'Hairy polyp' of the pharynx in association with an ipsilateral branchial sinus: evidence that the 'hairy polyp' is a second branchial arch malformation

Oropharyngeal Lesion in a 7-Year-Old Girl

A 7-year-old girl was referred to the otolaryngology clinic for a left pharyngeal lesion noted 18 months prior. What is your diagnosis?

Imaging features of pharyngeal hairy polyps in infants

BACKGROUND

Hairy polyps are the most common congenital deformity of the oral-nasopharynx/oral cavity in infants, which may lead to severe complications in the newborns. However, few studies have been published with respect to their radiological features, and most are case reports.

OBJECTIVE

This study aimed to analyze radiological features of the oral‑nasopharyngeal hairy polyps and to identify the radiological features with the highest diagnostic value.

MATERIALS AND METHODS

From 2014 to 2019, pediatric cases pathologically diagnosed as hairy polyps and having received radiological examination at the Children's Hospital Affiliated to Zhejiang University were retrospectively analyzed. Radiological evaluations were conducted on tumor size, location, morphology, density or signal features as well as the enhancement pattern.

RESULTS

A total of six infants were recruited. Clinical features observed in these cases included choking on milk with cyanosis, intermittent dyspnea, oropharyngeal mass, and snoring. Lesions were derived from the left tubal torus in three out of six cases, from the left lateral aspect of soft palate in one, from the left lateral pharyngeal wall in one, and from the right tubal torus in one. They were shown as pedicled polyp-like well-circumscribed mass with fat density or signal as well as a stalk on CT or MRI. In the contrast-enhanced scan, the fat components were not enhanced, while the stalk was mildly enhanced.

CONCLUSION

Hairy polyps had typical radiological features. Hairy polyps should be considered for pedicled polyp-like well-circumscribed mass in the oral-nasopharynx of infants with fat density or signal as well as a stalk.

Hairy polyps: A new case presentation and a pathogenetic hypothesis

Hairy polyps are benign lesions found in the oropharynx or nasopharynx that are thought to be present at birth and can lead to upper airway obstruction in infants. Also known as naso-oropharyngeal choristoma, they are increasingly viewed as aggregates of bigeminal tissue, likely from the first or second branchial arches, found in aberrant locations. They are benign lesions that are usually successfully treated by surgical excision. Here we present a rare case of a hairy polyp originating in the eustachian tube of a 7-week-old male, discuss our management of the patient, and put forth a new hypothesis as to the origin of these lesions. Laryngoscope, 129:2398-2402, 2019.

Nasopharyngeal Dermoids and Cleft Palate

Nasopharyngeal dermoids associated with cleft palate present as intraoral protruding masses. Only 5 cases of nasopharyngeal dermoids associated with cleft palate have been reported in the literature. We are reporting 4 such cases encountered by us in the last 10 years in our series of 900 cleft palate surgeries. Imaging studies were done to know the extension of dermoid and to look for any associated congenital intracranial anomalies. We observed that nasopharyngeal dermoids are usually nonmalignant and can be easily managed by complete local excision followed by palatal closure after 6 months.

Congenital hairy polyp of the oropharynx presenting as an esophageal mass in a neonate, a case report and literature review

PURPOSE

To review the literature of congenital hairy polyps and describe the clinical presentation, operative management, and histologic findings of a congenital hairy polyp arising from the palatopharyngeus muscle in a neonate with recurrent choking episodes.

METHODS

Chart review of a 2-month-old male referred to a tertiary care pediatric hospital.

RESULTS

We present a case of a 2-month-old male who presented to the emergency room with recurrent episodes of choking and vomiting. The patient was previously healthy with no prior medical or neonatal history. The parents noted a small fleshy mass in the patient's oropharynx that he would chew on and swallow after several minutes. However, on physical exam, there was no evidence of oropharyngeal mass. The patient did not have respiratory distress. Imaging revealed a 22×7×11mm oblong, fatty mass in the lower cervical and upper thoracic esophagus with a thin stalk extending proximally to the upper collapsed esophagus. Intraoperative recorded laryngoscopy revealed a pedunculated soft palate mass attached to the right superior palatopharyngeus muscle. Histopathology revealed ectodermal and mesodermal elements in a polypoid structure lined by keratinizing squamous epithelium with adnexal structures and central mature adipose tissue, consistent with congenital hairy polyp resembling an accessory tragus of the ear and branchial anomaly. At 6-week follow up, the patient was doing well and gaining weight appropriately with no further choking episodes. There was no evidence of velopharyngeal dysfunction on follow up exam. The surgical site was completely healed and there was no evidence of recurrence.

DISCUSSION

Congenital hairy polyps of the naso- and oropharynx are rare but may present as airway or esophageal masses, causing respiratory distress or choking episodes in a pediatric patient. The pathologic findings of keratinizing squamous epithelium, adnexal structures, adipose and cartilage tissues resemble congenital accessory tragus and may be considered a branchial arch anomaly.

A Rare Case: Cartilaginous Choristoma of the Soft Palate

Cartilaginous choristomas occur in abnormal sites that usually do not contain chondrocytes. These lesions are very rarely seen in the soft palate. We present a 38 year-old patient with cartilaginous choristoma located in nasopharyngeal surface of soft palate. Histopathological examination demonstrated a well demarcated mature hyaline cartilage tissue which was surrounded with seromucous salivary glands under a benign respiratory epithelium.

Oropharyngeal Hairy Polyp Causing Dysphagia

Hairy polyp is a rare, benign tumor that comprises ectodermal and mesodermal germ layers. The embryogenesis of hairy polyp is precisely unknown, and concurrently, it has a female predominance. Although hairy polyp is observed in every part of the body; it is frequently located in the nasopharynx and oropharynx. Respiratory distress and feeding difficulties are the most related symptoms. Differential diagnoses comprise hemangioma, teratoma, epidermoid cyst, neuroblastoma, and meningocele. In this report, a seven-year-old patient who was admitted to our clinic with swallowing difficulty because of an oropharyngeal hairy polyp was described.

Severe respiratory distress at birth caused by a hairy polyp of the Eustachian tube: Transoral endoscopy-guided treatment

Hairy polyps are rare developmental lesions, which present as masses mainly consisting of fatty tissue covered by skin, seldom localized in the nasopharynx, causing respiratory obstruction. We describe the case of a female newborn affected by a hairy polyp arising from the left Eustachian tube, who presented severe respiratory distress soon after birth. The polyp was successfully removed transorally under videoendoscopic guidance. This case highlights the importance of including hairy polyp in the differential diagnosis of respiratory distress at birth because this type of tumor can be lethal and requires prompt treatment. A transoral endoscopy-guided approach can allow successful and minimally invasive excision even in a newborn.

Hairy polyp of the supratonsillar fossa causing intermittent airway obstruction

Introduction Dermoids frequently called “hairy polyps” and their nature have not been completely clarified.

Objectives To discuss the unusual presentation, symptoms, incidence, histology, and perioperative management of hairy polyps in the light of a case and current literature.

Resumed Report A 3-year-old boy presented with intermittent respiratory distress since birth. Oropharyngeal examination revealed a nasopharyngeal mass originating from the supratonsillar fossa. The mass was so mobile that it moved between the oropharynx and the nasopharynx during swallowing. The radiologic and pathologic examinations confirmed the mass as a hairy polyp.

Conclusion In a pediatric age group with airway obstruction, hairy polyps of the oropharyngeal region must also be included in the differential diagnosis.

Naso-oropharyngeal choristoma (hairy polyps): an overview and current update on presentation, management, origin and related controversies

This review presents a comprehensive and updated overview of bigerminal choristomas (hairy polyps) of naso-oropharynx/oral cavity, and discusses the controversies related to nosology and origin from a clinico-embryologic perspective. English-language texts of the last 25 years (January 1989-January 2014) were collected from the PubMed/MEDLINE database using the given keywords. Of the 330 records, 64 full-text articles (mostly case reports/series) were selected, incorporating clinical data from 78 patients, after screening through duplicates and the given exclusion criteria. With the available evidence, hairy polyps appear more common than generally believed, and are increasingly being recognized as an important, often-missed cause of respiratory distress and feeding difficulty in neonates and infants. Such a child without any apparent cause should be examined with flexible nasopharyngoscope to specifically look for hairy polyps which might be life-threatening, especially when small. The female preponderance as believed today has been found to be an overestimation in this review. These lesions are characteristically composed of mature ectodermal and mesodermal tissue derivatives presenting as heterotopic masses, hence termed choristoma. However, little is known about their origin, and whether they are developmental malformations or primitive teratomas is debatable. Involvement of Eustachian tube and tonsils as predominant subsites and the speculated molecular embryogenesis link hairy polyps to the development of the first and second pharyngeal arches. They are exceptionally rare in adults, but form a distinct entity in this age-group and could be explained as delayed pluripotent cell morphogenesis or focal neoplastic malformations, keeping with the present-day understandings of the expanded "teratoma family".

Hairy polyp can be lethal even when small in size

A case of sudden cardiopulmonary arrest in a 3-month-old girl is presented. The patient had barely recovered from hypoxic encephalopathy when she presented with repeated respiratory distress. Computed tomography and endoscopic analysis revealed a shiny polyp in the lateral wall of the nasopharynx, and this polyp was suspected to be the main cause of respiratory distress. After referral to our hospital, surgical removal was performed, and the histopathological diagnosis was hairy polyp. Hairy polyp is a rare congenital benign tumor that sometimes induces respiratory distress. This polyp can potentially induce a life-threatening event. In a systematic review of 40 reported cases, polyps of ≤ 3.0 cm in diameter have a higher risk of respiratory distress than do those >3.0 cm in diameter (P = 0.01). Small hairy polyps may be lethal because of delayed diagnosis. To locate small hairy polyps, physicians should not hesitate to perform further examination because there is the possibility of oversight with only physical examination.

Hairy polyp, a clinicopathologic study of four cases

Hairy polyps (HPs), dermoids or teratoid tumors are rare tumors of naso-oropharyngeal region which commonly present at or shortly after birth. The etiology and classification of these tumors is still debatable and categorized by different authors differently. HPs have female predominance and usually present with respiratory and feeding problems. Microscopically, the polyp is covered by skin with underlying mesenchymal core. The aim of this study is to describe the clinicopathological features of Hairy polyps on a cohort of cases. We reviewed the surgical pathology database of our institution for last 10 years and retrieved four cases of hairy polyps. The age of patients ranged from 1 month to 18 years (mean = 12 years), with a female to male ratio of 1:3. Two of our cases presented at birth and two cases in late teens. Two of the HPs were located in nasopharynx, one on soft and hard palate and one on lower lip. One case was associated with bifurcation of tongue. Size of the polyps ranged from 2.3 to 4.5 cm (mean = 3 cm). Histologically, all HPs were lined by skin and the underlying core consisted of adnexal structures, adipocytes, skeletal muscle, smooth muscle and seromucinous glands. Lymphoid aggregates, cartilage and bone were seen in one case each. Our series highlights the diverse nature of this entity in terms of age of presentation and location. HP at lower lip and associated bifurcation of tongue has not been previously reported. We observed a male predominance in contrast to the published literature. However, number of cases is too few to read a definite conclusion on this point. The etiology is still controversial and includes congenital malformation and activation of pluripotent stem cells.

Caught on camera: hairy polyp of the posterior tonsillar pillar

BACKGROUND

Hairy polyps are rare congenital growths of the head and neck, mainly found in the nasopharynx and oropharynx. They are made up of two germ cell layers: the ectoderm and mesoderm.

METHODS

This paper reports a four-month-old who presented with breathing and feeding difficulties. Clinical examination was unremarkable, but a video taken by the patient's mother on her smartphone showed a mass protruding from the infant's mouth. Laryngoscopy performed in the operating theatre showed that the mass emanated from the left posterior tonsillar pillar.

RESULTS

The mass was removed transorally with no complications. Pathological examination showed a skin-covered pedunculated structure characteristic of a hairy polyp. The patient's follow up was unremarkable.

CONCLUSION

To the best of our knowledge, this is the second English-language case report of a patient with a hairy polyp emanating from a posterior tonsillar pillar. This paper also highlights the growing usage of smartphones by patients to help physicians with their diagnosis and management.

Hairy polyp of the oropharynx in association with a first branchial arch sinus

OBJECTIVES

Hairy polyps are rare, congenital malformations of the oropharynx and nasopharynx. To date, approximately 145 cases have been reported. However, the histogenesis of these lesions remains unclear.

CASE REPORT

We report the case of a 2-day-old neonate presenting with a hairy polyp attached to the left palate, who re-presented aged 16 months with a discharging first branchial arch sinus.

CONCLUSION

We propose this case as supporting evidence for the theory that hairy polyps are a malformation of the first branchial arch system.

HAIRY POLYP on the dorsum of the tongue - detection and comprehension of its possible dynamics

Background

The formation of a Hairy Polyp on the dorsum of the tongue is a rare condition that may hinder vital functions such as swallowing and breathing due to mechanical obstruction. The authors present the situation on a child with an approach of significant academic value.

Methods

Imaging diagnostics with the application of a topical oral radiocontrastant was used to determine the extent of the tumor. Performed treatment was complete excision and diagnostics was confirmed with anatomopathological analysis.

Results

The patient was controlled for five months and, showing no signs of relapse, was considered free from the lesion.

Conclusion

Accurate diagnostics of such a lesion must be performed in depth so that proper surgical treatment may be performed. The imaging method proposed has permitted the visualization of the tumoral insertion and volume, as well as the comprehension of its threatening dynamics.

Pharyngeal hairy polyps: five new cases and review of the literature

Pharyngeal hairy polyps are rare lesions that present as a pedunculated mass that may arise from the oropharyngeal or nasopharyngeal regions of the pharynx. The mass has the potential to partially or completely obstruct pathways towards the trachea and/or esophagus resulting in respiratory distress and/or feeding difficulties respectively. They have a predilection for female infants of 6:1 with the vast majority of the cases occurring in the infantile period. We report 5 cases of the hairy polyp in female infants, one of which showed unusual presentation since it was diagnosed at ten months of age.

Congenital hairy polyp of the soft palate

Hairy polyp is an unusual developmental malformation that is most frequently seen as a pedunculated tumor in the neonate. They are benign lesions containing elements of both ectodermal and mesodermal origin. The symptoms of hairy polyps relate both to their location and their size. Larger lesions produce symptoms due to feeding difficulties and airway obstruction while smaller lesions cause intermittent symptoms resulting from a ball-valve type of obstruction. We present two cases of a soft palate hairy polyp causing respiratory and feeding difficulties and review the literature.

Primary tumors and tumor-like lesions of the eustachian tube: a systematic review of an emerging entity

Eustachian tube (ET) primary tumors and tumor-like lesions are rare diseases presenting with common ear, nose and throat symptoms. Pathology can range from developmental anomalies to high malignant neoplasms. Hence this review aimed at suggesting a classification and outline relevant aspects of ET primary tumors and tumor-like lesions, describing clinical findings, diagnostic management and therapeutic approaches. MEDLINE, CINAHL, OVIDSP, HIGHWIRE, and GOOGLE databases were searched from inception to July 2011 for relevant studies. Further papers were identified by examining the reference lists of all included. Sixty-five papers met the inclusion criteria, enclosing 78 cases. Case reports are increasing in the past few years. Benign lesions and tumor-like lesions of ET have been reported. Moreover, melanomas, carcinomas, and sarcomas can affect the ET as a primary site.

Unusual case of soft palate hairy polyp causing airway obstruction and review of the literature

Hairy polyps are rare benign tumors that are derived from 2 germ layers: ectoderm and mesoderm. Although location in the head and neck area is rare, the soft palate as the site of origin is even more unusual. The clinical presentation depends on the polyp's location and size. These masses can commonly cause respiratory and feeding difficulties. We present a case of a soft palate hairy polyp causing respiratory and feeding difficulties in a 6-month-old female infant and review the literature.

Nasopharyngeal hairy polyp with recurrence in the middle ear

A 6-year-old girl was referred to The Johns Hopkins Hospital for a suspected congenital cholesteatoma. The lesion was determined to be a recurrence of a nasopharyngeal hairy polyp removed in the postnatal period. Simple excision is normally regarded as curative: malignant transformation and local recurrence do not occur. Our case is exceptional in that incomplete excision of the nasopharyngeal polyp was followed by re-growth and extension into the middle ear over a 6-year period. Thus, not all hairy polyps are static lesions. Indeed, this case documents progressive growth of a hairy polyp during physical development of a child, and indicates a potential for local recurrence following incomplete excision. A review of possible etiologies is conducted.

[Congenital hairy polyp of the nasopharynx--a case report]

INTRODUCTION

Hairy polyps are very rare benign tumors that can occur anywhere in the body, and they are the most common congenital nasopharyngeal masses.

CASE REPORT

A two-day-old full-term female was admitted to the newborn Special Care Unit with noisy breathing, intermittent upper airway obstruction and feeding difficulty. A 3.4 kg infant was born by spontaneous vaginal delivery to a healthy mother, following a normal pregnancy. On admission, she presented with noisy inspiratory breathing which was louder and more labored in prone position. Flexible endoscopy showed a pale sausage-like mass protruding from nasopharynx just behind the soft palate, to the oropharynx and back. A computed tomography scan showed a 1.8 cm round mass in the right nasopharynx, with central fat density and no intracranial communication. The mass was excised transorally with no evidence of a residual tumor. The infant made a full and uneventful postoperative recovery.

DISCUSSION

Hairy polyps usually occur as isolated defects and they are not associated with other congenital anomalies. Genetic predisposition has not been established. It does not have malignant alteration. However, there is some confusion about the histological classification of these lesions. One theory supports the idea that hairy polyps originate from disturbed development of stomodeum in the 28th week of gestation and regression of the nasopharyngeal membrane. The second theory supports the idea of origin from the first or second bronchial arch. Probably the best assumption would be that it develops as a special and unique entity.

CONCLUSION

Hairy polyp is an unusual malformation that most frequently appears during the first days after birth. Complete resection provides permanent cure.

A rare cause of wheezing in infancy

We describe an infant with recurrent wheezing and cough caused by an oropharyngeal cyst. Mucosal oropharyngeal cysts arise from obstruction or traumatic severance of a duct in a minor salivary gland, which leads to retention of mucous secretion . The mucosal cyst of the oropharynx is a rare cause of respiratory distress in the infants. The clinical symptoms depend on the size, shape, and location of the cyst.

Hairy polyp of the pharynx obscured on physical examination by endotracheal tube, but diagnosed on brain imaging

We report a case of hairy polyp of the pharynx diagnosed on brain MRI in order to stress the need to examine carefully all tissues included on an imaging study, even those outside the clinically stated region of interest, and to remind practitioners to consider unusual as well as common etiologies for neonatal respiratory distress. Our case is unique in that thorough examination of a brain MRI, ordered in the evaluation of presumed central apnea, led to the correct diagnosis.

An oral choristoma in a foal resembling hairy polyp in humans

A neonatal foal was presented with a 6.5-cm pedunculated mass arising from the upper deciduous incisors. The distal end was soft and covered by haired skin, whereas the proximal end was firm, covered with mucosal epithelium, and at the point of transection contained a fully developed tooth. Microscopically, the mass was covered by epidermis and mucosal epithelium and the remaining portion of the mass consisted of mature collagen, nonneoplastic fat and smooth muscle, and a single tooth within a bony socket. The mass is consistent with an oral choristoma and has features similar to those described for hairy polyp in humans.

Hairy polyp of the tongue: a case report

Hairy polyps or dermoids of the oro- and nasopharynx are benign lesions containing elements of both ectodermal and mesodermal origin. Because of its rarity, we report a case of hairy polyp arising from the tongue in a 40-day-old infant. The lesion was covered by squamous epithelium and a central core of fibroadipose tissue, minor salivary glands, and cartilage. We discuss the clinicopathological features, terminology, etiology, and differential diagnosis of this condition.

An unusual presentation of neck dermoid cyst

Congenital masses are the most common non-inflammatory neck lesions in children. Although usually present at birth, they can appear at any age. Dermoid cysts are benign lesions of congenital origin usually presenting as a midline neck mass. They rarely appear in the lateral region of the neck. Lateral cervical dermoid cyst is presented as a rare, unusual case, and differential diagnosis and management are discussed in light of recent literature.