UNILATERAL TONSIL ENLARGEMENT MIMICKING MALIGNANCY: A CASE REPORT
DOI:
https://doi.org/10.46799/jhs.v6i3.2143Keywords:
unilateral tonsil enlargement, tonsil hypertrophy, tonsil asymmetry, tonsillectomyAbstract
Unilateral Tonsil Enlargement (UTE) can present clinically as a significant challenge in differentiation between benign and malignant processes. The suspicion of malignancy increases in older patients who are symptomatic. The purpose of this study was to show that unilateral tonsillar hypertrophy does not always indicate malignancy. A 51-year-old woman presented with a recurring sore throat, but it has been persistent for the past 1 month. A globus sensation accompanied the complaint. On Ear, Nose, and Throat (ENT) examination, the right tonsil grade was T2 and the left tonsil was T4, hyperemic, with dilated crypts. The patient was referred before with a working diagnosis of unilateral tonsil hypertrophy suspect malignancies, with a planned tracheostomy. The literature search was conducted on PubMed, Cochrane, Scopus using keywords “unilateral tonsil enlargement” and “tonsil hypertrophy” and “tonsil asymmetry” in the last 10 years. Based on the investigation, it was found that tonsillectomy for asymptomatic Unilateral Tonsil Enlargement does not need to be performed immediately. Given that the occurrence of malignancy in asymmetrical tonsils is minimal in the absence of additional risk factors, a period of watchful waiting may be deemed appropriate before considering any surgical intervention. It is recommended to observe for four weeks.
References
Akgül, G., Cingi, C., & Sarafoleanu, C. (2023). Tonsillar Hypertrophy. In Airway Diseases (pp. 2311–2324). Springer.
Arambula, A., Brown, J. R., & Neff, L. (2021). Anatomy and physiology of the palatine tonsils, adenoids, and lingual tonsils. World Journal of Otorhinolaryngology-Head and Neck Surgery, 7(03), 155–160.
Bajpai, S., Zhang, N., & Lott, D. G. (2021). Tracking changes in age distribution of head and neck cancer in the United States from 1975 to2016. Clinical Otolaryngology, 46(6), 1205–1212.
Bowers, L. M., Vissink, A., & Brennan, M. T. (2021). Salivary gland diseases. Burket’s Oral Medicine, 281–347.
Campbell, E., McLaren, O., Sheldon, A., Rock, B., Bracey, T. S., Malik, T., & Reddy, V. M. (2024). A two-centre experience of tonsil biopsies in the investigation of patients with tonsillar asymmetry. The Annals of The Royal College of Surgeons of England, 106(1), 41–44.
Faraji, N., Pourbahram, R., Goli, R., Parvaresh, B., Alidoust, H., & Dastgerdi, M. E. (2024). A simple sore can lead to limb amputation; metastatic squamous cell carcinoma of the sole in a 22-year-old man. International Journal of Surgery Case Reports, 124, 110378.
Fleming, J. C., & Hackman, T. G. (2024). Standard Tonsillectomy. In Atlas of Head and Neck Surgery (pp. 321–328). Springer.
Kulali, F., Semiz-Oysu, A., & Aygun, N. (2023). Imaging of the Oral Cavity and the Oropharynx. In Airway Diseases (pp. 189–219). Springer.
Kynaston, J., Drever, S., & Shakeel, M. (2021). Unilateral tonsillar swelling: role and urgency of tonsillectomy. J Otolaryngol ENT Res, 13(1), 10–11.
Leu, G. R., Links, A. R., Ryan, M. A., Walsh, J. M., Tunkel, D. E., Beach, M. C., & Boss, E. F. (2021). Assessment of parental choice predisposition for tonsillectomy in children. JAMA Otolaryngology–Head & Neck Surgery, 147(3), 263–270.
Milinis, K., Hampton, T., Lau, A. S., & Sharma, S. D. (2025). Oxford Case Histories in Otolaryngology and Head and Neck Surgery. Oxford University Press.
Patel, S. D., Daher, G. S., Engle, L., Zhu, J., & Slonimsky, G. (2022). Adult tonsillectomy: An evaluation of indications and complications. American Journal of Otolaryngology, 43(3), 103403.
Tan, E. T., Simpson, L., Braggins, R., & Edafe, O. (2025). Evaluation of the Management of Asymptomatic Unilateral Tonsillar Enlargement—Can We Avoid Diagnostic Surgery? Clinical Otolaryngology, 50(1), 137–142.
Tan, Y. H., & Hishammuddin, N. H. A. N. (2022). A Rare Cause of Unilateral Tonsillar Enlargement.
Thomas, R., Kelemen, N., Molena, E., & Lester, S. (2024). Indications for oropharyngeal biopsy in head and neck squamous cell carcinoma of unknown primary: A systematic review (HNSCCUP). Clinical Otolaryngology, 49(5), 552–566.
Vaddi, A., Renapurkar, S., & Khurana, S. (2023a). Benign and malignant tumors of the tonsils. In Tonsils and Adenoids. IntechOpen.
Vaddi, A., Renapurkar, S., & Khurana, S. (2023b). Benign and malignant tumors of the tonsils. In Tonsils and Adenoids. IntechOpen.
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