Smoking as Trigger in the present case for tissue aggression is matter of debate.
Teaching points by Dr MGK Murthy
MRI Tech: Mr Satish
1. Tonsilar masses are rare and usually are of infectious nature with abscess / sequelae
2. Pathogenesis possibly, is exaggerated response to tissue aggression of unknown aetiology. Differentials on histology like lymphoproliferative causes/ spindle cell sarcomas may need immunohistochemistry
3. The term Inflammatory pseudo tumour , though primarily used in ref to retro orbital location, can be found in tonsilar / laryngo tracheal/ middle ear/ salivary/ ganglion/ pterygo maxillary/ para pharyngeal regions as well
4.Labdata may show signs of infection including neutrophilia / raised ESR etc,but not necessary .
5. Cross sectional imaging may show tonsilar enlargement or grossly nodular thickening of nasopahrynx/ supra glottis with cervical lymphadenopathy. Radiology has no definite characteristics to exclude other aetiologies , though presence of necrosis/ tissues oedema/ enhancement on contrast may help.
6. If antibiotics and steroids do not resolve , surgical excision would resolve the aetiology