Case Report

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

Table 1

Summary of ectopic tonsils reported in the literatures.

AuthorYearAnatomic locationNumber of casesClinical presentationMicroscopic findings
Clinical featuresLesion size (mm)

Floor of the mouth32Firm, nodular, pale pink, and up to 10 mmHypertrophic oral tonsil
(i) Numerous enlarged lymphoid follicles with germinal centers 
(ii) Single or a branched crypt which was lined with stratified squamous epithelium
Knapp [2]1970Ventral surface of the tongue552 totalSlightly compressible, yellowish “cystic” mass, creamy or cheese-like discharge, and up to 10 mmTonsillar pseudocyst
(i) The lesion consisted of a cystic cavity which represented a dilated crypt lined with stratified squamous epithelium
Soft palate15Red, firm rounded nodule, and from 1 to 3 mmHyperemic oral tonsil
(i) It showed a prominent hyperemia of the tonsillar and peritonsillar blood vessels

Wolter and Roosenberg [10]1977Orbit1A smooth surface, an oval shape, and a rubber-like consistency24 × 15 × 10(i) Many primary lymphoid nodules with germinal centers

Paslin [5]1980Floor of the mouth1Oval, pink, lucent, rounded, and firm papule on the sublingual fold just to the right of the frenulum.3 × 3(i) Circumscribed masses of lymphoid cells forming germinal centers surrounding the central crypt of stratified squamous epithelium

Pellettiere et al. [7]1980Larynx1Firm and freely movable and covered by normal appearing, smooth, and intact mucosa15(i) Moderately well delineated germinal center

Furukawa et al. [9]1983Nasal septum1Firm and greyish-white mass28 × 22 × 14(i) The surface epithelium of the tumour was fibrous tissue covered with squamous cells which invaginated into the lymphoid tissue producing crypts surrounded by lymphoid follicles

Mogi [3]1991Floor of the mouth1Small, dark red, and soft tumor with no tender 6 × 3 × 3(i) A germinal center surrounded by fibrous tissue invaded by squamous epithelium

Patel et al. [4] 2004Floor of the mouth1Three small, red, and circular lesions in the mucosa of the floor of the mouth3(i) Aggregation of lymphoid tissue within the lamina propria 
(ii) Well-defined lymphoid follicles
Ventral surface of the tongue 1White, soft, and nontender mucosal nodule of the frenum of the ventral surface of the tongue4(i) A focus of lymphoid tissue including follicles with well-formed germinal centers 
(ii) A cystic lesion lined with stratified squamous epithelium filled with keratinous debris

Baba et al. [8]2010Hypopharynx1Smooth mucosal swelling in the right pyriform recessNo mention(i) Germinal center, lymphoid tissue, and crypt involving lymphoepithelial symbiosis

Kashima et al. [6]2012Floor of the mouth1Well-circumscribed, smooth, round, painless, swelling covered by intact normal-appearing mucosa4(i) Abundant reactive lymphoid aggregates with well-formed germinal centers
(ii) A nondilated central crypt lined with stratified squamous epithelium and containing desquamated epithelial cells
(iii) Keratin debris in a central lacuna-like space

Present cases (Kimura et al.) 2014Ventral surface of the tongue1Well-circumscribed, slightly red, hard on palpation, and bilateral presentation 
A small pit was evident at the tip (Case  1)
8/6 Shown in Table 2
Floor of the mouth2Well-circumscribed, slightly red, and hard on palpation (Case  2)5
Well-circumscribed and soft on palpation mass covered by normal mucosa (Case  3)6