Illoncaseating granulomatous lesions of the tonsil are uncommon. Arriving at a specific diagnosis depends on the clinical history, characteristic histologic appearance, and supportive laboratory, radiologic, and skin testing. Sarcoidosis is a chronic multisystem disease characterized by noncaseatmg granuloma formation. It has been reported to involve the tonsil and should be considered in the differential of tonsillar masses. Exclusion of tubercular, fungal, and neoplastic processes is critical. We present a patient in whom sarcoid involvement of the tonsil initially m a s q u e r a d e d as a malignancy.
CASE REPORTA 78-year-old black man was referred to the otolaryngology clinic with a several-week history of throat pain and a left neck mass unresponsive to antibiotics. The patient also reported weight loss and severe dysphagia. He had no history of alcohol or tobacco use, and his past medical history was unremarkable. Examination revealed prominent left tonsillar fullness accompanied by a nontender, firm, 6-cm left jugulodigastric node. The white blood cell count was 2.4 thousand cells/mmL The remainder of his hematology and chemistry panels were normal, including calcium and liver function test results. Chest x ray was normal.A computed tomogram was obtained and reveated a large submucosal, infiltrative mass in the tonsil extending inferiorly to the supraglottic region, with massive cervical adenopathy (Fig. 1). Fine-needle aspiration biopsy specimens of the left neck mass were nondiagnostic. A panendoscopy was performed, which confirmed the presence of