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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:
    • On imaging, they present as expansile polypoid lesions arising from the palatine tonsil, showing regular and well-defined borders.
    • 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.
  • 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.
December 17, 2020

A 19-year-old man presented to the emergency department with an intraoral mass 3 days after an episode of emesis. The patient denied pain, bleeding, fever, and odynophagia. Oroscopy revealed a smooth and regularly shaped pedunculated mass in the left tonsil, with no ulceration and no signs of hemorrhage. There were no palpable lymph nodes on physical examination.

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