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.
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.
Four additional malignancies were diagnosed, including a clinically unsuspected lymphoma in a 14-year-old patient. In our experience, although most tonsillar malignancies present with suspicious clinical or gross findings, occult malignancies do occur.
Recognition of these occult findings may facilitate early diagnosis and treatment; thus pathologic study of these specimens may still be justified.