Tonsillectomy is among the most commonly performed operations in children. Although follicular lymphoid hyperplasia is usually the main and only pathologic finding at microscopic examination, a variety of other rare but important pathologic changes may be encountered. This review aims to provide an inclusive practical resource and reference for both training and practising pathologists. It discusses the spectrum of pathologic findings, including both neoplastic and non-neoplastic conditions and provides illustrative images.