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Tonsillar Hypertrophy in Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma: A Mini-Review
Rafal Al-Shibly1, Elrazi A Ali2, Nabeel M Qasem1
1Internal Medicine, Hamad Medical Corporation, Doha, QAT.
Insights
Tonsillar hypertrophy is a rare presentation of chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL). Early diagnosis via tonsillectomy and multidisciplinary evaluation is crucial for effective management and improved outcomes in these patients.
Area of Science:
- Hematology
- Oncology
- Otorhinolaryngology
Background:
- Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are B-cell malignancies, often affecting older adults.
- Tonsillar hypertrophy is an uncommon yet significant presentation of CLL/SLL.
- This presentation can mimic other conditions, leading to diagnostic challenges.
Purpose of the Study:
- To review the clinical features, diagnostic challenges, and outcomes of CLL/SLL presenting with tonsillar enlargement.
- To emphasize the importance of considering CLL/SLL in adults with unexplained tonsillar hypertrophy.
Main Methods:
- Systematic literature search of PubMed, Scopus, Semantic Scholar, and Google Scholar up to November 8, 2025.
- Identification and analysis of published cases of CLL/SLL with tonsillar enlargement.
- Review of clinical presentation, diagnostic workup, and management strategies.
Main Results:
- 14 cases of CLL/SLL with tonsillar enlargement were identified.
- Common symptoms included dysphagia, airway obstruction, and obstructive sleep apnea.
- Diagnosis often required tonsillectomy with subsequent histopathology, flow cytometry, and FISH.
- Management varied from observation to chemoimmunotherapy and targeted agents (e.g., BTK inhibitors).
- Most patients achieved remission or symptom improvement, but some succumbed to rapidly progressive disease.
Conclusions:
- Unexplained tonsillar hypertrophy in adults warrants consideration for CLL/SLL.
- Prompt tonsillectomy for biopsy and diagnosis, alongside multidisciplinary evaluation, is essential.
- Timely diagnosis and appropriate treatment can lead to favorable outcomes, though aggressive disease remains a risk.
Abstract:
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.
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