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Tonsillectomy in own material

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Introduction: Tonsillectomy belongs to the most frequently performed surgical treatments; however, the necessity of its performance is questioned. Therefore, there are many attempts to unify and define the indications for the procedure. Aim: The main objective of the current dissertation was an analysis of the clinical symptoms occurring in patients qualified for tonsillectomy, as well as a comparison of those with a histopathological image of the removed tonsils in a repeatedly carried out, unified pathomorphological examination. The secondary objective was the designation of the demographic profile, existing comorbidities, and complications in the form of postoperative bleeding in patients after tonsillectomy in own material. Material and method: A retrospective analysis of 301 procedures of palatine tonsil removal was performed, which were completed in the years 2017–2019 at the Department of Otolaryngology with Division of Cranio-Maxillo-Facial Surgery of the Military Institute of Medicine, Warsaw, Poland. The indications were defined on the grounds of data from the anamnesis. Based on unified criteria, the removed material was divided into 2 groups: with the signs of Chronic Tonsillitis (CT) as well as Tonsillar Hyperthrophy (TH). Results: The average size of tonsils was the greatest in a group of patients under 35 years of age, and smallest in the group over 51 years of age. As patients aged, the reduction in size of the palatal tonsils was observed. In the examined group, the histopathological diagnosis in the form of HT was found in 165 patients (54.8%), while CT in 136 (45.2%). It was proven that the larger the tonsils in the clinical picture, the more often the histopathological image responded to HT. Among clinical symptoms reported by patients qualified for tonsillectomy, the following were observed: recurring tonsil inflammation in 211 (70.1%), snoring and sleep apnea in 47 (15.6%), as well as sleep apnea in 33 (11%) patients. Primary bleeding occurred in 10 patients (3.34%), and secondary in 8 patients (2.66%). The most common comorbidities were cardiovascular burdens. Conclusions: For most cases, clinical symptoms were confirmed by adequate features of removed material in histopathological examination. The most common histopathological diagnosis was tonsillar hyperthrophy.
2
Publication available in full text mode
Content available

Tonsillectomy in own material

100%
EN
Introduction: Tonsillectomy belongs to the most frequently performed surgical treatments; however, the necessity of its performance is questioned. Therefore, there are many attempts to unify and define the indications for the procedure. Aim: The main objective of the current dissertation was an analysis of the clinical symptoms occurring in patients qualified for tonsillectomy, as well as a comparison of those with a histopathological image of the removed tonsils in a repeatedly carried out, unified pathomorphological examination. The secondary objective was the designation of the demographic profile, existing comorbidities, and complications in the form of postoperative bleeding in patients after tonsillectomy in own material. Material and method: A retrospective analysis of 301 procedures of palatine tonsil removal was performed, which were completed in the years 2017–2019 at the Department of Otolaryngology with Division of Cranio-Maxillo-Facial Surgery of the Military Institute of Medicine, Warsaw, Poland. The indications were defined on the grounds of data from the anamnesis. Based on unified criteria, the removed material was divided into 2 groups: with the signs of Chronic Tonsillitis (CT) as well as Tonsillar Hyperthrophy (TH). Results: The average size of tonsils was the greatest in a group of patients under 35 years of age, and smallest in the group over 51 years of age. As patients aged, the reduction in size of the palatal tonsils was observed. In the examined group, the histopathological diagnosis in the form of HT was found in 165 patients (54.8%), while CT in 136 (45.2%). It was proven that the larger the tonsils in the clinical picture, the more often the histopathological image responded to HT. Among clinical symptoms reported by patients qualified for tonsillectomy, the following were observed: recurring tonsil inflammation in 211 (70.1%), snoring and sleep apnea in 47 (15.6%), as well as sleep apnea in 33 (11%) patients. Primary bleeding occurred in 10 patients (3.34%), and secondary in 8 patients (2.66%). The most common comorbidities were cardiovascular burdens. Conclusions: For most cases, clinical symptoms were confirmed by adequate features of removed material in histopathological examination. The most common histopathological diagnosis was tonsillar hyperthrophy.
EN
The authors presents a case of cribriform breast carcinoma in a cyst that clinically imitated an abscess. The case concerns a 71-year-old female patient treated for ankylosing spondylitis, with a positive family history of breast cancer. The patient presented at the surgical clinic for incision of an abscess of the mammary gland localized in the lower inner quadrant that was a consequence of previous trauma to the right breast. The abscess was incised and the serosanguineous contents were evacuated. The wound was drained and antibiotics (Dalacin with Metronidazol) were administered for the period of 10 days. During the treatment, a cutaneous fistula was formed. At the incision site, a hard thickening was palpable (tumor). Core needle biopsy of the clinically palpable tumor was performed and the purulent material from the fistula was collected for a culture test. Complete blood count did not reveal leucocytosis. In accordance with the obtained sensitivity report, the patient was started on antibiotics again. Breast ultrasound performed upon the completion of the antibiotic therapy, in the right breast, revealed two solidcystic oval lesions with thick echogenic walls and blurred margins. Both masses contained dense levels of fluid material and solid polycyclic structures. On sonoelastography, the lesions were heterogeneous with a high Young’s modulus. In the right axillary fossa, ultrasound examination revealed three abnormal lymph nodes enlarged to 31 mm length, which were rounded, hypoechoic and without visible sinuses. Histopathology of the core needle biopsy performed at admittance and after the antibiotic therapy indicated a breast abscess (presence of fibrinous and partly fibrinopurulent material). The mass was finally resected to confirm histopathology. The resected material revealed the presence of an invasive, moderately differentiated cribriform carcinoma, which developed within a cyst, with a 40% necrotic component. Eighteen months after the commencement of treatment, the patient remains under oncological supervision and continues hormonal therapy. There are no signs of relapse or foci of distant metastases. The occurrence of breast carcinoma within an abscess emphasises the need for comprehensive assessment and correlation of the clinical picture with imaging and histopathological findings. It also highlights the necessity to include breast abscess in the differential diagnosis of rare forms of carcinomas.
PL
Przedstawiono przypadek raka sitowatego piersi w torbieli klinicznie imitujący ropień. Dotyczy on 71‑letniej pacjentki leczonej z powodu zesztywniającego zapalenia stawów kręgosłupa, obciążonej rodzinnie rakiem piersi. Kobieta zgłosiła się do poradni chirurgicznej w celu nacięcia ropnia gruczołu piersiowego, zlokalizowanego w kwadrancie dolnym wewnętrznym, który powstał w następstwie urazu prawej piersi. Nacięto ropień, ewakuując treść surowiczo‑krwistą. Ranę zdrenowano oraz włączono antybiotykoterapię (Dalacin z Metronidazolem) na okres 10 dni. W trakcie leczenia doszło do powstania przetoki skórnej. W miejscu po nacięciu ropnia było wyczuwalne twarde zgrubienie (guz). Wykonano biopsję gruboigłową klinicznie wyczuwalnego guza oraz pobrano treść ropną z przetoki na posiew. W badaniu morfologii krwi nie występowała leukocytoza. Włączono ponownie antybiotykoterapię zgodnie z otrzymanym antybiogramem. W badaniu ultrasonograficznym piersi, wykonanym po zakończonej antybiotykoterapii, w prawej piersi uwidoczniono dwie lito‑płynowe owalne zmiany, z obecnością grubych echogennych ścian, o zatartych brzegach. W obu zmianach występowały poziomy zagęszczonej treści płynowej oraz lite struktury o policyklicznych kształtach. W sonoelastografii oceniane zmiany były heterogenne, o wysokich wartościach modułu Younga. W prawym dole pachowym w badaniu ultrasonograficznym stwierdzono trzy nieprawidłowe węzły chłonne, powiększone do 31 mm długości, zaokrąglone, hipoechogeniczne, bez widocznych zatok. Wynik badania histopatologicznego z biopsji gruboigłowej wykonanej przy przyjęciu oraz po zakończonej antybiotykoterapii wskazywał na ropień piersi (opisano obecność mas włóknikowych, częściowo włóknikowo‑ropnych). Dopiero wycięcie całej zmiany celem weryfikacji histopatologicznej ujawniło obecność inwazyjnego, średnio dojrzałego raka sitowatego, który rozwinął się w świetle torbieli, z obszarami martwicy obejmującej około 40% masy guza. Pacjentka po 18 miesiącach od rozpoczęcia leczenia pozostaje pod opieką onkologiczną, kontynuuje hormonoterapię, nie ma nawrotu choroby oraz ognisk przerzutów odległych. Opisany przypadek raka piersi w ropniu wskazuje na potrzebę kompleksowej oceny i korelacji obrazu klinicznego z wynikami badań obrazowych oraz histopatologicznych, a także uwzględniania w diagnostyce różnicowej ropnia piersi rzadko występujących postaci raka.
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