Unilateral Pedunculated Lymphangiectatic Fibrolipomatous Polyp of the Palatine Tonsil: A Rare Case

Abstract

Lymphangiomatous polyps are rare benign hamartomatous tumors of the palatine tonsils that can cause significant distress to the patients such as sore throat, foreign body sensation, a lumpy feeling in the throat region, dysphagia, and eventual suffocation. In this paper, the case of a 17-year-old male who came to the outpatient clinic with a complaint of difficulty in swallowing, eventual vomiting, and occasions of hematemesis is presented. On physical examination, the patient had a smooth-surface, polypoid, pedunculated tumoral lesion originating from the middle pole of the left palatine tonsil and protruding into the oropharyngeal isthmus. The patient underwent left tonsillectomy. Histopathological examination of the surgical specimen showed typical features of a lymphangiectatic fibrolipomatous polyp. The case reported herein with the brief literature review points out the clinical and the benign, non-neoplastic characteristics of the lymphangiectatic fibrolipomatous polyp, which can be cured by surgical excision along with tonsillectomy.

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.…”

“…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.…”