Palatine Tonsillar Metastasis of Lung Adenocarcinoma: an Unusual Immunohistochemical Phenotype and a Potential Diagnostic Pitfall

Metastasis rarely occurs to the palatine tonsils. Herein, we present an exceedingly rare case of palatine tonsillar metastasis from poorly differentiated lung adenocarcinoma with anaplastic lymphoma kinase (ALK) mutation in a 51-year-old woman. The patient manifested clinically as pharyngalgia without obvious respiratory symptoms, with swelling tonsil histomorphologically resembling lymphoma and partially expressing the markers of epithelial and squamous cell carcinoma (CK5/6, P63, and P40). Due to the non-specific immunohistochemical expression, it is easily misdiagnosed as a primary poorly differentiated squamous cell carcinoma of the tonsil. This case highlights the importance of a comprehensive assessment of suspicious tonsillar lesions, that may be a sign of a primary malignancy elsewhere in the body.