Lipoma is a benign neoplasm composed of abnormal adipose tissue, most commonly found in subcutaneous regions [1]. Although lipomas are the most frequent mesenchymal tumors, only approximately 15% arise in the head and neck region, affecting sites such as the oral cavity, parotid glands, larynx, hypopharynx, and retropharynx [1],[2]. Lipomas occurring within the aerodigestive tract are rare [2],[3],[4],[5],[6], and their presence in the palatine tonsils is exceptionally uncommon. Among benign tonsillar neoplasms—which constitute roughly 25% of all tonsillar tumors—lipomas are rarely encountered [1]. Clinical presentation can vary widely, from incidental findings to symptoms related to mass effect, such as dysphagia or foreign body sensation. This case report describes a right tonsillar lipoma in a male patient and highlights its clinical presentation, diagnostic workup, and surgical management.

A 28-year-old Saudi male presented with one-year history of foreign body sensation in his throat. The course of his complaint was waxing and waning and he gave no history of smoking or alcohol abuse. Upon initial physical examination, there was a 1 × 2 cm whitish mass with a smooth mucosa located on the upper pole of the right tonsil. The patient asked for medical assessment because he noted that the mass had increased in size. Computed tomography (CT) scan was done for him and showed a small fat attenuating lesion that measured about 1 × 2 cm in diameter and was located on the right palatine tonsil.

The mass was excised with both tonsils under general anesthesia (Figure 1). The operation went well and the excised mass was sent for histopathology examination, which showed a yellowish mass with a smooth surface measuring 2 × 1 × 1 cm. Low power microscopic examination revealed a well-circumscribed fat tissue composed of lobules and mature adipocytes with characteristic eccentric nuclei and intervening variable thickness bands of fibrous tissue (Figure 2). No cytonuclear atypia or mitotic activity was identified. The postoperative course was uneventful and the patient was discharged after one day. A three months follow-up revealed no evidence of recurrence.

Benign neoplasms of the tonsils are extremely rare and typically classified based on the predominant histological tissue type, including squamous papilloma, fibrovascular polyp, lymphangiectatic fibrous polyp, hemangioma, and lipoma [6]. Given their rarity, tonsillar masses may initially raise suspicion for more common pathologies such as chronic tonsillitis, hypertrophic lymphoid tissue, or even malignancies. Therefore, lipoma should be considered in the differential diagnosis of unilateral tonsillar enlargement, particularly when presenting with a soft, slow-growing, non-tender mass.

This report adds to the limited number of documented cases of tonsillar lipoma in the literature [2],[3],[4],[5]. The exact pathogenesis of tonsillar lipomas remains uncertain. However, this case supports the theory proposed by Begin and Frenkiel, who argued that tonsillar lipomas represent true benign neoplasms rather than hamartomatous malformations, based on the absence of other germ cell layers in histopathologic evaluation [5]. Additionally, chronic irritation and local trauma have been suggested as possible contributing factors in their development [2].

Our patient, a 28-year-old male, presented with a foreign body sensation in the throat and was found to have a lipoma arising from the upper pole of the right tonsil. He underwent bilateral tonsillectomy with no recurrence observed after a three-month follow-up. While some reports advocate for conservative excision of the mass alone [3],[5],[7], bilateral tonsillectomy was selected in our case to ensure complete excision, facilitate histopathological diagnosis, and reduce the risk of recurrence. This approach is consistent with the most frequently reported management strategy for tonsillar lipomas in the literature [7].

Tonsillar lipomas may present with a range of clinical symptoms including cough [8], voice change [9], or obstructive sleep apnea [7], although they are frequently discovered incidentally. Most lipomas arise from the tonsillar body, though cases originating from the lower or upper poles have also been described [7], as demonstrated in our patient. The clinical and histopathological findings in this case further underscore the variable presentation and diagnostic challenges of tonsillar lipomas, especially in low-prevalence regions.

Lipoma of the tonsils is a very rare benign tumor that is usually discovered accidentally and my present differently. The current report presents a case of tonsillar lipoma manifested as foreign body sensation in the throat which was managed by bilateral tonsillectomy with no recurrence after a three months follow-up.