Unilateral Tonsillar Enlargement: Is Tonsillectomy Always a Choice?

Introduction: It is known that unilateral tonsillar enlargement can be associated with malignancy. Among children, lymphoma is the most frequent malignant tumor in the head and neck. Frequently, the disease is shown by alterations in the appearance and/or size of tonsils. Objectives: This study aims to report a case of unilateral tonsillar enlargement with appearance alterations. Resumed Report: An 11-year-old patient (F.A.R.), previously healthy, without history of weight loss or fever. Major complains were recurrent tonsillitis, snoring, and mouth breathing, which worsened in the past 2 years. Concomitant with the symptoms, the mother of the child noticed slow enlargement of the right tonsil. The physical examination showed tonsil hypertrophy and asymmetry (right: grade 4; left: grade 3) with a verrucous aspect of the mucosa from the right tonsil and 70% obstructive adenoid seen through nasofibroscopy. It was performed adenotonsillectomy with histopathological analysis that concluded: right tonsil: 5.0 × 3.5 × 2.0 cm, coated with brownish mucosal invaginations, fibroelastic consistency, exuberant reactive lymphoid hyperplasia, and mild superficial mixed inflammation, with several granules of Actinomyces species; left tonsil: 3.0 × 2.0 × 1.0 cm, coated with brownish mucosal invaginations, fibroelastic consistency, reactive lymphoid hyperplasia, and mild superficial mixed inflammation; adenoid: 1.8 × 1.0 × 0.7 cm, multiple fragments of whitish color, soft consistency, and reactive lymphoid hyperplasia. Conclusion: Isolated alterations in appearance and size of tonsils may justify investigation even in asymptomatic children. It should be considered that many diseases such as lymphoma may not express significant clinical features and the tonsillectomy is a simple procedure considering the benefits of an early diagnosis.