Tonsils and adenoids are commonly removed in children with chronic infections and in individuals of any age with sleep apnea. Under these circumstances, gross abnormalities are not usually observed; however, adult specimens require close gross examination for mucosal irregularities (which could represent squamous dysplasia or carcinoma) or a fleshy cut surface (which could represent lymphoma).
Count the number of tissue pieces per container and identify each piece as tonsil or adenoid. Determine whether any orienting marks (e.g. sutures) are in place to distinguish left vs. right.
Measure each piece (three dimensions).
Describe the external surfaces (color, cerebriform, smooth, rough, presence of yellow granules). If tumor is present, ink the resection margin and describe and measure the tumor. See Lymphoma Work-Up if lymphoma is clinically or grossly suspected.
Serially section each piece and describe the cut surfaces (color, homogeneous, necrotic, hemorrhagic, presence of yellow granules). If tumor is present, sectioning should be done perpendicular to the resection margin. Determine the degree of involvement of the cut surface by tumor.
Pediatric patients <20 years: Gross only, if grossly normal. If there is a gross abnormality, sections must be submitted.
Adult patients >21 years: if no gross abnormality, submit a section of each tonsil and the adenoids.
If there is gross abnormality, sections must be submitted from each tonsil and the adenoids.
In adult patients, if the weight difference of the tonsils is >20%, submit a section of each tonsil and representative sections of the adenoids, and process the larger tonsil according to lymphoma protocol.
Regardless of the patient's age or weight difference of the tonsils, if lymphoma is suspected or request for lymphoma workup is submitted, the tonsil must be processed according to lymphoma workup (protocol).
If tumor suspected: minimum of three cross-sections in suspicious pieces.
Received without fixative/in formalin, labeled with patient's name, medical number and “_____” (tonsils and adenoids), are two palatine tonsils and multiple fragments of adenoids. One tonsil are __ grams and __ x __ x __ cm, and with a cereiform surface (portially covered by thin white exudate). The second tonsil is __ grams and __ x __ x __ cm with an unremarkable cerebriform surface. The cut surface of both tonsils is soft, gray-tan with crypts. A few, 0.1 to 0.2 cm diameter, firm, yellow granules are present in the crypts of the first tonsil. The adenoidal tissue __ grams and __ x __ x __ cm in aggregate and consists of multiple fragments of soft, gray-tan tissue. Representative sections, including 5% of the specimen, are submitted in __ cassettes labeled as follows: