Hamartomatous polyp of the tonsil: A case report

Abstract

Hamartomatous polyps of the tonsil are rare. They have been described using various terms such as a lymphangiomatous polyp, lymphangiectatic fibrous polyp, lipomatous polyp, or pedunculated tonsil; hence, the actual incidence is difficult to be quantified. Polyp of the palatine tonsils is an unusual benign lesion of the head and neck. It is a rare polypoidal mass that generally arises from a pedicle attached to the tonsil and projecting into the oropharynx. Polypoid lesions of the head and neck are likewise rare, and such tumors arising from the palatine tonsils are sparse. Tonsillar polyp is an uncommon hamartomatous lesion that generally arises from the tonsillar surface. It has rarely been reported in the medical literature. We present a case of hamartomatous polyp of the palatine tonsil in a 17-year-old male patient.

Hamartomatous polyp of the palatine tonsil: histological considerations and review of the literature

“…Lymphangiomatous polyps are common in the low gastrointestinal tract, 3. However, tonsillar lymphangiomatous polyps are rare entities with sparse reports in the literature, 1–19. Nevertheless, most authors agree that this condition has a higher incidence than reported because these masses can be overlooked in a routine examination and because of inconsistencies with their classification 1–6.…”

“…Commonly, they are polypoid, but sessile lesions have also been described 1 10. The age of appearance varies, but it seems more common during the second decade of life,1–19 contrary to the typical lymphangiomas that are usually present at or around the time of birth 2. Most series do not show any sex or laterality predilection;1 10 however, a recent study supports a 1.4:1 male to female ratio 21.…”

“…In most cases of tonsillar hamartomatous polyps, the procedure of choice is a bilateral tonsillectomy, 2 4 10 11 14–16. However, a simple lesion excision is probably sufficient with no recurrences reported in a 1-year follow-up, 3 7. These operations would not be expected to be more complicated than a typical tonsillectomy because the hamartomatous polyp is not invading the deep peritonsillar tissues.…”

“…The typical histological features of a tonsillar hamartomatous polyp include a non-keratinising stratified squamous epithelial covering, a core of loose fibrous and adipose tissue with sparse lymphoid aggregations and dilated thin-wall lymphatic and blood channels filled with lymph and lymphocytes, especially T-cells, 1–5 7–11 15. More rarely, these lesions appear as lymphoid papillary hyperplasia, which does not have prominent lymphoid follicles but more prominent lymphatic spaces 1.…”

“…A hamartomatous polyp is not expected to manifest any cytologic atypia or abnormal lymphatics infiltrating the deeper tissues of the tonsil 2 11. The different arrangement of normal tonsillar components may eventually classify the lymphangiomatous polyps as hamartomas instead of tumours 1 2 5–7 10–13 15–17. Immunohistochemical staining is unnecessary for the histological diagnosis; however, some studies have shown that most channels stained positive for Factor VIII-related antigen, anti-CD31 or anti-CD34 1 2 9…”