Acute Lymphoblastic Lymphoma

One of the red flags of tonsillitis is asymmetry.¹ This 27-year-old US Army soldier presented with his right tonsil markedly enlarged compared with the left one. In addition, the posterior cervical chain of lymph nodes was also swollen.

The complete blood cell count was essentially normal. Chest and abdominal CT scans were unremarkable except for one or two reactive mediastinal lymph nodes.

The patient was referred to an otolaryngologist, and he underwent a tonsillectomy. Subsequent pathology studies confirmed the diagnosis of acute lymphoblastic lymphoma with bone marrow involvement. The patient is currently undergoing chemotherapy. 

REFERENCE:

1. Beaty MM, Funk GF, Karnell LH, et al. Risk factors for malignancy in adult tonsils. Head Neck. 1998;20(5):399-403.