Gnepp D R, Souther J
Department of Pathology, Brown University School of Medicine, Rhode Island Hospital, Providence 02903, USA.
Hum Pathol. 2000 Jul;31(7):813-6. doi: 10.1053/hupa.2000.8439.
Over the past 10 years, 1 of the authors (D.G.) has been consulted about several medical legal cases involving complications allegedly related to excessive surgery as documented by finding skeletal muscle in tonsillectomy specimens. A review of the literature showed little information about the incidence of skeletal muscle in routine tonsillectomy specimens; therefore, this study was undertaken. Thirty sequential tonsillectomy specimens from patients with histories of hyperplastic tonsils (10 males, 20 females; ages 5, 17 to 39; mean age, 24.3 years) were processed routinely (1 section/tonsil), and evaluated on a retrospective basis using routine light microscopy (group 1). In addition, 20 sequential tonsillectomy specimens were processed in a prospective fashion, excluding sleep apnea specimens (5 males, 15 females; ages 12 to 59 years; mean age, 28.9 years) (group 2). All specimens in the first group had lymphoid hyperplasia; 25 of the 30 (83%) had skeletal muscle in soft tissue adjacent to the lymphoid elements, 20 (67%) had seromucinous glands, and in 1 there was a focus of cartilage. In group 2, 18 had lymphoid hyperplasia and 2 contained carcinomas; 19 of 20 contained skeletal muscle ranging from a single fiber to abundant, multifocal areas with muscle, 16 (80%) had seromucinous glands, and 4 contained areas with cartilage. Additional tissue from the specimen without muscle and the tonsil with a single fiber was processed, and abundant skeletal muscle was identified in each. One may conclude that skeletal muscle is very frequently found in routine tonsillectomy specimens and, by itself, is not an indication of inappropriate surgical technique.
在过去10年里，有一位作者（D.G.）曾就几起医疗法律案件提供咨询，这些案件涉及一些据称与过度手术相关的并发症，扁桃体切除标本中发现骨骼肌可作为相关证据。文献回顾显示，关于常规扁桃体切除标本中骨骼肌发生率的信息很少；因此开展了本研究。对30例有扁桃体增生病史的患者（10例男性，20例女性；年龄5岁、17至39岁；平均年龄24.3岁）的连续扁桃体切除标本进行常规处理（每个扁桃体1个切片），并采用常规光学显微镜进行回顾性评估（第1组）。此外，前瞻性地处理了20例连续扁桃体切除标本，排除了睡眠呼吸暂停标本（5例男性，15例女性；年龄12至59岁；平均年龄28.9岁）（第2组）。第1组的所有标本均有淋巴组织增生；30例中有25例（83%）在淋巴组织相邻的软组织中有骨骼肌，20例（67%）有浆液性腺，1例中有软骨灶。在第2组中，18例有淋巴组织增生，2例含有癌；20例中有19例含有骨骼肌，范围从单根纤维到大量多灶性肌肉区域，16例（80%）有浆液性腺，4例含有软骨区域。对无肌肉标本和仅有单根纤维的扁桃体的额外组织进行处理，结果在每个标本中均发现了大量骨骼肌。可以得出结论，在常规扁桃体切除标本中经常发现骨骼肌，其本身并非手术技术不当的指征。
