A Rare Case of All Presenting With Unilateral Tonsillar Enlargement - A Case Report

Abstract

Acute Lymphoblastic leukemia (ALL) is more common in children and least in adults. About 6,000 people are diagnosed with ALL each year. Children account for two-thirds of these cases. ALL represents about 15% of all malignancies in 1-15yrs, 5% in 15-19yrs and <10% in >20 yrs of age respectively. Its initial presentation is nonspecific which can lead to misdiagnosis and delay in the treatment thereby affecting the prognosis. Advances in the treatment regimen include multi-agent chemotherapy and radiotherapy. Here we report a rare case of ALL diagnosed in an adult who presented with unilateral tonsillar enlargement. INTRODUCTION:Leukemia is a malignant neoplasm characterized by proliferation of abnormal leukocytes within the bone marrow. Maturational arrest occurs and a proliferative, clonal population of cells results. Leukemias are classified based on the type of white blood cells involved as lymphoid or myeloid. Acute lymphoblastic leukemia (ALL) is the most common type of cancer diagnosed in children, accounting for 75% of childhood leukemias. The 5-year survival rate in patients with ALL has increased from 60% to approximately 90% for children <15 years and from 28% to approximately.70% for adolescents aged 15-19 years. Despite the high cure rates, approximately 20% of patients with ALL have disease relapse. 1,2 CASE REPORT: A 28 year old male patient presented to the OPD with foreign body sensation in the throat, difficulty in swallowing since 15 days and swelling over the left side of neck since 10 days. Patient also gives history of easy fatigability and fever of moderate degree.On examination of oropharynx, left tonsil was enlarged crossing the midline, pushing the uvula to the right with an ulcerative surface (figure 1), examination of the neck revealed multiple enlarged level II, III, IV group of lymphnodes, largest being level II group, 5x4cms (figure 2).Rest of the ENT examination was normal. Systemic examination revealed presence of hepatosplenomegaly. Within a period of two weeks patient developed enlargement of right tonsil with superficial petechial spots.