Giant tonsilloliths (typically defined as greater than 1 cm) pose a diagnostic challenge because they can mimic which more serious pathology on clinical and radiographic examination?

 # Giant tonsilloliths (typically defined as greater than 1 cm) pose a diagnostic challenge because they can mimic which more serious pathology on clinical and radiographic examination?

a) A primary or metastatic calcifying tumor of the tonsil or adjacent parapharyngeal space

b) Ranula of the floor of the mouth

c) Peritonsillar Abscess (Quinsy)

d) Glandular Fever (Infectious Mononucleosis)

The correct answer is a) A primary or metastatic calcifying tumor of the tonsil or adjacent parapharyngeal space.

Giant tonsilloliths (>1 cm) often present as firm, unilateral tonsillar masses with asymmetry, induration, or displacement, mimicking calcified neoplasms like squamous cell carcinoma, lymphoma, or metastases (e.g., from thyroid or breast) in the tonsil or parapharyngeal space—especially if occult or embedded, obscuring visualization. Radiographically, their dense opacities on CT/CBCT overlap with tumor calcifications, prompting biopsy risks (e.g., false positives from inflammation). Case reports highlight this diagnostic pitfall: up to 20% of suspected tonsillar malignancies prove benign stones post-excision, per otolaryngology literature (e.g., Head Neck Pathol and PMC studies). This is more serious than abscess (c, soft/fluctuant, febrile) or mononucleosis (d, bilateral exudate, systemic), while ranula (b) is sublingual, not tonsillar. Rule out via fine-needle aspiration or imaging-guided biopsy before tonsillectomy.