Beware of the tonsillar remnant

Beware of the tonsillar remnant
Reviewed by: James Kennedy
Jul/Aug 2011 (Vol 20 No 3)

Squamous cell carcinoma (SCC) of the tonsil is the most common malignant tumour of the oropharynx. However, squamous cell carcinoma of the tonsillar remnant (SCCTR) in a previously tonsillectomised patient is rare, with only one previously documented case report in the literature. This well presented study is a retrospective review of patients presenting with SCCTR at the head and neck unit at Guy’s, Kings and St Thomas’ NHS Trusts from 2000 to 2007. In the seven-year period, 251 patients presented with SCC, and ten (4%) had a tonsillectomy performed in childhood. In this study, five patients (50%) had no obvious site of primary tumour when initially seen in clinic. In patients with no primary indentified the authors stress the importance of a systematic approach and advocate following the BAO-HNS guidelines for the management of head and neck cancer. The therapeutic strategy for SCCTR will depend on the stage of the disease at diagnosis. In this series all patients deemed curable were given combined treatment with surgery and radiotherapy. The two year disease free survival was found to be 89% and for five year 83%. The study highlights the importance of a high index of suspicion in patients who have previously undergone tonsillectomies and who present with, potentially, occult primary SCC in the head and neck region. A tonsil biopsy should be performed when investigating an unknown primary, despite childhood tonsillectomy and a normal appearance of the tonsillar remnant. The series concludes by suggesting that SCCTR can be considered as a clinical sub-group within SCC of the tonsil. The management strategy of these patients however should be the same as for patients with primary SCC and they appear to have similar oncologic outcomes.
Squamous cell carcinoma of the tonsillar remnant – clinical presentation and oncological outcome.
Skilbeck CJ, Jeannon J, O'Connell M, Morgan PR, Simo R.