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Clinical Challenge
April 2018

A Pediatric Nasopharyngeal Mass

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor
  • 2Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor
JAMA Otolaryngol Head Neck Surg. 2018;144(4):371-372. doi:10.1001/jamaoto.2017.3072

An otherwise healthy 3-year-old boy presented with symptoms of sleep-disordered breathing. He had no reported respiratory issues at birth and no feeding difficulties. His symptoms included gasping and apneic episodes at night, as well as nighttime nasal congestion. He had been evaluated by an outside otolaryngologist, who had scheduled an adenoidectomy. Intraoperatively, he was found to have a nasopharyngeal mass, and thus surgery was aborted. Nasal endoscopy in clinic revealed a firm, mobile mass in the nasopharynx. Magnetic resonance imaging of the brain revealed a 21 × 14 × 18-mm irregular, but well-defined, heterogeneously enhancing mass in the left nasopharynx with increased perfusion (Figure, A). Given the vascularity of the tumor, the boy underwent preoperative embolization with interventional radiology. He was subsequently taken to the operating room, where endoscopic resection of the mass and division of the pedicle were performed without complication (Figure, B). Final pathologic results demonstrated keratinizing squamous cysts and collections of ductal structures set within a myxoid stroma, with small nests of primitive mesenchyme (Figure, C and D).