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Clinical Challenge
March 2017

A Young Man With Enlarging Unilateral Tonsil Mass

Author Affiliations
  • 1Department of Otolaryngology, University at Buffalo, Buffalo, New York
  • 2Department of Pathology, University at Buffalo, Buffalo, New York
  • 3Pediatric Ear, Nose, and Throat Associates, Amherst, New York
JAMA Otolaryngol Head Neck Surg. 2017;143(3):309-310. doi:10.1001/jamaoto.2016.2472

A young man in his late teens presented to a pediatric otolaryngologist for evaluation of enlarged tonsils and recurrent tonsillitis. The patient reported 2 episodes of streptococcal tonsillitis and infectious mononucleosis over the past 8 months, as well as frequent throat soreness and associated difficulty swallowing throughout the past year. Results from a review of systems were negative for weight loss, fevers, and malaise. On physical examination, he appeared well and had 2+ cryptic tonsils. A lobular mass was noted to be extending from the inferior pole of the right tonsil. There was no cervical lymphadenopathy. The patient was scheduled for tonsillectomy for recurrent tonsillitis and tonsillar asymmetry. His surgery was delayed for several months to accommodate his college schedule. In the operating room, the tonsils were noted to be 3+ bilaterally. The right tonsil had a smooth, pedunculated, flesh-colored mass extending inferiorly. The mass had enlarged since the prior examination. Both tonsils were removed without complication. The right tonsil with the attached mass was submitted to the pathology service fresh to allow evaluation by flow cytometry. Flow cytometry revealed no lymphoid abnormality. Grossly, the polypoid oval mass measured 2 × 1 × 1 cm, weighed 8.7 g, and had a narrow 0.4-cm-long stalk connecting it to the tonsil (Figure, A). Histologic sections revealed a polypoid structure composed of a fibrovascular core covered by stratified squamous epithelium (Figure, B). A subepithelial band of lymphoid tissue was noted (Figure, C) as well as lymphatic channels accentuated by D2-40 antibody (Figure, D). No cellular atypia was identified.

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