The spectrum of tonsillar involvement in chronic lymphocytic leukemia (CLL)

Tonsillar enlargement in chronic lymphocytic leukemia (CLL) either with or without symptoms has been rarely reported. We describe 22 cases of CLL with tonsillar involvement and demonstrate this is a CLL disease site that may be under-recognized in routine practice. Tonsillar involvement can be divided into three categories: (1) symptomatic CLL tonsillar involvement with upper airway obstruction (UAO) requiring therapy managed with: (a) tonsillectomy without systemic therapy when tonsillar enlargement is disproportionate to overall disease state, (b) tonsillectomy and systemic CLL therapy, and (c) standard systemic CLL therapy alone for both UAO and overall CLL state; (2) asymptomatic CLL tonsillar enlargement in proportion to other CLL disease sites not necessarily requiring imminent therapy; and finally, (3) tonsils as the site of Richter's transformation (RT). Tonsillar involvement in CLL can be evaluated by simple clinical examination in most cases, with imaging utilized if there is concern for UAO or RT.