Isolated tonsillar sarcoidosis mimicking malignancy: Diagnostic and therapeutic dilemmas

Hippokratia 2005, 9(3):134-137

G Fyrmpas, S Ereliadis, J Constantinidis, M Manthou, J Daniilidis
Dpt Otolaryngology, Head & Nech Surgery, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
Patholgy Dpt, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece


Background: Sarcoidosis is a multisystemic, granulomatous disease of obscure aetiology. Isolated tonsillar sarcoidosis is very rare and may mimic neoplasia.
Case report: We report a case of a 43 year old lady with isolated tonsillar sarcoidosis, whose clinical presentation was initially regarded as malignant tumour of the tonsil. The patient underwent tonsillectomy and received no further treatment. She remains free of symptoms one year following the diagnosis.
Discussion: Tonsillar sarcoidosis, in the absence of other systemic manifestations, may not be a straightforward diagnosis. ??n caseating granulomas, the histological hallmark of the disease, are non-specific and may be found in granulomatous processes of a known cause (e.g. tuberculosis). The diagnostic approach aims at supporting the clinical findings and revealing the true extent of the disease. Correct and timely diagnosis prevents delays in treatment and institution of contraindicated therapies (e.g. steroids for masqueraded tonsillar tuberculosis). Sarcoidosis should always be included in the differential diagnosis of asymmetric tonsils therefore histological examination of the tonsils is imperative. Patients suffering from sarcoidosis in the Head and Neck region need long term follow up. The initial diagnosis may change in the light of new symptoms and there may be a risk of developing malignant neoplasms in sarcoidosis.