Postoperative routine pathologic evaluation of tonsillectomy and adenoidectomy specimens rarely reveals a diagnosis of malignancy. The object of this case report is to highlight this rare clinical occurrence. A 4-year-old boy presented with symptoms of sleep-disordered breathing and had a history of recurrent tonsillitis. Physical examination revealed adenoid hypertrophy and Brodsky Grade 1 bilateral tonsillar hypertrophy. The patient underwent adenoidectomy and tonsillectomy. The adenoids were found to be MAGS Grade 4 (Modified Adenoid Grading System) hypertrophic causing 100% obstruction. After the histologic examination, T-cell lymphoblastic leukemia/lymphoma was diagnosed. Proper treatment allowed full recovery. Currently, no consensus has been made about routine pathological evaluation. To achieve a cost-effective and precautionary approach, we recommend pathological follow-up of cases with unusual intraoperative findings with/without clinical malignancy suspicion.
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