Oropharyngeal lymphomas are rare, typically high-grade neoplasms. We describe a case of plasmablastic lymphoma that originated in the oropharynx of a 40-year-old man who was positive for human immunodeficiency virus (HIV). The diagnosis was based on fine-needle aspiration cytology of the mass followed by histopathologic examination supplemented with immunophenotyping. The mass was excised, but the patient refused antiretroviral therapy, and he died within 6 months of the diagnosis. In HIV-positive patients, non-Hodgkin lymphomas frequently involve sites, including the oropharynx, that are unusual in patients without HIV.