Teratoid polyp of the nasopharynx By A. K.
CHATTOPADHYAY
and G.
DASGUPTA
(Miraj)
TERATOMA literally means 'a malformation which is also a tumour'. It contains multiple tissues foreign to the part, but differs from 'hamartoma' by virtue of its potentiality of progressive growth in both benign and malignant forms. It is more common in the ovaries and testes, although reported in other sites. Recently, we removed a polypoidal mass from the nasopharynx of a 9-month-old child and the histopathological report showed a teratoid polyp. The case is being reported here for its rarity.
Case report M.J., a male child aged 9 months, was referred for examination from the paediatric service due to noisy breathing and recurrent cough with fever since birth. The patient was suffering from bronchopneumonia at the time of presentation. E.N.T. examination revealed a whitish mass hanging behind the uvula. PNS roentgenogram showed clear antra. Blood for V.D.R.L. was negative both in patient and in parents. There were no other congenital abnormalities detected in the body. After controlling the bronchopneumonia with a course of antibiotics, the polypoidal mass was removed under general anaesthesia. It was firm to feel with areas of cystic consistency. The mass was attached to the roof of the nasopharynx with a pedicle. Histopathological report Macroscopic: The specimen consists of a polypoidal mass measuring 2 • 5 x 1-8x1-5 cms., greyish white in colour, with areas of cystic degeneration. The cysts were found to be filled with clear fluid on cutting. Microscopic: Sections show a mass of soft tissue covered with stratified squamous as well as pseudostratified columnar epithelium. The mass is composed of (i) mature collagenous tissue with many blood vessels, (ii) areas of myxomatous degeneration and cyst formation, (iii) mucus glands, (iv) cerebral nervous tissue, (v) groups of cells in solid acini resembling hypophyseal gland, (vi) hyaline cartillage and (vii) bone. Impression: Teratoid polyp of the nasopharynx. Discussion Teratoma of the nasopharynx, though uncommon, is a well defined clinical entity. It is sparsely mentioned in ENT text books but isolated cases are reported in the journals. Most of these cases are reported as 'hairy-polyp' or dermoid of the nasopharynx (Foxwell and Kelham, 1958) The polyp occasionally causes asphyxia neonatorum when it has to be removed within a few hours or a few days after birth (Akbay, 1965). The child 1065
A. K. Chattopadhyay and G. Dasgupta may come late, when respiratory distress is not acute, as in the case recorded here. It may produce difficulty in swallowing rather than breathing, when' it hangs into the oropharynx (Boies and Harris, 1965). It may even produce a thick voice on crying, without any difficulty in deglutition or respiration (Badrawy et al., 1973).
FIG. I.
Showing gross specimen.
FIG. 2. Microphotograph showing areas of myxomatous degeneration (H & E stain x 100).
The tumour may be attached anywhere around the nasopharynx. Usually, it can easily be avulsed as it is pedunculated (Bicknell, 1967). \ Histologically, the tissue may represent all the components of the three; 'germ-layers'. However, the gross appearance of these tumours varies greatlyj according to the variety of tissues which they contain. 1 1066 j
Clinical records Badrawy et al. (1973) suggested its origin on a developmental basis. In their opinion, incomplete resorption of the bucconasal membrane leads to the formation of these polypoidal tumours. Alternatively, growth hormones which determine the orderly sequence of normal development, may play a part in its origin (Willis, 1951).
FIG. 3. Microphotograph showing areas of brain tissue (H & E stain X 100).
FIG. 4. Microphotograph showing areas of hyaline cartilage (H & E. stain x 100).
Summary A case of teratoma of the nasopharynx in a 9-month-old child is reported. A short review of literature is made as to the presentation and origin of the growth. 1067
A. K. Chattopadhyay and G. Dasgupta Acknowledgement We are grateful to the Medical Superintendent, for allowing us to use the hospital records. Our thanks are due to the Department of Pathology for the histopathological reports and microphotographs. REFERENCES 66, 1094. A. M. (1973) Journal of Laryngology and
AKBAY, Y. (1965) Journal of Paediatrics, BADRAWY, R., FAHMY, S. A., and TAHA,
Otology, 87, 796. BICKNELL, M. R. (1967) Journal of Laryngology and Otology, 81, 1045. BOIES, L. R., and HARRIS, D. (1965) Laryngoscope, 75, 763. FOXWELL, P. B., and KELHAM, B. H. (1958) Journal of Laryngology and Otology,
72,
647. R. A. (1951) Atlas of Tumor Pathology, Section III, Fasciele, 9, Armed Forces Institute of Pathology, Washington, D.C.
WILLIS,
Department of Otolaryngology, Wanless Hospital, Miraj Medical College, Miraj, Maharashtra, India-416 410.
1068
CHATTOPADHYAY
and G.
DASGUPTA
(Miraj)
TERATOMA literally means 'a malformation which is also a tumour'. It contains multiple tissues foreign to the part, but differs from 'hamartoma' by virtue of its potentiality of progressive growth in both benign and malignant forms. It is more common in the ovaries and testes, although reported in other sites. Recently, we removed a polypoidal mass from the nasopharynx of a 9-month-old child and the histopathological report showed a teratoid polyp. The case is being reported here for its rarity.
Case report M.J., a male child aged 9 months, was referred for examination from the paediatric service due to noisy breathing and recurrent cough with fever since birth. The patient was suffering from bronchopneumonia at the time of presentation. E.N.T. examination revealed a whitish mass hanging behind the uvula. PNS roentgenogram showed clear antra. Blood for V.D.R.L. was negative both in patient and in parents. There were no other congenital abnormalities detected in the body. After controlling the bronchopneumonia with a course of antibiotics, the polypoidal mass was removed under general anaesthesia. It was firm to feel with areas of cystic consistency. The mass was attached to the roof of the nasopharynx with a pedicle. Histopathological report Macroscopic: The specimen consists of a polypoidal mass measuring 2 • 5 x 1-8x1-5 cms., greyish white in colour, with areas of cystic degeneration. The cysts were found to be filled with clear fluid on cutting. Microscopic: Sections show a mass of soft tissue covered with stratified squamous as well as pseudostratified columnar epithelium. The mass is composed of (i) mature collagenous tissue with many blood vessels, (ii) areas of myxomatous degeneration and cyst formation, (iii) mucus glands, (iv) cerebral nervous tissue, (v) groups of cells in solid acini resembling hypophyseal gland, (vi) hyaline cartillage and (vii) bone. Impression: Teratoid polyp of the nasopharynx. Discussion Teratoma of the nasopharynx, though uncommon, is a well defined clinical entity. It is sparsely mentioned in ENT text books but isolated cases are reported in the journals. Most of these cases are reported as 'hairy-polyp' or dermoid of the nasopharynx (Foxwell and Kelham, 1958) The polyp occasionally causes asphyxia neonatorum when it has to be removed within a few hours or a few days after birth (Akbay, 1965). The child 1065
A. K. Chattopadhyay and G. Dasgupta may come late, when respiratory distress is not acute, as in the case recorded here. It may produce difficulty in swallowing rather than breathing, when' it hangs into the oropharynx (Boies and Harris, 1965). It may even produce a thick voice on crying, without any difficulty in deglutition or respiration (Badrawy et al., 1973).
FIG. I.
Showing gross specimen.
FIG. 2. Microphotograph showing areas of myxomatous degeneration (H & E stain x 100).
The tumour may be attached anywhere around the nasopharynx. Usually, it can easily be avulsed as it is pedunculated (Bicknell, 1967). \ Histologically, the tissue may represent all the components of the three; 'germ-layers'. However, the gross appearance of these tumours varies greatlyj according to the variety of tissues which they contain. 1 1066 j
Clinical records Badrawy et al. (1973) suggested its origin on a developmental basis. In their opinion, incomplete resorption of the bucconasal membrane leads to the formation of these polypoidal tumours. Alternatively, growth hormones which determine the orderly sequence of normal development, may play a part in its origin (Willis, 1951).
FIG. 3. Microphotograph showing areas of brain tissue (H & E stain X 100).
FIG. 4. Microphotograph showing areas of hyaline cartilage (H & E. stain x 100).
Summary A case of teratoma of the nasopharynx in a 9-month-old child is reported. A short review of literature is made as to the presentation and origin of the growth. 1067
A. K. Chattopadhyay and G. Dasgupta Acknowledgement We are grateful to the Medical Superintendent, for allowing us to use the hospital records. Our thanks are due to the Department of Pathology for the histopathological reports and microphotographs. REFERENCES 66, 1094. A. M. (1973) Journal of Laryngology and
AKBAY, Y. (1965) Journal of Paediatrics, BADRAWY, R., FAHMY, S. A., and TAHA,
Otology, 87, 796. BICKNELL, M. R. (1967) Journal of Laryngology and Otology, 81, 1045. BOIES, L. R., and HARRIS, D. (1965) Laryngoscope, 75, 763. FOXWELL, P. B., and KELHAM, B. H. (1958) Journal of Laryngology and Otology,
72,
647. R. A. (1951) Atlas of Tumor Pathology, Section III, Fasciele, 9, Armed Forces Institute of Pathology, Washington, D.C.
WILLIS,
Department of Otolaryngology, Wanless Hospital, Miraj Medical College, Miraj, Maharashtra, India-416 410.
1068
