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Laryngoscope. 2000 Nov;110(11):1807-10.

Incidence of carcinoma in incidental tonsil asymmetry.

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House Ear Institute and House Ear Clinic, Los Angeles, California 90057, USA.



To determine the incidence of malignancy in patients with incidentally discovered unilateral tonsillar enlargement with an otherwise normal physical examination.


A retrospective review of our institution's experience with unilateral tonsillar enlargement.


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.


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.

[Indexed for MEDLINE]

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