2019年7月17日星期三

Tumours of the tonsil (扁桃體腫瘤)

Benign cysts (良性囊腫)
Clinical features:
Mucous retention cysts, tonsilloliths or cysts of inspissated epithelial debris may occur. They are smooth and localized to one portion of the tonsil.

Management:
Symptomatic cysts may be helped by tonsillectomy.


Lymphoma (淋巴瘤)
Clinical features:
Unilateral tonsillar swelling with an intact overlying mucosa may cause dysphagia and is suspicious of a lymphoma. The tonsil feels rubbery. Excision biopsy confirms the diagnosis.

Management:
After staging the disease, treatment involves radiotherapy for localized disease, with chemotherapy being added in more advanced cases.


Carcinoma (癌)
Clinical features:
Squamous carcinoma of the tonsil presents as otalgia, sore throat or dysphagia in heavy drinkers and smokers. More than 50%of cases have involved neck nodes ipsilaterally: this may be the mode of presentation. The tonsil is hard and ulcerated.

Management:
After full endoscopy and biopsy small primaries without nodes are best treated by radiotherapy. Surgery (which involves a block dissection of neck, partial mandibulectomy and excision of the primary) is reserved for radiation failures and large primaries. 


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