Pediatric Tonsillar Malignancies: Misleading Presentations

Objective: To review a case series of pediatric patients with tonsillar malignancy presenting with symptoms similar to peritonsillar infection. Methods: We performed a chart review of patients presenting to the emergency department in 2008 with CT imaging who were diagnosed with tonsillar malignancy by otolaryngology after initial diagnosis of peritonsillar cellulitis or abscess by the emergency department. CT and MRI imaging were independently reviewed by two pediatric radiology fellows. Charts were reviewed for five years following initial diagnosis to identify evidence of recurrence. Results: Three patients, who presented with unilateral tonsillar enlargement without fevers, dysphagia, or trismus, were initially diagnosed with peritonsillar cellulitis. Imaging studies were inconsistent with an infectious process, leading to further investigation and a final diagnosis of tonsillar malignancy. Urgent treatment precipitated recurrence-free survival in all 3 patients. Conclusion: Appropriate imaging and careful evaluation aided in differentiating malignancy from an infections process and facilitated rapid diagnosis and institution of treatment. High index of suspicion for tonsillar malignancy is necessary for pediatric patients presenting with unilateral tonsil hypertrophy without cardinal symptoms of infection.