A clinicopathologic series of 22 cases of tonsillar granulomas.
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.
Kardon
D E
DE
Department of Endocrine and Otorhinolaryngic-Head and Neck Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
Thompson
L D
LD
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
D004396:Coloring Agents; D005456:Fluorescent Dyes