Childhood lymphangiomatous polyp of the palatine tonsil is a very unusual lesion found in the head and neck. Tonsillectomy has been reported to be the curative procedure of choice for this lesion. We report a case of a very young child with unilateral lymphangiomatous polyp of the palatine tonsil.
Lymphangioma or lymphatic malformation is a benign congenital tumor of the lymphovascular system that most commonly occurs in the head and neck region [
Lymphangiomatous polypoid lesions of the head and neck are very rare and case reports of these tumors arising from the palatine tonsils in the literature are sparse [
In this paper, we describe a case of a very young child who was found to have a lymphangiomatous polypoid lesion of the palatine tonsil.
A 3-year-old girl was seen in the pediatric otolaryngology clinic for evaluation of dysphagia to solid foods. She had no other local or systemic symptoms. Esophagogastroduodenoscopy was arranged to rule out eosinophilic esophagitis and any structural pathologies. Intraoperatively, she was found to have a polypoid lesion arising from the superior pole of the right palatine tonsil (Figure
Intraoperative photograph showing a pedunculated polypoid lesion of the right palatine tonsil.
The endoscopic examination was normal and eosinophilic esophagitis was ruled out. The histopathologic sections of the lesion arising from the tonsil showed a polypoid portion of fibrous connective tissue with nonkeratinizing stratified squamous epithelium at the surface and dense lymphoid tissue at the base (Figure
Histopathologic specimen showing proliferation of thin-walled lymphovascular channels containing luminal valve structures and sparse proteinaceous material with fibrous background, surrounding lymphoid tissue, and surface nonkeratinizing stratified squamous epithelium (40x magnification).
Postoperative followup at one year revealed no evidence of any residual or recurrent polypoid disease. Interestingly, the symptoms of dysphagia gradually improved without any other interventions.
Lymphangiomatous polyps are uncommon benign lesions mostly occurring in the lower gastrointestinal tracts, including the colon [
To date, there has been just over 30 cases of tonsillar lymphangiomatous polyps reported in the literature [
The incidence of these tumors in the general population is currently unknown but many authors suggest that the true incidence is most likely higher than expected [
Prior cases of lymphangiomatous polyp of the palatine tonsil have shown that it mostly occurs unilaterally and does not appear to have a gender predilection. The average age of patients in the aforementioned large case series was 25 years [
Benign tumors of the palatine tonsil are less common than malignancies [
The histopathologic features of a lymphangiomatous polyp that distinguish it from the other processes include dilated vascular channels containing luminal proteinaceous fluid and lymphocyte aggregation, which were present in the biopsied specimen in our case. When compared to other lymphatic malformations in the head and neck, the polypoid lesions differ in that they contain a greater degree of dense connective tissue and the lymphatic channels are not as prominently dilated.
The pathogenesis of tonsillar lymphangiomatous polyps remains unclear. Chronic inflammation and associated obstruction of lymphatic channels were previously suggested as a possible mechanism [
Lymphangiomatous polyps of the palatine tonsils have not been linked to other lymphatic lesions elsewhere in the head and neck region [
Regarding the management of the polypoid lesions, most authors suggest that a tonsillectomy is the curative procedure of choice [
The authors have no financial disclosure or conflict of interests. This material has never been published and is not currently under evaluation in any other peer-reviewed publication.