Occult hematologic malignancy in routine tonsillectomy specimens: a single institutional experience and review of the literature

Objectives: Handling of tonsillectomy specimens often includes gross and histologic examination. The published incidence of occult malignancy in benign-appearing tonsils is vanishingly rare, and consequently some propose omitting histologic analysis in young patients without clinical risk factors for malignancy or grossly suspicious features. Methods: At our institution, an occult Burkitt lymphoma in a grossly benign-appearing tonsil from an otherwise healthy 5-year-old prompted review of our cases. We retrospectively reviewed tonsillectomy findings over a 5-year period, excluding patients with known lymphoma or head and neck malignancies. A total of 740 patients were identified. All cases underwent gross and histologic examination. Results: Four additional malignancies were diagnosed, including a clinically unsuspected lymphoma in a 14-year-old patient. In our experience, although mosttonsillar malignancies present with suspicious clinical or gross findings, occult malignancies do occur. Conclusions: Recognition of these occult findings may facilitate early diagnosis and treatment; thus pathologic study of these specimens may still be justified. © American Society for Clinical Pathology.