Introduction: The prevalence of synchronous bilateral tonsil squamous cell carcinoma (TSCC) remains unexplored. To date, only 32 cases have been described in the literature. With an aim to substantiate the Danish recommendation of performing bilateral tonsillectomy in patients with suspected or proven TSCC and in patients with cervical carcinoma metastases from an unknown primary tumour (CUP), the current study was undertaken to determine the prevalence of synchronous bilateral TSCC.
Methods: A retrospective review of all patients diagnosed with TSCC in the period 2000-2015 at Aarhus University Hospital, Denmark, was performed.
Results: Seven of 211 (3.3%) consecutive patients with TSCC, who had undergone bilateral tonsillectomy (n=180) or unilateral tonsillectomy (on the clinically normal side) combined with contralateral tonsil biopsy (on the side with suspected cancer) (n=31), had synchronous bilateral TSCC. Furthermore, moderate to severe dysplasia was found in the contralateral tonsil in two patients with unilateral TSCC. Four of 171 (2.3%) patients with suspected unilateral tonsillar cancer had additional contralateral TSCC. Three of 34 (8.8%) patients without clinical signs of tonsillar malignancy on any side (32 patients with CUP) had bilateral synchronous TSCC. In none of the patients were bilateral TSCC suspected. Patients with unilateral vs synchronous bilateral TSCC had similar clinical and tumour characteristics.
Conclusion: Knowledge on additional contralateral synchronous tonsillar malignancy is crucial for avoidance of early recurrence of oropharyngeal cancer in patients with TSCC. Based on our findings, we recommend bilateral tonsillectomy in all patients with suspected or proven TSCC (unilateral or bilateral) and CUP.