Lymphangiomatous Tonsillar Polyp

Lymphangiomatous tonsillar polyps are benign tumours of the palatine tonsil, accounting for about 2% of all tonsillar neoplasms. They have been reported by a number of different names such as angiomas, angiofibromas, fibrolipoma, polypoid tumour containing fibro-adipose tissue and hamartomatous tonsillar polyp and lymphangiectatic fibrous polyp [105]. They are pedunculated, mostly unilateral proliferations in the upper pole of the palatine tonsils in adults and children (age range of reported cases 3-63 years, with a median age of 26 years). Clinical symptoms are dysphagia, sore throat and the sensation of "a mass in the throat". Lymphangiomatous tonsillar polyps measure between 0.5 and 4 cm. They are covered by respiratory epithelium or glycogenated or keratinised squa-mous epithelium with foci of hyper- and parakera-tosis. Clusters of lymphocytes are found within the squamous epithelium (lymphocytic epitheliotropism) or in the submucosa beneath the basement membrane (Fig. 6.7). The stalk consists of dense fibrous tissue, adipose tissues or myxoid and oedematous stroma, which contains numerous small to medium-sized, endothelial-lined, lymphatic/vascular channels filled with proteinaceous fluid and lymphocytes [82]. Valves can be appreciated. Some endothelial cells stain with antibodies to factor VIII, CD31 and CD34; others are non reactive. The pathogenesis of the lymphangiomatous polyps is uncertain. They may be a hamartomatous proliferation, but they may also be the result of a chronic inflammatory hyperplasia. Especially in children, lymphangiomatous polyps and papillary lymphoid polyps may be a manifestation of a chronic tonsillitis.

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