Sayed Kadria, Van Savell H, Hutchison Robert E, Kepner James, Link Michael P, Schwenn Molly, Mahmoud Hazem, Parham David M
Department of Pathology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 800 Marshall Street, Little Rock, Arkansas 72211, USA.
Pediatr Dev Pathol. 2005 Sep-Oct;8(5):533-40. doi: 10.1007/s10024-005-0043-6. Epub 2005 Oct 5.
Financial considerations have led to suggestions that routine microscopic evaluation of tonsils and adenoids is neither cost effective nor clinically indicated. However, the possibility of tonsillar lymphoma must be carefully weighed when making institutional policy decisions. One way to find an appropriate algorithm for pathologic examination is to examine the characteristics of biopsy-proved tonsillar lymphomas. To investigate the clinicopathologic characteristics of tonsillar lymphoma, we performed a retrospective analysis of patients who had non-Hodgkin lymphoma (NHL) and large-cell or Burkitt lymphoma involving the tonsils and adenoids and were registered on Pediatric Oncology Group (POG) protocols. Seventy-seven (9%) of 832 POG cases of NHL involved the tonsils and adenoids. Review of the pathology reports available from 29 of these cases revealed that NHL was incidentally discovered by pathologic examination in only 5 cases, all of which had clinical evidence of unilateral tonsillar enlargement or size discrepancy by gross examination. The other 24 cases indicated a clinical suspicion of tonsillar cancer, as judged by a preoperative diagnosis or by a request for frozen-section examination. We conclude that in most cases there is a clinical suspicion of tonsillar NHL at the time of gross examination. With routine cases, we predict that the use of comparative organ weights, a clinical impression of tonsillar asymmetry, and review of clinical history will increase the recognition of tonsillar lymphoma when "gross-only" protocols are employed for specimen handling.
出于经济方面的考虑，有人提出对扁桃体和腺样体进行常规显微镜检查既不具有成本效益，也无临床指征。然而，在制定机构政策决策时，必须仔细权衡扁桃体淋巴瘤的可能性。找到合适的病理检查算法的一种方法是研究经活检证实的扁桃体淋巴瘤的特征。为了研究扁桃体淋巴瘤的临床病理特征，我们对患有非霍奇金淋巴瘤（NHL）以及累及扁桃体和腺样体的大细胞或伯基特淋巴瘤且登记在儿童肿瘤学组（POG）方案中的患者进行了回顾性分析。832例POG NHL病例中有77例（9%）累及扁桃体和腺样体。对其中29例病例的病理报告进行回顾发现，仅5例通过病理检查偶然发现NHL，所有这些病例在大体检查时有单侧扁桃体肿大或大小差异的临床证据。另外24例根据术前诊断或冷冻切片检查请求判断临床怀疑为扁桃体癌。我们得出结论，在大多数情况下，大体检查时临床怀疑为扁桃体NHL。对于常规病例，我们预测当采用“仅大体检查”方案处理标本时，使用比较器官重量、扁桃体不对称的临床印象以及回顾临床病史将提高对扁桃体淋巴瘤的识别率。
