Introduction The vast majority of cancers in the head and neck region are of epithelial origin. Lymphoma is the next most common malignancy in this area. Metastases in the head and neck other than lymph node metastases are rare. 10 Case report 1 2 Fig. 1 Enlarged right palatine tonsil with ulceration  Fig. 2 Biopsy right tonsil: adenocarcinoma (intestinal type)  Discussion 4 9 2 10 6 6 9 6 5 7 3 7 3 2 7 8 8 2 3 1 1 3 3 2 8 2 In conclusion, when finding a tumour of the tonsil a metastasis from a distant primary malignancy should be considered, although this is very rare. The route of dissemination eventually remains unclear.