The presence of unilateral tonsillar enlargement in patients diagnosed with palatine tonsil lymphoma: experience at a tertiary care pediatric hospital.

OBJECTIVE: There is a significant debate over the need for tonsillectomy to rule out lymphoma in cases of unilateral tonsillar enlargement. Several publications have suggested that the presence of unilateral tonsillar enlargement in children was an ominous sign of the possibility of underlying lymphoma. More recently, some authors have recommended that routine tonsillectomy in this context is not indicated given the low incidence of tonsillar lymphoma in the pediatric population and the high cost associated with this procedure. The aim of this study is to determine whether or not children diagnosed with tonsillar lymphoma originally presented with unilateral tonsillar enlargement.

METHODS: We queried the tumour board registry records at a pediatric tertiary care institution from 1949 to January 2006 for all cases of tonsillar lymphoma. We examined the clinic, pre-operative and operative notes as well as the pathology results and noted the presenting signs and symptoms with a specific interest in the presence of unilateral tonsillar enlargement.

RESULTS: Our query returned six patients with a diagnosis of palatine tonsil lymphoma. All six identified patients presented at their first visit with clinically apparent asymmetry of the tonsils. In all six cases B symptoms were absent at the first visit.

CONCLUSIONS: We conclude that even though the majority of patients who have unilateral tonsillar enlargement will not have tonsillar lymphoma, most patients with tonsillar lymphoma will have unilateral tonsillar enlargement as one of their presenting signs. Therefore, despite the low incidence of this malignancy in children, careful close follow-up of these patients is warranted until the diagnosis has been ruled out given the potentially devastating consequences of missing this diagnosis or prolonging the time to treatment. Moreover, a low level of suspicion should warrant a tonsillectomy.