title: Incidence of carcinoma in incidental tonsil asymmetry.
abstract: OBJECTIVE
  To determine the incidence of malignancy in patients with incidentally discovered unilateral tonsillar enlargement with an otherwise normal physical examination.
  
  
  METHODS
  A retrospective review of our institution's experience with unilateral tonsillar enlargement.
  
  
  RESULTS
  During a five-year period, 570 patients underwent tonsillectomy at our institution. Of patients undergoing tonsillectomy, 49 patients (8.6%) underwent tonsillectomy with normal mucosa, no lymphadenopathy, and asymmetry of the tonsils. Two (4.8%) of the 49 patients with unilateral enlargement had the presence of malignancy. The two adult patients had B-cell lymphoma. Of all of the patients undergoing tonsillectomy, 0.35% had occult malignancy. In additional, the ability of the clinically assessed size (1+, 2+, 3+, and 4+) to predict volume was evaluated. The clinically assessed size and pathologically measured volume were significantly correlated (R = 0.333, P < .013). In 60.5% of the patients, the clinically assessed size and the pathologically measured volume agreed with the asymmetry reported on physical examination.
  
  
  CONCLUSIONS
  A relatively high number of tonsillectomies will be performed to yield an approximately 5% positive rate of malignancy within removed tonsils that are asymmetrical with normal mucosa and no cervical adenopathy.
authors.affiliation: House Ear Institute and House Ear Clinic, Los Angeles, California 90057, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Syms
authors.forename: D P
authors.initials: DP
authors.lastname: Birkmire-Peters
authors.forename: M R
authors.initials: MR
authors.lastname: Holtel
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006801:Humans; D006984:Hypertrophy; D015994:Incidence; D008297:Male; D014066:Palatine Tonsil / Q000473:pathology*; D012189:Retrospective Studies; D014067:Tonsillar Neoplasms / Q000453:epidemiology* / Q000601:surgery; D014068:Tonsillectomy