Tonsillar lymphangioma with adipose and smooth muscle proliferation: a case report

BACKGROUND: Lymphangiomatous lesions commonly occur in the head and neck region; however, involvement of the palatine tonsil is rare. Tonsillar lymphangiomatous polyps containing both adipose tissue and smooth muscle proliferation are exceptionally uncommon. We report a rare case of tonsillar lymphangioma with adipose tissue and focal smooth muscle proliferation. CASE PRESENTATION: A 28-year-old Iranian man presented with sore throat and was found to have a pedunculated mass arising from the right palatine tonsil. Physical examination revealed a smooth-surfaced, non-ulcerated polypoid lesion measuring 2 × 1 × 0.3 cm. Owing to the small size and clinically benign appearance of the lesion, no preoperative imaging was performed. Right-sided tonsillectomy was undertaken. Histopathologic examination demonstrated a lymphangiomatous polyp (lymphangioma) composed of dilated lymphatic channels within a fibroadipose stroma with focal smooth muscle proliferation. The lesion was completely excised with negative surgical margins. No recurrence was observed during 1 year of follow-up. CONCLUSIONS: Tonsillar lymphangiomatous lesions are rare benign entities that may clinically mimic other tonsillar masses. Histopathologic examination is essential for definitive diagnosis. Complete surgical excision appears curative, and recurrence is uncommon.