Occult hematologic malignancy in routine tonsillectomy specimens: a single institutional experience and review of the literature.

OBJECTIVES: Handling of tonsillectomy specimens often includes gross and histologic examination. The published incidence of occult malignancy in benign-appearing tonsils is vanishingly rare, and consequently some propose omitting histologic analysis in young patients without clinical risk factors for malignancy or grossly suspicious features. METHODS: At our institution, an occult Burkitt lymphoma in a grossly benign-appearing tonsil from an otherwise healthy 5-year-old prompted review of our cases. We retrospectively reviewed tonsillectomy findings over a 5-year period, excluding patients with known lymphoma or head and neck malignancies. A total of 740 patients were identified. All cases underwent gross and histologic examination. RESULTS: Four additional malignancies were diagnosed, including a clinically unsuspected lymphoma in a 14-year-old patient. In our experience, although most tonsillar malignancies present with suspicious clinical or gross findings, occult malignancies do occur. CONCLUSIONS: Recognition of these occult findings may facilitate early diagnosis and treatment; thus pathologic study of these specimens may still be justified.

Mast cell sarcoma in an infant: a case report and review of the literature.

Mast cell diseases comprise a spectrum of disorders including cutaneous mastocytosis, indolent or aggressive systemic variants including leukemia, and unifocal tumor formations such as benign extracutaneous mastocytoma or aggressive mast cell sarcoma (MCS). Many mast cell diseases are associated with aberrancy of c-KIT proto-oncogene resulting in tyrosine kinase activity, typically exhibiting point mutation in codon 816. MCS is an exceedingly rare clinicopathologic entity characterized by a unifocal accumulation of neoplastic mast cells that grow in a locally destructive manner. We report a case in a 2-year-old boy who was initially diagnosed at 8 months of age with atypical cutaneous mastocytoma of the right ear with subsequent aggressive, destructive growth pattern; features that were most consistent with MCS. So far, MCS has been documented in the literature in at least 6 human cases. To the best of our knowledge, our case represents the first MCS in an infant. Thorough multimodal approach with strict follow-up is relevant in appropriately diagnosing this rare entity, particularly in differentiating this lesion from other neoplasms that are more likely to occur in infancy.

Barrett's esophagus: A review of diagnostic criteria, clinical surveillance practices and new developments.

Barrett's esophagus is defined by metaplastic glandular changes to the distal esophagus and is linked to an increased risk of esophageal adenocarcinoma. Controversy exists whether the definition should be limited to intestinal type glands with goblet cells or should be expanded to include non-goblet cell columnar epithelium. Barrett's esophagus may be asymptomatic in a large proportion of the population but screening should be considered for those with certain clinical findings. The diagnosis of Barrett's should be based on the combination of careful endoscopic evaluation and histologic review of the biopsy material. Continued surveillance biopsies may be necessary in cases of indeterminate or low grade dysplasia. Clinical follow-up of patients with high grade dysplasia should be tailored to the individual patient. Development of newer endoscopy techniques including chemoendoscopy, chromoendoscopy and use of biomarkers on frozen tissue have shown some promise of identifying patients at risk for malignancy.