Unusual Site for a White Nodule on the Palatine Tonsil
A 20-year-old woman visited the oral medicine clinic for evaluation of a nine-month history of a painless, white lesion at the back of the mouth. She believed that the lesion started as a pinhead size and then grew in size over time until it reached the present size. She did not recall any trauma or surgery in the area of the white patch. Her medical and dental histories were noncontributory. She denied taking any over-the-counter or prescribed medications, such as antibiotics or steroids. In addition, genetic problems, family medical history, and social history were unremarkable. Furthermore, the lesion was worrisome, which had a negative impact on daily life. Extraoral clinical examination was not significant. Routine laboratory blood test results were normal. The patient denied a history of fever, fatigue, body rashes, stuffy nose, headache, earaches, stiff neck, hoarseness, sore throat, coughing, sneezing, difficulty chewing or swallowing, halitosis, lymphadenopathy, and difficulty breathing. She also denied having hemoptysis and an unexplained weight loss in the last few weeks. Intraoral inspection revealed a 0.5?cm, asymptomatic, light yellow-white hued, smooth, raised, soft on palpation, movable, well-circumscribed, unilateral, localized submucosal nodule, exhibiting no exudate arising from the normal-sized left palatine tonsil. Radiographic interpretation of orthopantomography showed normal anatomical structures and no signs of radiopacities in the left palatine tonsil region.

The differential diagnoses of the white lesion on the palatine tonsil, in this reported case, included tonsillar cyst, tonsilloliths, tonsillitis, papilloma, lipoma, strep throat, infectious mononucleosis, oropharyngeal candidiasis, and peritonsillar abscess.

In this case, the distinct clinical appearance, features, and clinical examination highly indicated a LEC. The patient was assured that the clinical appearance of the white lump in the tonsil was highly associated with the diagnosis of a benign nodule called an oral lymphoepithelial cyst. She was also provided with information regarding the possible treatment options and associated outcomes.

The ideal management for the white lesion on the palatine tonsil is to excise the lesion along with the whole tonsil. Therefore, an oral medicine specialist recommended performing a left palatine tonsillectomy. However, the surgical procedure of the affected palatine tonsil was not an option from the patient's side. Notably, the patient was anxious and worried about the surgical procedure and its consequences. Therefore, she refused to proceed with the surgical option. Because the nodule was asymptomatic and based on the lesion size (5?mm) and the patient's decision, the lesion was monitored regularly for an eight-month period. One-month, two-month, three-month, six-month, and eight-month follow-up periods were scheduled to monitor the lesion. The nodule did not change in size or color during this period. Surprisingly, the lesion ruptured and resolved spontaneously without any conventional or surgical intervention. At the one- and two-year follow-up, there were no signs of lesion recurrence.