Indian Journal of Medical Research

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

Initial presentation of tonsillar carcinoma with candidiasis


Cheng-Ping Shih1, Wen-Chiuan Tsai2,  
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

Correspondence Address:
Cheng-Ping Shih
Department of Otolaryngology-Head & Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
R.O.C




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


How to cite this URL:
Shih CP, Tsai WC. Initial presentation of tonsillar carcinoma with candidiasis. Indian J Med Res [serial online] 2019 [cited 2020 Sep 25 ];149:80-80
Available from: http://www.ijmr.org.in/text.asp?2019/149/1/80/256699


Full Text

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}{Figure 2}

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.