Adenocarcinoma of the tonsil – metastasis or primarius

Squamous cell carcinomas are common entities for the ENT physician. They account for around 75 per cent of all oropharyngeal cancers. Other epithelial tumors are much rarer.

A 70-year-old patient was presented with dysphagia, globus sensation and a cervical lymph node swelling on the left with MRI already performed. Here, a cervical metastatic tonsil carcinoma on the left side was presented. After fine needle puncture, panendoscopy and laser tonsillectomy the histological examination revealed infiltrates of an adenocarcinoma. This was followed by laser surgical resection and left neck dissection (pT1pN1R0). In the course of the staging, a malignant space in the right upper lobe of the lung with mediastinal lymph node infestation was impressing in the CT thorax. In the interdisciplinary tumor board, the indication for an upper lobe lobectomy on the right with lymphadenectomy was decided. Histology showed a morphological and immunohistological differentiation identical to that of the tonsil. The primarius could not be distinguished from the metastasis by the immunohistochemical characteristics. The patient received adjuvant radiochemotherapy.

Metastases in the tonsils are very rare and account for only 0.8% of malignant findings. The adenocarcinoma of the tonsil can develop not only as metastatic genesis but also as primarius due to salivary glands scattered in the squamous epithelium. With regard to diagnosis and therapy, the acquisition of a histology to differentiate primarius vs. metastasis is necessary, but not always meaningful. A possible metastasis of another primarius into the tonsil must not be ignored.

Publication History

Publication Date:
23 April 2019 (online)