Tonsillar Fullness Mimicking Malignancy Secondary to a Cervical Osteophyte: A Case Report.

Tonsillar asymmetry and firmness on examination often raise concern for underlying malignancy, particularly squamous cell carcinoma or lymphoma. However, rare benign etiologies may mimic these findings and lead to diagnostic uncertainty. We present the case of an 83-year-old female who presented with globus sensation and was found to have left-sided tonsillar fullness with firmness on physical exam, raising concern for malignancy. Flexible laryngoscopy was unremarkable. Computed tomography of the neck demonstrated a prominent anterior cervical osteophyte at the C1-C2 level, causing mass effect on the left palatine tonsil, resulting in anteromedial displacement and mild oropharyngeal narrowing. No mucosal lesions or lymphadenopathy were identified. This case highlights an unusual cause of tonsillar asymmetry and underscores the importance of imaging in distinguishing malignant from benign etiologies.