The histomorphological pattern of various tonsillar lesions. A 3-year study in the tertiary care center.

done along with this special stain- PAS (periodic acid- Schiff) for actinomycosis and ZN stain for AFB. Results: Amongst the cases, 78 cases showed chronic tonsillitis. 11 cases were chronic tonsillitis with actinomycosis, acute chronic tonsillitis in 07 cases, granulomatous tonsillitis in 03 cases, acute ulcerative tonsillitis with microabscesses in 01 case, and reactive lymphoid hyperplasia in 02 cases. Three malignancies were observed – Two cases of squamous cell carcinoma and one case of undifferentiated carcinoma/lymphoma. Conclusion: Chronic tonsillitis is a common problem facing in all age groups, Histopathology plays a significant role in diagnosing both benign and malignant lesions of the tonsil.


Material and Methods
and 04 were tonsillar biopsies. The specimens were fixed in 10% formalin. Sections were taken from tonsillectomy specimens from representative areas while tonsillar biopsies were submitted entirely to make paraffin blocks. The sections were cut at 3-4 micron thickness and stained with Hematoxylin and Eosin. Special stains like PAS (periodic acid-Schiff) for actinomycosis and ZN stain for AFB was also done. Microscopic examination of all the stained slides was done.

Inclusion criteria
All tonsillar tissue (punch/ excision biopsies/ tonsillectomy tissue) received in the histopathology department.

Exclusion Criteria
Inadequate biopsies (Very superficial biopsy/ tonsillar anterior pillar excision biopsy without tonsil tissue)

Result
Total 105 cases were received, out of which 101 were tonsillectomy specimens and 04 were tonsillar biopsies. There were 46 males and 59 females, ranging in age from 1-70 years. The female mean age was of 30 years and the male mean age 34 years. A slight predominance of females (56.2%) was noted ( Figure 1).

Fig-1: Percentage of distribution of cases in males and females.
The most common age group affected is 21-30 years ( Table 2). The most common clinical presentation was recurrent intermittent episodes of throat pain and odynophagia (Table 3). The most common clinical sign is congestion of tonsils, anterior pillars, a peritonsillar region seen in 47.6% of cases (Table 4).  (Table 1). Amongst 105 cases, histopathological examination showed 78 cases showed chronic tonsillitis only and 11 cases of chronic tonsillitis showed actinomycotic colonies, however, there was no tissue reaction (Figure 2 and 3). 07 cases were acute on chronic tonsillitis, acute ulcerative tonsillitis with microabscesses in one case, and reactive lymphoid hyperplasia in two cases was seen.
Granulomatous tonsillitis was seen in three cases ( Figure 4 and 5). Malignancy in the tonsil was observed in 3 cases, out of which two cases reported squamous cell carcinoma (Figure 6 and 7) and one as undifferentiated carcinoma/ lymphoma ( Figure 8 and 9).      During aging, whereas lymphoid tissue regresses, subepithelial tissue changes into fibrotic tissue, and crypts alter into cavities filled with keratin.
In case of infection, bacteria that inhabit the crypts spread into the tonsil and leave their toxins and other products in it, eventually leading to polymorphonuclear leukocyte infiltration, swelling, necrosis, and surface ulceration in tonsils [10].
Chronic tonsillitis most often affects children, but can be seen in adults, probably due to a local dysfunction of the epithelium.
The recurrent nature of acute tonsillitis is attributed to the bacteria surviving intracellularly, thus avoiding antibiotic killing and causing re-infection.
Repeated attacks of tonsillitis can lead to tonsillar hypertrophy causing airway obstruction, thus leading to excision [11].
In the present study patients, age group ranged from 1-70 years, majority of the patients belong to the age group of 21-30 years not coincide with a study done by Irmeen Manzoor et al [12].   [14].
Cancer of the palatine tonsils was the most common tumor of the oropharynx. Carcinoma arising from these sites usually is squamous in origin and related strongly to smoking, HPV infection, and a lesser degree alcohol ingestion [16].   Tropical Journal of Pathology and Microbiology 2020;6(8)