316 Clinical Significance and Diagnostic Approach for Paediatric Unilateral Tonsillar Enlargement: Insights from a Retrospective Analysis

Aim Tonsillectomy for unilateral tonsillar enlargement (UTE) in the paediatric population remains a topic of debate among ENT surgeons. The majority of UTE is benign in nature; however, concerns exist around the differential diagnosis of lymphoma which is typically found in the presence of other sinister symptoms. The aim is to identify the common features associated with UTE and malignancy to stratify risk at clinical presentation, allowing for appropriate listing of patients for diagnostic tonsillectomy. Method A retrospective case series analysis was performed of all paediatric tonsillectomy specimens, at Bristol Children’s Hospital and between January 2006 and January 2023. Anonymised data included patient demographic details, clinical history including history and histopathological results. Results Six (1.9%) lymphoma diagnoses were identified from the 321 patients that underwent tonsillectomy for UTE. Three patients had localised disease to cervical region, and three patients had systemic infiltration of disease with bony disease, oropharyngeal and abdominal disease, mediastinal disease respectively These patients presented with other signs of malignancy in addition to UTE including cervical lymphadenopathy (100%), tonsillar asymmetry (83%), alteration of appearance of tonsil including colour or visible lesion (67%), snoring (67%), dysphagia (50%), recurrent fever (17%) and weight loss (17%). Conclusions The incidence of malignancy in our study is low (1.9%), consistent with previously reported literature. In all cases of confirmed lymphoma, the enlarged tonsil appeared grossly abnormal on clinical examination. We suggest tonsillectomy for histology should only be performed in the presence of associated symptoms suggestive of lymphoma.