Lymphoma is the second most common type of tonsillar malignancy. Lymphoma of the tonsil usually presents with a submucosal mass in an asymmetrical enlargement of one tonsil. When lymphadenopathy is present, multiple enlarged lymph nodes commonly are observed on the same side of the neck.
Lymphomas are difficult to distinguish from undifferentiated carcinomas and lymphoma markers are required to establish the diagnosis. Such studies require a large amount of tissue which is sent fresh (in saline, not formaldehyde) to the pathologist. This is why a tonsillectomy is preferable to a biopsy.