title: Risk factors for malignancy in adult tonsils.
abstract: BACKGROUND
  Tonsillectomy in adults (age 18 years and older) is performed for a variety of conditions. The palatine tonsils may harbor carcinoma or lymphoma, and this potentially unanticipated finding may follow routine tonsillectomy in the adult. The ability to preoperatively identify adult tonsillectomy patients at increased risk for tonsillar malignancy could sensitize the clinician to this possibility and the potential need for expedited rather than routine tonsillectomy scheduling.
  
  
  METHODS
  A retrospective review of 476 consecutive adult patients who underwent tonsillectomy during the last 10 years at the University of Iowa Hospitals and Clinics was undertaken. Proposed risk factors for tonsillar malignancy included a prior history of head and neck cancer, tonsillar asymmetry, palpable firmness or visible lesion in the tonsil, neck mass, unexplained weight loss, and unexplained constitutional symptoms. These risk factors were correlated with the pathologic diagnosis in the reviewed cases.
  
  
  RESULTS
  Of these 476 patients, 25 had malignant tonsil pathology. No patient without risk factors was found to have malignancy on pathologic evaluation of the tonsils. Of the 25 patients with malignant tonsillar pathology, 23 had two or more risk factors, and 2 patients had one risk factor. Tonsillar asymmetry, found in 20 of the 25 cases, was the risk factor most frequently associated with malignant pathology.
  
  
  CONCLUSIONS
  These results indicate that the presence of certain preoperatively identifiable risk factors are associated with the pathologic finding of malignancy in adult tonsillectomy specimens. Based on these criteria, a model which is predictive of the presence of tonsil malignancy may be constructed.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242-1078, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Beaty
authors.forename: G F
authors.initials: GF
authors.lastname: Funk
authors.forename: L H
authors.initials: LH
authors.lastname: Karnell
authors.forename: S M
authors.initials: SM
authors.lastname: Graham
authors.forename: T M
authors.initials: TM
authors.lastname: McCulloch
authors.forename: H T
authors.initials: HT
authors.lastname: Hoffman
authors.forename: R A
authors.initials: RA
authors.lastname: Robinson
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014067:Tonsillar Neoplasms / Q000453:epidemiology* / Q000473:pathology; D014068:Tonsillectomy; D014069:Tonsillitis / Q000473:pathology* / Q000601:surgery