A 45-year-old man with a history of chronic alcohol and tobacco use presents with progressive dysphagia, otalgia, and a neck mass. Examination reveals an ulcerated, friable mass on the left tonsil with indurated margins. Biopsy shows squamous cell carcinoma. Which is the most common site for tonsillar carcinoma within the tonsil?
- A Tonsillar fossa (posterior pillar region) ✓
- B Anterior surface
- C Upper pole
- D Lower pole
Correct answer: A. Tonsillar fossa (posterior pillar region)
Explanation
Tonsillar carcinoma most commonly arises in the tonsillar fossa, particularly involving the anterior and posterior pillars. The crypt epithelium of the tonsillar fossa is the most common site of origin. Upper pole lesions are less common. Tonsillar SCC frequently presents with advanced disease due to its deep location and rich lymphatic drainage, often manifesting with cervical lymphadenopathy. HPV-related oropharyngeal SCC is increasingly common in younger patients without traditional risk factors.
Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.