Tonsillar and Adenoid Noncaseating, Epithelioid Granulomas in a Young Girl

Waldeyer's lymphatic ring granulomas in children are infrequent, and may represent an underlying systemic disease, often nondiagnosed before adenotonsillectomy is performed. The authors report on a 5-year-old otherwise healthy girl presented with remarkable tonsillar asymmetry as well as adenoid hypertrophy, with no systemic signs or complaints. Adenotonsillectomy was performed to rule out malignancy. Blood workup was normal. Microscopy of both adenoidectomy and tonsillectomy specimens showed multiple foci of epithelioid, noncaseating granulomas with giant multinucleated cells surrounded by nonspecific chronic inflammation. Immunostainings for B-cell markers, Ki-67, and Ziehl-Neelson were negative. This unusual pathology raised a differential diagnosis which included inflammatory diseases (sarcoidosis, Crohn's disease), foreign body reaction, lymphoma and infections (tuberculosis, fungi). However, none of these entities could be attributed to the girl's condition, and the reason for her pathologic findings remained unknown.