A Large Tonsillar Mass in a Healthy Teenager
Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME
JAMA Otolaryngology–Head & Neck Surgery
March 1, 2019
Clinical Challenge
Article Information and Disclosures
Khalil K. Rahman, BS1; Lawrence Kashat, MD, MSc2; Todd E. Falcone, MD2 Author Affiliations Read article on JAMA Network
MOC/CME Information

Read Case Take Quiz Answer
A previously healthy 18-year-old woman presented with a growth in the right oropharynx of 4 months’ duration. At the time of presentation, it had begun to cause changes in her voice, globus sensation, and dysphagia. The patient reported a 20-pound weight loss over the prior 3 months and decreased appetite. She denied any associated difficulty breathing, pain, fever, chills, rash, or night sweats. She was a nonsmoker and nondrinker.

On examination, she appeared well. Despite a muffled voice, she was not in respiratory distress. Fiberoptic laryngoscopy revealed a large, partially obstructing mass in the right oropharynx protruding from the right tonsil. It descended inferiorly and was partially compressing the epiglottis. The true and false vocal cords, although partially obstructed, appeared normal and mobile. The lesion was without ulceration, exudate, or erythema. The contralateral tonsil was small and normal in appearance. The remainder of her physical examination findings were unremarkable, including no neck masses.