A Suspected Case of Occupationally Caused Multiple Tonsillolith.

We recently examined a 59-year-old male patient with microscopically confirmed multiple tonsillolith. The patient, complaining of abnormal sensations in the throat, first visited a nearby clinic where he was diagnosed with chronic tonsillitis and tonsillolith in the left tonsil. Following this diagnosis, the patient was referred to our hospital. During his 20s and 30s the patient had been occupationally engaged in the development of fluorescent materials for electroluminescence, and of photoconductive cells using cadmium sulfide. Between 1958 and 1965, the patient had frequent exposure to cadmium sulfide.Upon first examination, a black mass, which was ulcerated through the upper pole of the left tonsil, was observed, and bilateral tonsillectomy was subsequently performed under general anesthesia. During surgery, adhesion of the tonsillar capsule and peritonsillar tissue was observed in each side. The resected tonsils contained many small tonsilloliths, centered on the crypta of the upper pole. The tonsilloliths were dark brown and were spherical in shape with small spikes. They were located within or near the crypta, and their diameters were less than 3mm. The total number of tonsilloliths was 67. The pathohistological diagnosis was chronic tonsillitis. Chemical analysis of the stones showed they consisted of calcium phosphate. Elemental analysis using an energy dispersive X-ray microanalyzer revealed they contained not only calcium and phosphate, but also quite a large volume of sulfur. Because the patient had handled cadmium sulfide for a long time, ICP emission spectral analysis and atomic absorption analysis were conducted, but cadmium was not detected. Abnormal sensations in the throat disappeared after the surgery, and the patient has been well since then. While the cause of tonsilloliths in this patient is unknown, we presume his previous occupational exposure to cadmium sulfide may be related to disease development.