(033) An Unusual Oropharyngeal Mass in an Immunocompromised Patient

Introduction: The findings of tonsillar asymmetry prompts a broad differential including carcinoma or lymphoma, however other common etiologies must not be excluded. This case report illustrates the importance of including benign pathology on the differential, such as tonsillolith, in an oropharyngeal mass. Characteristic findings on physical exam and radiological studies can possibly differentiate benign etiologies from cancer. This could potentially avoid unnecessary patient anxiety, testing and procedures.

Methods: This case report is about a 62 year old male with HIV with no history of tobacco use presented with an asymptomatic oropharyngeal tonsillar mass. On examination, the right tonsil was significantly enlarged and firm to palpation compared to the left tonsil. There was no cervical lymphadenopathy. The patient underwent computed tomography (CT) imaging and tonsillectomy.

Results: CT of the neck revealed a solitary 2.7cm x 1.1cm x 3.4cm right tonsil mass with no surrounding edema or pathologically enlarged lymph nodes (Figure 1). Due to concern for neoplasm, the patient underwent unilateral tonsillectomy. Intraoperatively, a firm intratonsillar calcified mass was revealed with a dimension of 3 cm x 3 cm x 1 cm (Figure 2). Pathological examination of the mass in the tonsil revealed a tonsillolith.

Conclusions: This case illustrates the importance of imaging and intraoral exam in patients with an oropharyngeal mass, especially in immunocompromised patients where there is a high degree of suspicion of neoplasm. On CT, a radiopaque mass in the tonsil region with no associated edema or cervical lymphadenopathy is more suggestive of a benign process such as tonsillolith rather than infection or malignancy. Tonsillectomy should be considered to confirm the diagnosis and symptomatically treat the patient.