Similarly, the single-layered tonsillar crypts constitute the epithelium with the highest susceptibility to cellular transformation in the head and neck region.9,16 These highly invaginated crypts are natural hosts for bacterial infections and foreign materials, driving the expression of programmed cell death-1 ligand-1 (PD-L1).17 Since PD-L1 is responsible for immune evasion by binding programmed death-1 (PD-1) receptors expressed by the cells of the immune system,18 PD-L1 overexpression in tonsils favours persistent HPV infection allowing tumorigenesis. The gene discussed is CD274; the disease is bacterial infectious disease.