الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
Mal ignant tonsi liar tumours account for about 3%
of malignant tumours of the whole body (Barrs, 1979).
Over 70% of tonsi liar mal ignancies are squamous eel I
carcinoma, of varying degree of histo-differentiation
(batsakis, 1979). Over 15% of tonsi liar mal ignancies
are mal ignant tonsi liar lymphoma (kabadia, 1985). The
so-cal led Iympho-epithel loma accounts for 5% of mal ignant
tonsi liar tumours (Chen, 1975). This term was used
to define a tumour with two components, epithel ial and
lymphoid elements present together, The origin of the
tumour was obscured, whether it arosed from one or the
other (Regaud, 1921 and Schmincke, 1921).
Tonsl liar squamous ce r l carcinoma of undifferentiated
nature and infiltrated with lymphocytes is difficult
or some times impossible to distinguish from
mal ignant lymphoma with the conventional methods even
with ski lied pathologist (Batzakis, 1979 and Micheals, using the electon microscopy, the epithelial
origin of the tumour is confirmed (Svoboda, 1967). We
choose the immunoperoxidase technique as it is simple,
accurate and can be done in ordinary laboratories using
simple Iight microscopy. Using the ~nticytokeratin
(AE1, AE3) we can ident I f ied the presence of ep I the Iia I
cells, as the cytokeratins are intermediate size fi lament
of water insoiuble proteins, which can be produced
by epithelial cell only. The AEI and AE3, constitute a
pool of antlcytokeratin which can be used as a common
antibodies for detection of all types of epithelial
eel Is. To detect lymphocytes, T and B cell we used T200
antibodies to detect the glycoproteins of high
molecuiar weight, which are surface antigens.
In our study, 26 patients were chosen from the out
patients of Cancer Institute, Cairo University, Benha
University Hospital, and Zagazig University Hospital,
and who were proved to suffer from undifferentiated
tonsi liar squamous eel I carcinoma.
Using immunoperoxidase technique with the two pri- mary antibodies, anticytokeratin (AEI and AE3) and T200
(common Ieucocyte ant Igen), the first to Ident ify
epithelial cells, whi Ie the second to detect of lymphocytes.
Using ABC method (Avidin Biotin conjugate method)
on forma lin fixed paraff in embedded sect Ions, the
problem of background staining was solved.
The biopsies were taken using local anaethesia,
then Heamatoxyl in and Eosin was done then the immunolgoic
study was done.
from our studies 80% of quirry undifferential
squamous eel i carcinoma, were proved to be undifferentiated
squamous eel I carcinoma, whi Ie 20% were proved
to be mal ignant lymphoma. Male were predominent, the
ratio of maies to females 5.5:1%.
There was no patients below 30 years, the average
age was 60.5 years, with two peaks 30% between 50-60
years and 40% between 60-70 years.
The heavy smoking i.e. smoking two box of
cigarettes for 15 years or more, was the special habit for 77% of the patients mainly the male ones, whi Ie the
alcohol drlning was 23% of the cases.
The presenting symptoms in our study were lump in
the neck 73%, sore throat in 7.9%, foreign body sensation
in 3.8%, dysphagia in 7.9%, haemoptysis in 3.8%
and referred ear ache in 3.8%.
The presenting signs in our study were exophytic
tonsl ilar mass 80% of cases and 20% in ulcerative type.
The exophytic type was classified into Tl 4.3%, T2
20.1%, T3 55.3% and T4 20.3% whi ie ulcerative type was
divided into Tl 40%, T2 60%.
As for lymph node Involvement 80% of cases have
eli n ica IIY pos i t ive Iymph nodes, ma in Iyin j ugu I0-
digastric lymph nodes. The lymph node involvement was
claisified as Nl 28%, N2 30%, N3 42%.
On applying anticytokeratin (AEI and AE3) on tonsi
liar mal ignant tumours, the epithelial origin tumours
only gives positive results i.e. undifferentiated tons!
liar squamous eel I carcinoma. Also, the more undifferentiated
is the tumour the less positively staining results wi II be obtained, the reaction was focal and
cytoplasmic as the cytokeratins are present in focal
areas in the cytoplasm and not membranous.
On applying the T200 (common leucocyte antigen),
we get positive results, membranous in site due to the
presence of T200 antigens, glycoproteins of high
molecular weight present on the surface of the lymphocytes.
There were no reiation between grading of Iympnoma
and the reaction of staining or the distribution
of staining.
The grading of the epithel ial tonsi liar malignant
tumours can be correlated with the intensity of the
Biologic reaction and its pattern. The more undifferent
ia ted the tumour, the less wi II be the i ntens ity of
the Biologic reaction and more focal is the pattern of
reaction.
The precise diagnosis of undifferentiated tonsi l-
Iar squamous eel I carcinoma from mal ignant tonsi liar
lymphoma helps the surgeons greatly in accurate treatment
whether surgery and/or radiotherapy in cases of carcinoma and chemotherapy and radiotherapy in cases
of lymphomas. Also, the exact diagnosis gives the surgeons
an idea about the expected prognosis and five
years survival rates.