Aim and objective: To report a case of multiple epidermoid cysts of the tonsil with actinomycosis in a 56-year-old female patient who presented with discomfort in the throat.
Background: The Actinomyces spp. are common saprophytic microorganisms, which are found in the oral cavity, pharynx, and palatine tonsils. The actinomycotic infections can be responsible for recurrent chronic tonsillitis. Epidermoid cysts are benign lesions that can be encountered anywhere in the body, usually seen in neck, chest, or trunk.
Case description: This study reports a case of multiple epidermoid cysts of the tonsil with actinomycosis in a 56-year-old female patient presented to our ENT outpatient department with discomfort in the throat and presence of a few whitish masses over her right tonsil, which was her major concern. She underwent a tonsillectomy followed by a course of antibiotic for 3 weeks; the diagnosis was confirmed by histology.
Conclusion: Though tonsillitis is the commonest lesion diagnosed in all age groups, histopathology plays an important role in diagnosis of various other non-neoplastic and neoplastic lesions of tonsil. There might be existence of two separate clinical entities in a single case, one being the causative factor of another.
Clinical significance: Our results indicate that actinomycetes may play an active role in the etiology of the epidermoid cyst of the tonsillar tissue. The clinical importance of recognizing this organism lies in the fact that definitive treatment requires a long course of penicillin group antibiotics even after surgical excision. To the best of our knowledge, this is the first case report in the English-indexed literature.
Priyadarshini SA, Shubhashree AR, Ganapathy H. Actinomycosis of tonsils-incidental or pathological?—A case report. Int J Pharm Bio Sci 2014;5(4):164–168.
Shobha K, Kumar H, Raj D, et al. Epidermoid cyst in tonsil: a rare presentation. Transw Med J 2014;2(1):75–76.
Kini YK, Kharkar VR, Rudagi BM, et al. An unusual occurrence of epidermoid cyst in the buccal mucosa: a case report with review of literature. J Maxillofac Oral Surg 2013;12(1):90–93. DOI: 10.1007/s12663-011-0188-y.
Shivakumar MS, Yogesh TL, Nagaraj T, et al. Epidermal inclusion cyst of buccal mucosa: a rare case report. Int J Med Dent Case Rep 2015. 050115.
Gulia SP, Lavanya M, Kamidi V, et al. Epidermoid cyst of the tonsil: an incidental finding. Int J Adv Case Rep 2015;2:777–779.
Macnamara M. Acute and chronic pharyngeal infections. In: Gleeson M, ed. Scott-Brown's Otorhinolaryngology. 7th ed., Hodder Arnold; 2008. pp. 1981–2025.
Dejan R, Aleksandar P, Biserka VD. A case of an unilateral tonsillar hypertrophy caused by actinomycosis. Acta Medica (Hradec Králové) 2010;53(1):31–33.
Kwartler JA, Limaye A. Pathologic quiz case 1. Cervicofacial actinomycosis. Arch Otolaryngol Head Neck Surg 1989;115(4):524–527. DOI: 10.1001/archotol.1989.01860280122032.
Mohanty S. Actinomycosis of faucial tonsil masquerading as oropharyngeal malignancy. Indian J Otolaryngol Head Neck Surg 2006;58(1):82–84.
van Lierop AC, Prescott CA, Sinclair-Smith CC. An investigation of the significance of actinomycosis in tonsil disease. Int J Pediatr Otorhinolaryngol 2007;71(12):1883–1888. DOI: 10.1016/j.ijporl.2007.08.021.
Aydin A, Erkiliç S, Bayazit YA, et al. Relation between actinomycosis and histopathological and clinical features of the palatine tonsils: a comparative study between adult and pediatric patients. Rev Laryngol Otol Rhinol (Bord) 2005;126(2):95–98.
Mammen S, Korulla A, Paul MJ. An epidermal cyst in the floor of the mouth: a rare presentation. J Clin Diagn Res 2013;7(2):381–382. DOI: 10.7860/JCDR/2013/4165.2776.
Ikeda I, Ono T. Basal cell carcinoma originating from an epidermoid cyst. J Dermatol 1990;17(10):643–646. DOI: 10.1111/j.1346-8138.1990.tb01709.x.
López-Ríos F, Rodríguez-Peralto JL, Castaño E, et al. Squamous cell carcinoma arising in a cutaneous epidermal cyst: case report and literature review. Am J Dermatopathol 1999;21(2):174–177. DOI: 10.1097/00000372-199904000-00012.
Devine JC, Jones DC. Carcinomatous transformation of a sublingual dermoid cyst. A case report. Int J Oral Maxillofac Surg 2000;29(2):126–127. DOI: 10.1016/S0901-5027(00)80009-0.