Infections (Sore Throat)
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The oropharynx is a common site of viral and
bacterial infections (sore throat).
Enlargement of the palatine tonsils as a result of inflammation is common.
The mucosa-associated lymphoid tissue around the pharynx (Waldeyer's ring)
the palatine tonsils (tonsils), the nasopharyngeal tonsil (adenoids), and the
tissue in the sub-mucosal region of the posterior third of the tongue (lingual
As part of the immune system, the lymphoid tissue in these areas reacts to
or infection in the region by undergoing lymphoid hyperplasia. The changes are
seen in the prominent palatine tonsils; reactive lymphoid hyperplasia is the
common cause of tonsillar enlargement, particularly in children and juveniles,
as a response to a viral or bacterial pharyngitis.
Acute tonsillitis usually occurs as a component of a widespread acute bacterial
pharyngitis, usually due to a-haemolytic streptococci. The tonsils are swollen.
red due to mucosal hyperaemia, and partly covered by creamy acute inflammatory
parenchymatous tonsillitis). Sometimes there are scattered, creamy yellow spots
on the surface
(acute follicular tonsillitis) due to beads of pus extruding from the mouths of
epithelial-lined crypts. Acute streptococcal pharyngitis and tonsillitis may be
the development of a peritonsillar abscess (quinsy) or, rarely, by spreading
in the neck (Ludwig's angina) or retropharyngeal abscess formation. Acute
may also be a component of a severe viral pharyngitis, e.g. in glandular fever
In adults the tonsils usually become progressively smaller as the lymphoid
However, in some cases the lymphoid element remains prominent, in association
crypts distended with keratin, in which numerous bacterial colonies
species) are seen. This is sometimes called chronic tonsillitis, although the
are considered to be commensals.
Tumours of the tonsil are usually squamous cell carcinoma or malignant lymphoma
Benign tumours of the tonsil are very rare, and most tumours are malignant.
papillomas of the tonsillar region are mainly benign viral overgrowths, and
occur on the
faucial pillars rather than on the tonsil.
Squamous cell carcinoma presents as a mass or an ulcer with raised edges,
in elderly men. The tumour invades the tongue and fauces, and lymphatic spread
nodes occurs early. Often, late presentation means that local and lymph node
advanced, and complete surgical removal is impossible.
Lymphomas of the tonsil are nearly always non-Hodgkin's lymphomas. Most are
which can occur in children and young adults; a smaller number are low-grade
lesions , which tend
to occur in elderly patients. Sometimes there is associated lymphoma in the rest
ring or in the gastrointestinal tract .
Lymphoma of the tonsil has a better prognosis than squamous carcinoma because of
response to chemotherapy.
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