Ectopic Oral Tonsillar Tissue: A Case Series with Bilateral and Solitary Presentations and a Review of the Literature

Abstract

An ectopic tonsil is defined as tonsillar tissue that develops in areas outside of the four major tonsil groups: the palatine, lingual, pharyngeal, and tubal tonsils. The occurrence of tonsillar tissue in the oral cavity in ectopic locations, its prevalence, and its developmental mechanisms that belong to its formation remain unclear. In this report, we describe a rare case of bilateral symmetric ectopic oral tonsillar tissue located at the ventral surface of the tongue along with two solitary cases arising from the floor of the mouth. The role of immune system and its aberrant response leading to ectopic deposits desires further studies. As an ectopic tonsil may simulate a benign soft tissue tumor, this case series highlights the importance of this entity in our clinical differential diagnosis of oral soft tissue masses.

Ectopic tonsil in the floor of the mouth: A case report

“…This can partly explain the close position of the ectopic tonsillar tissue to the sublingual salivary gland in the reported case. However, this cannot be accepted as a whole etiology as cases have been reported far from salivary glands [1]. Furthermore, it was found to be separated from the salivary gland during surgery.…”

“…The condition is reported in both male and female patients [1][2][3][4][5][6]. It is not clear whether the condition is more common among some populations group or at certain geographical sites than other but most of the cases being reported from Japan [1,2,5,6].…”

“…The condition is usually painless, and it's therefore difficult to establish a clinical diagnosis. In the literature, there are few reported cases, most frequently located at the floor of the mouth, followed by the soft palate and ventral surface of the tongue [1]. Ectopic tonsil has been even reported in the nasal septum and larynx [2,3] and in the orbital cavity [4].…”

Hallazgos normales que simulan patologías en la cavidad oral

“…Asimismo en la zona posterior de la cavidad oral se encuentra el anillo de Waldeyer, el cual conformado por las amígdalas palatinas, faríngeas y linguales; estas últimas, en ocasiones se pueden extender hacia la zona posterolateral de la lengua, donde se encuentran las papilas foliadas; lo que podría confundirse con alguna patología, pues est área es de alta incidencia de cáncer bucal [9,13,19,20]. Las amígdalas linguales se diferencian Universidad de Costa Rica.…”

“…Asimismo en la zona posterior de la cavidad oral se encuentra el anillo de Waldeyer, el cual está conformado por las amígdalas palatinas, faríngeas y linguales; estas últimas, en ocasiones se pueden extender hacia la zona posterolateral de la lengua, donde se encuentran las papilas foliadas; lo que podría confundirse con alguna patología, pues esta área es de alta incidencia de cáncer bucal [9,13,19,20]. Las amígdalas linguales se diferencian clínicamente con facilidad, pues son elevaciones regulares de color rosado que se presentan bilateralmente [3], [Ver figura 4] si se observaran eritematosas o de forma unilateral deberían diferenciarse de alguna patología y realizar el estudio histopatológico respectivo [14,19].…”