A 71-year-old female patient was referred to our clinic from a Psychiatric Hospital (where she was institutionalized for several years) for the diagnosis and treatment of a round, mobile, elastic, submandibular tumor of around 5 cm, which has been slowly growing in the last year (Figure 5). The fact that she had no close relatives and a scarce medical record, made it impossible to establish a history or opportunity of TB contact. However, the fact that she came from a psychiatric institution may be considered circumstantial evidence in this direction. The evaluation protocol included a complete ENT, chest X-ray and complete blood work, all of these showing minimal changes. The mass was excised under general anesthesia, and an additional smaller one (about 1 cm) was found intraoperatively, beneath it. Both masses had suppuration, being filled with a creamy yellow puss. The histopathological examination revealed lymph nodes with modified architecture, with frequent granulomas of various shapes and sizes, necrosis, giant multinuclear cells, areas of ulceration and granulation (Figure 6). The patient followed an uneventful post-operative course and was referred to the Infectious Disease Department for further diagnosis and treatment. The final diagnosis of primary tuberculous adenotonsilitis was set by special cultures and AFB staining of the sputum, and the classic WHO Category-3 regimen was employed. Follow-ups at 3, 6 and 12 months revealed no sign of recurrence or residual disease.