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Figure 1. Hamartomatous polyp in the oropharynx behind the soft palate (arrow). A nasogastric feeding tube is seen between the polyp and the posterior wall of the oropharynx.
Figure 2. Small glandular elements are lined by benign simple cuboidal epithelium with contiguous nests of metaplastic keratinizing squamous cells embedded in a rich capillary vascular bed (hematoxylin-eosin, original magnification ×100).
This patient presented with a relatively common diagnostic dilemma—stridor in the neonate. Stridor is produced by the turbulent flow of air through an obstructed upper airway during either inspiration or expiration depending on the site of obstruction. Causes of stridor can be divided into those of acute (usually acquired) or chronic (usually congenital) origin. Causes of stridor can also be differentiated by anatomic location such as supraglottic, glottic (laryngeal), or subglottic (intrathoracic). Supraglottic lesions generally produce inspiratory stridor as the poorly supported airways collapse during inspiration. Laryngeal lesions produce biphasic stridor. Expiratory stridor is produced by intrathoracic lesions as intrathoracic airways are narrowed or compressed during expiration.1
Causes of congenital stridor in neonates are numerous. Congenital anomalies account for most cases of stridor in young children. Laryngomalacia is the most common congenital laryngeal anomaly accounting for 60% to 75% of cases of stridor in newborns.1 Very rarely tumors or polyps of the oronasopharyngeal or laryngeal area are reported. These include hemangiomas, cysts, teratomas, or dermoid polyps.2
Benign hamartomatous polyps of the oronasopharynx, as seen in this infant, are very rare congenital malformations composed of tissue indigenous to the area in which they are found. They are nonneoplastic, self-limiting tumors that have been described as an exaggeration of normal physiologic tissue development.3 They are to be distinguished from the more common, although still rare, teratomas that develop from embryonic tissue, are foreign to the area in which they occur, and contain all 3 primitive germ cell layers, and dermoid polyps or hairy polyps that are composed of ectoderm and mesoderm and are believed to be inclusion errors in the fusion of the lateral palatine processes.2,4,5
These 3 rare malformations are most commonly seen in neonates. Most infants present with respiratory distress, difficulty feeding, or both.6 Symptoms may be intermittent if the mass is pedunculated and sporadically obstructs the laryngeal or esophageal openings. Sexton6 described a 19-day-old infant with similar symptoms who was found to have a hairy polyp of the oronasopharynx. To our knowledge, no cases of auto-amputation of one of these tumorlike polyps have been described. While the infant appeared stable on presentation, the clinical symptoms and rapid progression points to the necessity for direct or x-ray visualization and careful management of airways and their patency.
An oronasopharyngeal mass is a diagnosis that should be considered in a neonate or infant who presents with intermittent stridor and difficulty feeding. These infants may have had difficulties in the nursery.
Accepted for publication December 1, 1996.
We thank G. J. Walker Smith, MD, for help in preparing of the histological photographs.
Corresponding author: Lynn A. D'Andrea, MD, University of Virginia Health Sciences Center, Department of Pediatrics, Section of Respiratory Medicine, Box 386, Charlottesville VA 22908 (e-mail: email@example.com).
Pathological Case of the Month. Arch Pediatr Adolesc Med. 1998;152(1):94. doi: