A 67-year-old female received right tonsillectomy due to enlargement of right tonsil with symptoms of sore throat.The postoperative pathological results showed that right tonsillar small cell neuroendocrine carcinoma (SCNC).FDG Positron emission tomography (PET) /computed tomography (CT) demonstrated that there was metabolically active in lower lobe of right lung.In addition, foci of hypermetabolism were noted in the lymph node of right neck and mediastium.A needle biopsy of pulmonary mass demonstrated SCNC.The patient received chemotherapy and died of multiple distant metastases after 6 months.This is the first report of PET/CT evaluating tonsillar metastasis from lung SCNC .