Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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December 17, 2020
Lymphangiomatous Polyp
- Background:
- Histologically, hamartomatous polyps from the palatine tonsils are a mixture of fibrous elements, adipose tissue, and vessels. Depending on the preponderant elements, they may be classified as fibromas, fibrolipomas, or fibrovascular or lymphangiomatous polyps.
- Clinical Presentation:
- Most commonly, they present with dysphagia, dysphonia, odynophagia, and possibly a choking sensation.
- Intermittent regurgitation of the polyp is not an uncommon occurrence and usually is associated with episodes of coughing or emesis.
- Key Diagnostic Features:
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On imaging, they present as expansile polypoid lesions arising from the palatine tonsil, showing regular and well-defined borders.
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On CT, there are usually areas of fat-tissue attenuation, but fibrous components with soft-tissue attenuation and small vascular structures can also be found.
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- Differential Diagnoses:
- Other hamartomatous tonsilar lesions (fibromas, fibrolipomas, fibrovascular polyps): These lesions represent a disorganized proliferation of elements normally found in the tonsil and are histologically similar, varying in the preponderance of fibrous elements, vascular structures, and adipose and lymphoid tissues. Together with the lymphangiomatous polyp, they are part of the same spectrum and it may be impossible to differentiate them in imaging studies.
- Squamous papilloma: May present as a pedunculated lesion with soft-tissue attenuation arising from the tonsil, soft palate, or epiglottis, similar to the hamartomatous polyps previously described. Histologically, they show epithelial proliferation, arranged in multiple layers, not invading the underlying stroma, and lack the lymphatic and lymphocytic components seen in lymphangiomatous polyps.
- Other possible differential diagnoses include: juvenile angiofibroma (typically occurs in the nasopharynx; more aggressive growth pattern; intense contrast enhancement; patients clinically present with epistaxis), lipoma (homogeneous fat density mass), liposarcoma (infiltrative growth pattern; inhomogeneous attenuation with significant amounts of soft tissue within the fatty mass; areas of contrast enhancement), and teratoma (heterogeneous mass; fat and soft-tissue attenuation; foci of calcification).
- Treatment:
- Surgical excision along with tonsillectomy is considered curative treatment.
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