Coexistence of an Epidermal Inclusion Cyst and Actinomyces in the Palatine Tonsil: A Case Report

Epidermal inclusion cysts have an incidence of less than 0.01% in locations such as the tonsillar fossa and can result in a foreign body sensation while swallowing in patients. Epidermal inclusion cysts in a palatine tonsil are an infrequent finding, let alone with their association with Actinomyces colonies. Although radiology and fine needle aspiration cytology can guide clinicians, the final diagnosis lies with histopathology. A 34-year-old female patient presented to the ear-nose-throat department with chief complaints of swelling in the right side of her throat for the last 1.5 years and foreign body sensation while swallowing for the last 3 months. Histomorphology showed multiple cystic lesions surrounded by lymphoid tissue and lined by keratinizing stratified squamous epithelium intermixed with numerous cleft spaces and keratin flakes. Alongside also seen were mixed inflammatory infiltrate and multiple colonies of Actinomyces among the hyperplastic lymphoid follicles. A final diagnosis of multiple tonsillar epidermal inclusion cysts along with Actinomyces colonization was made. Owing to the rarity of such conditions, we would like to add another case report to the English literature, so that the treating physicians and diagnosing histopathologists are well-versed with such conditions.