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Fig. 2.23 A Nasopharyngeal papillary adenocarcinoma. The tumour comprises complex papillae and glands lined by columnar to spindly cells with bland-looking nuclei. B Mucoepidermoid carcinoma of nasopharynx. There are solid islands of squamoid cells and clear cells.

Benign epithelial tumours

Hairy polyp

Definition

A presumed developmental anomaly that clinically manifests as a polyp covered by skin with hair and sebaceous glands.

Synonyms

Teratoid polyp, dermoid polyp. Epidemiology

Hairy polyps occur in newborns and older infants. There is an unexplained female predominance (female to male ratio 6:1) {1296}.

Localization

The lateral wall of the nasopharynx, the superior nasopharyngeal aspect of the soft palate, and the tonsils are classic locations for hairy polyps {1296}. They also have been infrequently reported in the middle ear {1310}. No cases have been reported in the sinonasal tract.

Clinical features

The usual clinical presentation is a pedunculated mass in the oropharynx or nasopharynx of a newborn or older infant. In the middle ear, the hairy polyps cause recurrent otitis media that is not responsive to the usual treatment. There are individual reports of associated cleft palate or multiple congenital anomalies, including the Dandy-Walker malformation {88}.

Histopathology

The surface of the polyp is composed of skin with a delicate hyperkeratotic layer and pilosebaceous units. The core is formed by fibroadipose tissue often with foci of cartilage, muscle and bone. Hairy polyps are distinguished from teratomas by a lack of endodermal components.

Histogenesis

It has been argued that these polyps are congenital anomalies of the first branchial cleft or choristomas {1045}.

Prognosis and predictive factors

Complete surgical excision is curative.

Schneiderian-type papilloma

Definition

A benign tumour that arises from the surface epithelium of the nasopharynx and resembles Schneiderian papillomas of the sinonasal tract {81,1924}.

ICD-O code

8121/0

Synonyms

Fungiform papilloma, Inverted papilloma, transitional papilloma, nasopharyngeal papilloma.

Epidemiology

Schneiderian-type papillomas of the nasopharynx are distinctly uncommon. They occur in older individuals (mean 62 years, range 45-79) and are 2-3 times more common in males {2499}.

Etiology

Anatomically, the posterior choanae represent the boundary between the ecto-dermally-derived (Schneiderian membrane) and endodermally-derived respiratory mucosa that, respectively, line the sinonasal tract and nasopharynx. It is thought that aberrant embryologic displacement of normal Schneiderian mucosa might account for these lesions in the nasopharynx.

Clinical features

Most do not exceed two cm in greatest dimension. They are often incidental findings or, at most, result in nasal airway obstruction. The more common Schneiderian papilloma of the sinonasal tract with secondary involvement of the nasopharynx must be excluded before accepting the lesion as primary in the nasopharynx.

Histopathology

They are similar to those occurring in the nasal cavity and paranasal sinuses (see section on sinonasal papillomas). Most are of the inverted type (ICD-O code 8121/1).

Prognosis and predictive factors

Transnasal or transoral excision is the treatment of choice. Local recurrences are not uncommon. At least one case has been associated with a separate focus of nasopharyngeal squamous cell carcinoma {2499}.

Squamous papilloma

Squamous papillomas are uncommon in the nasopharynx, and they are morphologically similar to those found in the larynx. See chapter on 'Tumours of the hypopharynx, larynx and trachea'.

Ectopic pituitary adenoma

Definition

A benign pituitary gland neoplasm occurring separately from, and without involvement of the sella turcica (i.e., with normal anterior pituitary gland).

Fig. 2.24 Ectopic pituitary adenoma. Ectopic pituitary adenoma of the nasopharynx appearing as a submucosal and unencapsulated cellular tumour; the nasopharyngeal surface epithelium is intact and seen on top.

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