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A man in his 50s presents with a 4 week history of a lump on the right side of his neck, initially noticed while shaving. The lump was associated with a mild sore throat radiating to his right ear that persisted despite antibiotics. He is a lifelong non-smoker, who rarely drinks alcohol. On examination he had a firm, fixed 3 cm mass in the right anterior triangle, anterior to the upper third of the sternocleidomastoid muscle. Oropharyngeal exam revealed an irregularly enlarged right tonsil with a hard consistency.