The adequacy of gross pathological examination of routine tonsils and adenoids in patients 21 years old and younger.". Hum Pathol 34 (10): 1053-7. PMID 14608541.

[pmid20426908-3] Wang, XY.; Wu, N.; Zhu, Z.; Zhao, YF. (May 2010). "Computed tomography features of enlarged tonsils as a first symptom of non-Hodgkin's lymphoma.". Chin J Cancer 29 (5): 556-60. PMID 20426908.

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Tonsillitis

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