Lymphangiomatous Polyp of Palatine Tonsil in A Child Presenting with Dysphagia and Dysarthria

Abstract

A 14-year-old boy presented with one year history of mass in the oral cavity which was initially small and progressively increased in size. He complained of difficulty in speaking and swallowing since four months. There was no history of respiratory difficulty sore throat or bleeding. Patient was undergoing psychiatric treatment for behavioral problems and is on resperidone therapy. Otorhinological examination of oral cavity revealed a smooth pinkish white mobile nontender firm pedunculated mass arising from superior pole of left tonsil and extending over the anterolateral surface of the tongue [Table/ Fig-1]. Patient could voluntarily swallow and regurgitate the mass. Rest of the oral cavity, nasopharynx and larynx were normal. There was no evidence of cervical lymphadenopathy. Systemic examination and all other routine investigations were normal. A left tonsillectomy with tonsillar mass excision was done under general anesthesia and the specimen was sent for histopathological examination. Grossly the left tonsil measured 2.5x1.5cms. A polypoid large smooth mass was seen arising from the superior pole of the tonsil attached to it by a small stalk measuring 7x2x2cms [Table / Fig-2]. Cut section was homogenous white tan and the mass had a firm consistency. Microscopic examination of hematoxylin and eosin stained sections showed a polypoid mass lined by nonkeratinising stratified squamous lining. Subepithelium showed a dense collection of lymphocytes along with few lymphoid follicles [Table/ Fig-3]. Stroma of the polyp showed many dilated lymphatic and blood vessels admixed with fibrocollagenous and adipose tissue [Table / Fig-4 [

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

“…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. Characteristically, a tonsillar lymphangioma may be reported in the literature under various terms like lymphangiomatous polyp, polypoid lymphangioma of the tonsil, lymphoid polyp, tonsillar angiofibroma, lymphangiectatic fibrolipomatous polyp, fibrolipoma, angiofibrolipoma, polypoid tumour containing fibroadipose tissue, hamartomatous tonsillar polyp and lymphangiectatic fibrous polyp 2 3 5 10. Notably, the last edition (5th) of the WHO classification of Head and Neck tumours uses the term ‘tonsillar hamartomatous polyp’ for a tonsillar lymphangiomatous polyp;20 thus, we comply with that terminology in our case report article.…”

“…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.…”

“…Macroscopically, these lesions usually present as large, pale, smooth masses 1–3 5 10–13. Commonly, they are polypoid, but sessile lesions have also been described 1 10.…”

Differential Diagnostics of a Tonsillar Lymphoangiomatous Polyp

“…Specifically, pedunculated lymphoangiomatous polyp (PLP) of tonsils is extremely uncommon and there are only a few cases dedicated to this pathology [1,2].…”

Lymphangiomatous Polyp of the Palatine Tonsil

“…8 It has also recently been suggested that they may develop as a result of uncontrolled neoplastic proliferation of lymphatic vessels due to dysregulation of growth factors such as Prox-1 and vascular endothelial factor. 9 Lymphangiomatous polyps lead to swallowing difficulty, the sensation of foreign body in the throat, sore throat, and tonsillar mass. Respiratory difficulty and stridor may occur if the mass is very large.…”