Öz
Objective: The fact that the malignancy rates in pediatric adenotonsillectomies were regarded too low in the meta-analyses and reviews conducted leads to the suspicion that histopathological assessment gives rise to unnecessary loss of time, effort and money. The objective of this study was to determine the malignancy rates in our cases with childhood adenoidectomy/adenotonsillectomy. Patients & Methods: Pediatric patients who applied to the Ear,Nose&Throat ENT outpatient department of Bağcılar Education and Research Hospital between 1.1.2010 and 1.1.2013 and diagnosed with adenoid hypertrophy as a result of clinical-radiological examinations were included into the study. The histopathological results of 975 cases that underwent adenoidectomy/adenotonsillectomy were analyzed retrospectively. Results: Out of 975 pediatric patients 545 boys, 430 girls , 495 50.8% underwent only an adenoidectomy, while 480 49.2% underwent an adenotonsillectomy. The concomitance of chronic inflammation and lymphoid hyperplasia was among the symptoms encountered most frequently. No unexpected malignancy was detected in the histopathological assessment. Conclusion: Although we can’t identify the malignancy in routine pediatric adenoidectomy/ adenotonsillectomy materials we believe that all of the samples need to be analyzed as histologically. Macroscopic assessment and clinical-radiological and laboratory findings may be an alternative way to examine for reducing the cost and time loss. Nevertheless we recommend that the doctors care about the pathological examination in postoperative period for not to encounter with problems such as legal or an unexpected malignancy.
Anahtar Kelimeler
pediatrics adenoidectomy tonsillectomy histopathology unexpected malignancy.
Kaynakça
- Brodsky L. Tonsillitis, tonsillectomy, and adenoidectomy. In: Head and Neck Surgery-Otolaryngology. Bailey BJ, Calhoun KH. Eds. 2 nd ed, New York, Lippincott- Raven Press,1998,pp.1221-1235.
- Richardson MA. Sore throat, tonsillitis, and adenoiditis. Medical Clinics of North America 1999;83:75-84.
- Al-Mazrou KA, Al-Khattaf AS. Adherent biofilms in adenotonsillar diseases in children. Arch Otolaryngol Head Neck Surg 2008;34:20–23.
- Dohar JE, Bonilla JA. Processing of adenoid and tonsil specimens in children: a national survey of standard practices and a five-year review of the experience at the Children’s Hospital of Pittsburgh. Otolaryngol Head Neck Surg 1996;115:94-7.
- Younis RT, Hesse SV, Anand VK. Evaluation of the utility and cost- effectiveness of obtaining histopathologic diagnosis on all routine tonsillectomy specimens. Laryngoscope 2001;111:2166-9.
- Strong EB, Rubinstein B, Senders CW. Pathologic analysis of routine tonsillectomy and adenoidectomy specimens.Otolaryngol Head Neck Surg 2001;125:473-7.
- Erdag TK, Ecevit MC, Guneri EA, Dogan E, Ikiz AO, Sutay S. Pathologic evaluation of routine tonsillectomy and adenoidectomy specimens in the pediatric population: is it really necessary? Int J Pediatr Otorhinolaryngol 2005;69:1321-5.
- Yasan H, Doğru H, Candir O, Tüj M, Bircan S. Incidence of unexpected pathology in routine adenoidectomy specimens. Int J Pediatr Otorhinolaryngol 2006;70:95-98.
- Dewil B, Jorissen M, Lemkens P. Routine pathological evaluation after tonsillectomy: is it necessary? B-ENT 2006;2:103-8.
- Verma SP, Stoddard T, Gonzalez-Gomez I, Koempel JA.Histologic analysis of pediatric tonsil and adenoid specimens: is it really necessary? Int J Pediatr Otorhinolaryngol 2009;73:547-50.
- Faramarzi A, Ashraf MJ, Hashemi B, Heydari ST, Saif I, Azarpira N et al. Histopathological screening of tonsillectomy and/or adenoidectomy specimens: a report from southern Iran. Int J Pediatr Otorhinolaryngol 2009;73:1576-9.
- Hıdır Y, Aydın Ü, Deveci MS, Durmaz A, Gerek M. Rutin Pediatrik Adenotonsillektomilerde Mikroskopik Histopatolojik İnceleme. KBB- Forum 2010;9:60-64
- Koç S, Uysal İÖ, Yaman H, Eyibilen A. Histopathologic examination of routine tonsil and adenoid specimens: Is it a necessary approach? Kulak Burun Bogaz Ihtis Derg 2012;22:87-90.
- Garavello W, Romagnoli M, Sordo L, Spreafico R, Gaini RM. Incidence of unexpected malignancies in routine tonsillectomy specimens in children. Laryngoscope 2004;114:1103-5.
- Williams MD, Brown HM. The adequacy of gross pathological examination of routine tonsils and adenoids in patients 21 years old and younger. Hum Pathol 2003;34:1053-7.
- Randall DA, Martin PJ, Thompson LD. Routine histologic examination is unnecessary for tonsillectomy or adenoidectomy. Laryngoscope 2007;117:1600-4.
- Netser JC, Robinson RA, Smith RJ, Raab SS. Value-based pathology: a cost-benefit analysis of the examination of routine and nonroutine tonsil and adenoid specimens. Am J Clin Pathol 1997;108:158-65.
Öz
Amaç: Yapılan meta-analiz ve gözden geçirme çalışmalarında, pediatrik adenotonsillektomilerde malignite oranlarının çok düşük bulunması histopatolojik incelemenin gereksiz zaman, emek ve ekonomik kayıplara neden olduğu yönünde şüpheler uyandırmaktadır. Bu çalışmada çocukluk çağı adenoidektomi/adenotonsillektomi olgularımızdaki malignite oranlarının belirlenmesi amaçlandı. Hastalar ve Yöntem: Çalışmaya 1.1.2010 ve 1.1.2013 tarihleri arasında Bağcılar Eğitim ve Araştırma Hastanesi’nde KBB polikliniğine başvuran ve klinik-radyolojik değerlendirmeleri sonucunda adenoid hipertrofisi tanısı konan çocuk hastalar alındı. Adenoidektomi/adenotonsillektomi yapılan 975 olgunun histopatolojik sonuçları retrospektif olarak incelendi. Bulgular: 975 pediatrik hastanın 545’i erkek, 430’u kız olup 495’ine %50,8 sadece adenoidektomi, 480’ine %49.2 adenotonsillektomi ameliyatı yapılmıştı. Kronik inflamasyon ve lenfoid hiperplazi birlikteliği en sık rastlanan bulgulardı. Histopatolojik incelemede hiçbir olguda beklenmedik malignite çıkmadı. Sonuç: Rutin pediatrik adenoidektomi/adenotonsillektomi materyallerinde malignite bulamasak da tüm örneklerin histopatolojik olarak incelenmesi gerektiğine inanıyoruz. Makroskopik değerlendirme ve klinik-radyolojiklaboratuvar bulguların araştırılması maliyet ve zaman kaybını azaltmada alternatif bir yol olabilir. Biz yinede hekimlerin gerek legal gerekse beklenmedik malignite tanısı gibi sorunlarla karşılaşmaması için postoperatif dönemde patolojik incelemeyi önemsemelerini öneriyoruz.
Anahtar Kelimeler
pediatrik adenoidektomi tonsillektomi histopatoloji beklenmedik malignite.
Kaynakça
- Brodsky L. Tonsillitis, tonsillectomy, and adenoidectomy. In: Head and Neck Surgery-Otolaryngology. Bailey BJ, Calhoun KH. Eds. 2 nd ed, New York, Lippincott- Raven Press,1998,pp.1221-1235.
- Richardson MA. Sore throat, tonsillitis, and adenoiditis. Medical Clinics of North America 1999;83:75-84.
- Al-Mazrou KA, Al-Khattaf AS. Adherent biofilms in adenotonsillar diseases in children. Arch Otolaryngol Head Neck Surg 2008;34:20–23.
- Dohar JE, Bonilla JA. Processing of adenoid and tonsil specimens in children: a national survey of standard practices and a five-year review of the experience at the Children’s Hospital of Pittsburgh. Otolaryngol Head Neck Surg 1996;115:94-7.
- Younis RT, Hesse SV, Anand VK. Evaluation of the utility and cost- effectiveness of obtaining histopathologic diagnosis on all routine tonsillectomy specimens. Laryngoscope 2001;111:2166-9.
- Strong EB, Rubinstein B, Senders CW. Pathologic analysis of routine tonsillectomy and adenoidectomy specimens.Otolaryngol Head Neck Surg 2001;125:473-7.
- Erdag TK, Ecevit MC, Guneri EA, Dogan E, Ikiz AO, Sutay S. Pathologic evaluation of routine tonsillectomy and adenoidectomy specimens in the pediatric population: is it really necessary? Int J Pediatr Otorhinolaryngol 2005;69:1321-5.
- Yasan H, Doğru H, Candir O, Tüj M, Bircan S. Incidence of unexpected pathology in routine adenoidectomy specimens. Int J Pediatr Otorhinolaryngol 2006;70:95-98.
- Dewil B, Jorissen M, Lemkens P. Routine pathological evaluation after tonsillectomy: is it necessary? B-ENT 2006;2:103-8.
- Verma SP, Stoddard T, Gonzalez-Gomez I, Koempel JA.Histologic analysis of pediatric tonsil and adenoid specimens: is it really necessary? Int J Pediatr Otorhinolaryngol 2009;73:547-50.
- Faramarzi A, Ashraf MJ, Hashemi B, Heydari ST, Saif I, Azarpira N et al. Histopathological screening of tonsillectomy and/or adenoidectomy specimens: a report from southern Iran. Int J Pediatr Otorhinolaryngol 2009;73:1576-9.
- Hıdır Y, Aydın Ü, Deveci MS, Durmaz A, Gerek M. Rutin Pediatrik Adenotonsillektomilerde Mikroskopik Histopatolojik İnceleme. KBB- Forum 2010;9:60-64
- Koç S, Uysal İÖ, Yaman H, Eyibilen A. Histopathologic examination of routine tonsil and adenoid specimens: Is it a necessary approach? Kulak Burun Bogaz Ihtis Derg 2012;22:87-90.
- Garavello W, Romagnoli M, Sordo L, Spreafico R, Gaini RM. Incidence of unexpected malignancies in routine tonsillectomy specimens in children. Laryngoscope 2004;114:1103-5.
- Williams MD, Brown HM. The adequacy of gross pathological examination of routine tonsils and adenoids in patients 21 years old and younger. Hum Pathol 2003;34:1053-7.
- Randall DA, Martin PJ, Thompson LD. Routine histologic examination is unnecessary for tonsillectomy or adenoidectomy. Laryngoscope 2007;117:1600-4.
- Netser JC, Robinson RA, Smith RJ, Raab SS. Value-based pathology: a cost-benefit analysis of the examination of routine and nonroutine tonsil and adenoid specimens. Am J Clin Pathol 1997;108:158-65.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Research Article |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Haziran 2014 |
| Yayımlandığı Sayı | Yıl 2014Sayı: 2 |