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CLINICAL IMAGE
Year : 2019  |  Volume : 149  |  Issue : 1  |  Page : 80

Initial presentation of tonsillar carcinoma with candidiasis


1 Department of Otolaryngology-Head & Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
2 Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C

Date of Submission21-Sep-2017
Date of Web Publication22-Apr-2019

Correspondence Address:
Cheng-Ping Shih
Department of Otolaryngology-Head & Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
R.O.C
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_1536_17

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How to cite this article:
Shih CP, Tsai WC. Initial presentation of tonsillar carcinoma with candidiasis. Indian J Med Res 2019;149:80

How to cite this URL:
Shih CP, Tsai WC. Initial presentation of tonsillar carcinoma with candidiasis. Indian J Med Res [serial online] 2019 [cited 2019 Oct 22];149:80. Available from: http://www.ijmr.org.in/text.asp?2019/149/1/80/256699

†Patient's consent obtained to publish clinical information and images.


Clinical ImageA 57 yr old man presented to the department of Otorhinolaryngology-Head and Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan, in April 2014 with fever, otalgia, sore throat, odynophagia and mild swelling in the right side of infra-auricular region for three weeks. He had no systemic disease and had no history of ingestion of immunosuppressant drugs. Intraoral examination revealed a whitish pseudomembrane over right tonsil without enlargement and prominent ulceration [Figure 1]. There was no bleeding on touch. The tonsil culture was performed and Candida albicans was reported. The result from the fine-needle aspiration of neck mass demonstrated metastatic squamous cell carcinoma. Subsequently, the punch biopsy of right tonsil was performed. The histopathological result revealed tumour cells with high nuclear-cytoplasmic ratio infiltrating in the stroma and intermixed with proliferative fungus [Figure 2]. Poorly differentiated squamous cell carcinoma of the tonsil with candidiasis was confirmed. A contrast-enhanced computed tomography scan of the neck revealed no apparent enhancing lesion in the tonsillar region and an enlarged necrotic level II lymph node measured at 2.5 cm×1.6 cm in the right side of neck. No distant metastasis was found. The patient received concurrent chemoradiotherapy and no recurrence was found at three year follow up after treatment.
Figure 1: Endoscopic view of oropharynx showing pseudomembrane coating over right tonsil.

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Figure 2: (A) Photomicrograph of haematoxylin and eosin-stained section of punch biopsy of right tonsil showing carcinoma cells with focal necrosis and Candida pseudo-hyphae (arrow) (×200). (B) Periodic acid-Schiff-stained section highlighting fungal spores and hyphae (arrow) (×400). (C) Gomori methenamine silver-stained section showing fungal spores and hyphae (arrow) (×400).

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Patients with head and neck malignancies are predisposed to suffer from oropharyngeal candidiasis because of the impairment of host defence mechanism resulting from radiation therapy and chemotherapy; however, the first manifestation as Candida infection in a tumour site is uncommon. In this case, oropharyngeal candidiasis was related to the suppression of local immunity by tonsillar carcinoma. In addition, tonsillar candidiasis without a predominant ulceration or mass in the affected tonsil may be a negative factor to early recognition of tonsillar malignancy.

Conflicts of Interest: None.




    Figures

  [Figure 1], [Figure 2]



 

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