Is Routine Histopathology After Tonsillectomy Necessary? A Retrospective Study of Pediatric and Adult Populations

Abstract

Tonsillectomy is one of the most common surgical interventions in otolaryngology; however, the necessity of routine histopathological examination remains controversial. This retrospective cross-sectional study included 160 tonsillectomy specimens from 80 patients who underwent surgery between January 2024 and December 2025 at Al-Bayda Medical Center, Libya. Demographic and clinical variables were analyzed and correlated with histopathological results. The majority of patients were in the pediatric age group (75%), in whom reactive lymphoid hyperplasia was the predominant finding (98.3%), with no malignancies detected. In contrast, adult patients demonstrated a higher incidence of significant pathological findings, including non-Hodgkin lymphoma (10%) and squamous cell carcinoma (15%), particularly among individuals with risk factors such as heavy tobacco smoking. These findings highlight a clear distinction between pediatric and adult populations. Routine histopathological examination may not be necessary in low-risk pediatric cases; however, it remains valuable in adult and high-risk patients for early detection of occult malignancies. A selective, risk-based approach is recommended to optimize clinical outcomes and resource utilization.