title: A clinicopathologic series of 22 cases of tonsillar granulomas.
abstract: OBJECTIVE
  Tonsils are uncommonly affected by granulomatous inflammation, often with an obscure cause. This study attempts to elucidate the nature of tonsillar granulomatous inflammation.
  
  
  METHODS
  Retrospective clinicopathologic review.
  
  
  METHODS
  Twenty-two cases of tonsillar granulomas diagnosed between 1940 and 1999 were retrieved from the files of the Armed Forces Institute of Pathology. H&E slides and a series of histochemical stains were reviewed, and patient follow-up was obtained.
  
  
  RESULTS
  There were 11 males and 11 females, aged 7 to 64 years (mean, 29.9 y). Most of the cases presented bilaterally (n = 19) with sore throat, dysphagia, and/or nasal obstruction. The clinical differential included chronic tonsillitis, tuberculosis, nonspecific infection, sarcoidosis, and a neoplasm. Histologically, the granulomas were focal and scattered, or diffuse, identified in the interfollicular zones (n = 16) and/or the germinal centers (n = 13), and occasionally associated with necrosis (n = 6). Based on histochemical and clinical follow-up information, the etiology of the granulomas included sarcoidosis (n = 8), tuberculosis (n = 3), Hodgkin's lymphoma (n = 2), toxoplasmosis (n = 1), squamous cell carcinoma (n = 1), and no specific known cause (n = 7). Twelve patients were either alive at last follow-up or had died with no evidence of disease (mean, 12.4 y), and 9 were either alive at last follow-up or had died with disease (mean, 24.9 y). One patient was alive with unknown disease status (lost to follow-up after 13.3 y).
  
  
  CONCLUSIONS
  Although a cause for tonsillar granulomas is frequently identified, a number may not develop an identifiable etiology, with the granulomas probably representing an exaggerated immune response to chronic tonsillitis. However, a careful work-up must be conducted to exclude specific causes and avoid clinical mismanagement.
authors.affiliation: Department of Endocrine and Otorhinolaryngic-Head and Neck Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
authors.forename: D E
authors.initials: DE
authors.lastname: Kardon
authors.forename: L D
authors.initials: LD
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis; D002648:Child; D002908:Chronic Disease; D004396:Coloring Agents; D003680:Deglutition Disorders / Q000209:etiology; D003937:Diagnosis, Differential; D018572:Disease-Free Survival; D005260:Female; D005456:Fluorescent Dyes; D005500:Follow-Up Studies; D006099:Granuloma / Q000150:complications / Q000175:diagnosis* / Q000469:parasitology / Q000473:pathology; D006689:Hodgkin Disease / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000209:etiology; D010612:Pharyngitis / Q000209:etiology; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000175:diagnosis; D015996:Survival Rate; D014069:Tonsillitis / Q000150:complications / Q000175:diagnosis* / Q000469:parasitology / Q000473:pathology; D014123:Toxoplasmosis / Q000175:diagnosis; D014388:Tuberculosis, Lymph Node / Q000175:diagnosis
chemical_list: D004396:Coloring Agents; D005456:Fluorescent Dyes