A case report of bilateral synchronous tonsillar squamous cell carcinoma: A rarity among head and neck cancers of unknown primary origin

Abstract Bilateral synchronous tonsillar squamous cell carcinoma is a rare finding, and few cases are described in the medical literature. We present a case of a 67-year-old male with a history of a right neck swelling for 8 months. After imaging and fine needle aspiration cytology (FNAC), a diagnosis of head and neck squamous cell carcinoma (SCC) of unknown origin was reached. As per multidisciplinary meeting (MDT) advice, a conventional open bilateral diagnostic tonsillectomy was performed, and bilateral synchronous tonsillar squamous cell carcinoma was diagnosed. Hospital protocol does not facilitate transoral robotic surgery. The right tonsil tumor staging was T2N1M0, and the left T2N0M0. The patient successfully completed curative concurrent chemoradiotherapy as per MDT recommendation and local treatment protocols. In conclusion, bilateral synchronous tonsillar squamous cell carcinoma is a rare clinical presentation. In similar cases, a bilateral diagnostic tonsillectomy would be the most suitable diagnostic procedure, contrary to the unilateral approach performed in some centers.