A clinicopathologic series of 22 cases of tonsillar granulomas

Objectives: Tonsils are uncommonly affected by granulomatous inflammation, often with an obscure cause. This study attempts to elucidate the nature of tonsillar granulomatous inflammation. Design: Retrospective clinicopatholo gic review. Methods: Twenty-two cases of tonsillar granulomas diagnosed bet ween 1940 and 1999 were retrieved from the files of the Armed Forces Instit ute of Pathology. H&E slides and a series of histochemical stains were revi ewed, and patient follow-up was obtained. Results: There mere 11 males and II females, aged 7 to 64 years (mean, 29.9 y). Most of the cases presented bilaterally (n = 19) with sore throat, dysphagia, and/or nasal obstruction. The clinical differential included chronic tonsillitis, tuberculosis, nons pecific infect-ion, sarcoidosis, and a neoplasm. Histologically, the granul omas were focal and scattered, or diffuse, identified in the interfollicula r zones (n = 16) and/or the germinal centers (n = 13), and occasionally ass ociated with necrosis (n = 6). Based on histochemical and clinical follow-u p information, the etiology of the granulomas included sarcoidosis (n = 8), tuberculosis (n = 3), Hodgkin's lymphoma (n = 2), toxoplasmosis (n = 1), s quamous cell carcinoma (n = 1), and no specific known cause (n = 7). Twelve patients were either alive at last follow-up or had died with no evidence of disease (mean, 12.4 y), and 9 were either alive at last follow-up or had died with disease (mean, 24.9 y). One patient was alive with unknown disea se status (lost to follow-up after 13.3 y). Conclusions: Although a cause f or tonsillar granulomas is frequently identified, a number may not develop an identifiable etiology, with the granulomas probably representing an exag gerated immune response to chronic tonsillitis. However, a careful work-up must be conducted to exclude specific causes and avoid clinical mismanageme nt.