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ABSTRACT

Background: Despite being a relatively common condition, acute suppurative tonsillitis may be sometimes confused with other tonsillar disorders, including the equally common tonsillar detritus accumulation connected with halitosis or the less common tonsillar keratin cyst.

Aim: The purpose of this paper was to demonstrate the differences in gross and microscopic presentation between suppurative tonsillitis, tonsillar detritus accumulation, and tonsillar keratin cysts.

Material and methods. We documented these conditions photographically and conducted microscopic evaluations of the following samples: 1) tonsillar surface swab from 3 patients with suppurative tonsillitis, 2) detritus from tonsillar crypts in 8 patients, and 3) tonsillar keratin cyst contents extracted via cyst incision and drainage in a 63-year-old woman and 18-year-old man. Two patients had both acute suppurative tonsillitis and tonsillar detritus accumulation.

Results and discussion. In the case of acute suppurative tonsillitis, the surface of tissues with bacterial colonies is covered by a profuse exudate containing necrotic tissue and numerous neutrophils. In contrast, a microscopic examination of tonsillar detritus reveals necrotic homogeneous discharge, typically without any clear cells but with visible bacterial colonies which do not induce an inflammatory response. Tonsillar keratin cyst contents demonstrated the presence of superficial squamous epithelial cells and mononuclear inflammatory cells.  

Conclusions. Gross and microscopic assessments may reveal significant differences between suppurative tonsillitis, detritus accumulation in tonsillar crypts, and tonsillar keratin cysts, all of which require different treatment methods.