Hello Doctor, I Found 3 Months Ago White Spots On

Posted on Wed, 30 Oct 2019

Question: Hello doctor, I found 3 months ago white spots on left tonsil as I described as ??? with blue arrows on photos. Week ago I went to ENT doctor, he didn't see anything on first look, after moving tongue out, he said after a long time vs. leukoplakia on the upper half of left tonsil, and send me to hospital for biopsy. In hospital after 1 hour looking into my throat and tonsils doc said she can't see anything no leukoplakia, but because I have left tonsil larger, she send me to chief of ENT on duty and he made quick excision of medial side of tonsil as you can see in photo. Its 2 days ago, so I don't have histology yet. But what the white spots, I made a photo 1 hour ago, clearly visible. Its normal mucosa and docs thoughts, that I think something different, which is now gone to histology? So what are the white spots? Thank you very much

Answered by Dr. Dr. Rajat Basak (2 hours later)

Brief Answer:
Hii. White patch in the tonsil can be keratosis or tonsillolith. It may be

Detailed Answer:
Hii. White patch in the tonsil can be keratosis or tonsillolith. It may be due to any infection bacterial fungal or any granulomatous infection. Is the white spot is recurrent in nature? Is it disappears in between or is it can be peeled off?
Keratosis is due to chronic inflammation of the tonsilar tissue. Tonsillolith is due to tonsillar stone due to accumulated secretion. You can start betadine gargle as if for now. Wait for the biopsy report. If the biopsy report is normal then you don't need to worry. If the biopsy report came to some infection whether bacterial or fungal you need to send a swab for culture in the laboratory. If it is any tumour then you should remove the whole length and sent for biopsy. So wait for biopsy report.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dr. Rajat Basak (3 hours later)

Hello, I am sending it one more with zoomed white lession. It's the same minimum 3 months (from time I know about it). Cant be scratched off and there is nothing to scratch, it looks like in one line with normal mucosa. When touch it, it will go from white to red little bit. Maybe with very very little bloody swab after touching. I don't understand how docs in hospital cant see it. And how can be biopsy from place cca 2.5 cm distant from this lession representative? You said it can be tonsilolith/infection. Can it be squamous cell carcinoma? Or any form of precancerous dysplasia? Why I don't need other biopsy from this place? Thank for replying to all my questions. ZdenÄk

Answered by Dr. Dr. Rajat Basak (10 minutes later)

Brief Answer:
Hii. I think continue the betadine gargle for another 1-2 week. If you are

Detailed Answer:
Hii. I think continue the betadine gargle for another 1-2 week. If you are suspicious of that white spot you can have full tonsillectomy and sent for biopsy. But the decision need to be taken by doctor who will be seeing you. Sometimes it is nothing but crypts in the tonsils which is very normal. If you magnify it it may appear like spot. So your ent surgeon needs to decide and not us and if you are too much suspicious you can get your tonsils removed and sent for biopsy.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Dr. Rajat Basak (25 minutes later)

You send me in both answers different opinions about biopsies. In 1st, you can be ok, in 2nd another biopsy or total tonsillectomy. If you anytime saw cancer of tonsil, does this white patch looks like cancer/ dysplasia or does it look as crypts/infection/keratosis/tonsilolith. I paid a lot money for consultation with you, so if I ask, don't tell me my doctor will decide... because she and he didn't saw it...You can see white patch clearly from photo, it's there 3 months, don't think 2 weeks of Betadine will help. Just want to know your opinion...

Answered by Dr. Dr. Rajat Basak (7 hours later)

Brief Answer:
Hii. As I told you before white patch in tonsil can be of infective cause o

Detailed Answer:
Hii. As I told you before white patch in tonsil can be of infective cause or keratosis or tonsillolith or aNy premalignant lesion. Continue betadine gargle for 2 week. If it doesn't resolve then you send a throat swab for culture and sensitivity from the patch. It it comes normal then you consult your surgeon regarding tonsillectomy and send it and the white patch for biopsy.

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Yogesh D