A previously healthy 12-year-old boy presented with a 3-month history of nasal obstruction, progressive dysphonia, recurrent deep neck abscesses, and tender, bulky cervical lymphadenopathy. Computed tomography (CT) of the neck with contrast at his initial hospital admission was concerning for suppurative lymphadenitis. Despite incision and drainage, and intravenous ampicillin and sulbactam, his cervical lymphadenopathy persisted. Results of subsequent workup—including Haemophilus, tetanus, and pneumococcal antibody titers; QuantiFERON-TB Gold test; serum IgG, IgM, IgA, and IgE levels; absolute lymphocyte count; neutrophil phenotype and function; angiotensin-converting enzyme level; HLA-B27 test; and antinuclear antibody level—were within normal limits. Magnetic resonance imaging of the neck with gadolinium contrast demonstrated bilateral, bulky, enlarged cervical lymph nodes, as well as enhancing nodules in the left laryngeal ventricle (2.3 × 1.6 × 1.2 cm), right false vocal cord, and right tracheal wall (0.6 × 0.4 cm). Findings from nasal endoscopy, awake flexible laryngoscopy, and operative microlaryngoscopy revealed yellow submucosal masses in the left nasal cavity, left laryngeal ventricle, and right trachea, as well as left vocal cord paresis (Figure, A). Biopsies were taken of the tracheal, laryngeal, and nasal cavity masses, and an excisional biopsy was taken of a left cervical lymph node (Figure, B). Histopathologic examination revealed a prominent infiltrate of benign-appearing histiocytes with numerous forms showing emperipolesis and some nuclei showing distinct central nucleoli. Immunohistochemical staining in these cells was positive for S100 and negative for CD1a.