Tonsillolith. Case report and review of the literature

Large oropharyngeal concretions--giant tonsillolith--are not very common. Over the last few years only some 50 cases have been reported in the literature. Many tonsilloliths, especially small concretions, are asymptomatic; large concretions, on the contrary, may produce several symptoms. The case is described of a 56-year-old female complaining of dysphagia, odynophagia, sore throat, right otalgia and swelling in right tonsillar fossa. Routine panoramic radiography revealed a radio-opaque area in right tonsil region. Computed tomography of oropharynx was performed and axial slices revealed a calcified cylindrical lesion in posterior pharyngeal region, between palatoglossus and palatopharyngeus muscles. The tonsillolith was easily excised under local anaesthesia. The post-operative course was good with no recurrence. Microscopic examination of the specimen revealed necrotic debris, "ghost" cells, calcifications and inflammatory cells, confirming the diagnosis of tonsillolith. Authors stress that large tonsillar concretions are uncommon, and may be difficult to diagnose since the tonsillolith can also be mistaken for other anatomic and pathologic structures in the oropharyngeal area.