# Lymphoepithelial Cyst “En Crypto”: A Case Report of a Rare Localization in the Superior Pole of the Palatine Tonsil

## TL;DR

A rare case of a lymphoepithelial cyst in the tonsil was successfully diagnosed and surgically removed after years of symptoms.

## Contribution

Reports a rare tonsillar localization of a lymphoepithelial cyst and emphasizes diagnostic challenges and surgical management.

## Key findings

- Lymphoepithelial cysts in the tonsil are extremely rare and difficult to detect via standard endoscopy.
- Surgical excision confirmed the diagnosis and provided a complete cure with no recurrence.
- Dynamic oropharyngeal examination is crucial for diagnosing cryptic tonsillar lesions.

## Abstract

Background and Clinical Significance: Lymphoepithelial cysts are uncommon benign lesions of the head and neck, rarely encountered within the oral cavity and exceedingly infrequent in the palatine tonsils. Their nonspecific clinical presentation and ability to mimic more common benign entities often render diagnosis challenging. Case Presentation: We report the case of a 68-year-old woman with a four-year history of persistent foreign-body sensation in the oropharynx despite multiple normal otolaryngologic examinations. Flexible nasoendoscopy was non-diagnostic, as the lesion was deeply concealed within the superior tonsillar pole between the palatine pillars. Targeted tonsillar manipulation ultimately revealed a small pedunculated mass and contrast-enhanced computed tomography demonstrated a well-circumscribed, non-enhancing cystic lesion confined to the tonsillar parenchyma. Surgical excision under general anesthesia confirmed an oral lymphoepithelial cyst on histopathologic analysis. The patient remained asymptomatic with no recurrence at four months. Conclusions: This case underscores the rarity of tonsillar lymphoepithelial cysts, highlights the diagnostic limitations of endoscopic evaluation for cryptic superior-pole lesions and emphasizes the importance of meticulous dynamic oropharyngeal examination. Complete surgical excision is both definitive and curative, with an excellent prognosis.