A 5-year-old male with a lesion on the tonsil. Fibroepithelial polyp of tonsil.

475 Editor’s note: Each month, this department features a discussion of an unusual diagnosis. A description and images are presented, followed by the diagnosis and an explanation of how the diagnosis was determined. As always, your comments are welcome via email at [email protected]. Ahealthy 5-year-old male presented with a nodule on his right palatine tonsil that had been present for the past 2 weeks. During a short episode of fever (which lasted only a few hours, did not recur, and had no other symptoms), the mother looked into her son’s throat and discovered a “white projection” located at the pole of his right tonsil. During the 2 weeks prior to presentation, repeated inspections of his throat by his mother showed that the lesion persisted and had increased slightly in size, prompting the mother to take the boy for a medical consultation. The child was asymptomatic without any discomfort in the oral cavity (such as pain or a sensation of a foreign body), the lesion did not interfere with eating or swallowing, and it did not cause breathing difficulties or snoring. The child’s medical history was remarkable for upper respiratory tract infections (most of them with negative throat cultures for beta-hemolytic group A streptococcus) and infectious mononucleosis (positive immunoglobulin M for cytomegalovirus, and positive Epstein-Barr nuclear antigen [EBNA] immunoglobulin G for Epstein-Barr virus). Physical examination was normal, and the oropharyngeal examination revealed a mass arising from the right palatine tonsil (Figure 1). The tonsil itself was not inflamed. No palpable lymph nodes or swelling were detected on either side of the neck. Routine laboratory tests (complete blood cell count, blood chemistry panel, and urinalysis) were normal. The lesion was surgically excised. Following excision, the tissue specimen was sent for pathological examination. No complications were noted in the shortterm or long-term postoperative period. A microscopic examination of the lesion revealed the diagnosis.