Spiculated tonsilloliths of varying size can be found from around or within the substance of tonsils as a result of repeated episodes of inflammation of tonsils. Small tonsilloliths are frequently encountered on the section of tonsils via microscopic examination, but they are usually not recognizable clinically. Tonsilloliths of considerable size are very rare, and only a few cases have been reported. Recently, the authors have experienced a case of large tonsillolith which was managed with tonsillectomy. We report this case with a literature review.