Tonsillar Hypertrophy in Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma: A Mini-Review

Chronic lymphocytic leukemia (CLL) is a prevalent adult B-cell malignancy that primarily affects individuals over the age of 65. It is characterized by the accumulation of mature B lymphocytes in the blood and bone marrow, whereas small lymphocytic lymphoma (SLL) primarily involves the lymph nodes and lymphoid tissues, with minimal lymphocytosis in the blood. Both CLL and SLL are recognized as a single entity according to iwCLL guidelines. Tonsillar hypertrophy is a rare presentation of CLL and often an overlooked complication. We searched PubMed, Scopus, Semantic Scholar, and Google Scholar up to November 8, 2025, for patients with CLL or SLL and tonsillar enlargement. We identified 14 published cases of CLL/SLL with tonsillar enlargement. The review aims to highlight clinical features, diagnostic challenges, and outcomes. Most patients presented with dysphagia, airway obstruction, or obstructive sleep apnea. Diagnosis frequently required tonsillectomy, followed by histopathology, flow cytometry, and fluorescence in situ hybridization. Management strategies included observation, tonsillectomy for symptom relief and diagnosis, systemic chemoimmunotherapy, or targeted agents such as BTK inhibitors. Most patients achieved remission or symptom improvement; however, a few cases resulted in death due to rapidly progressive disease. This review highlights the importance of considering CLL in adults with unexplained tonsillar hypertrophy. Prompt biopsy, preferably with tonsillectomy and multidisciplinary evaluation, is essential to distinguish this rare entity from other conditions and to guide timely treatment.