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Título

Nasopharyngeal Polyp: an unusual presentation

RESUMO

Case Presentation: J.I.R.B., a 17-year-old male student with a history of pharyngeal pain, nocturnal nasal obstruction for 2 months, associated with a complaint of throat swelling for 1 month. He denied dysphagia, rhinorrhea, headache and allergic symptoms. He was not asthmatic. Oroscopy revealed a large polypoid lesion protruding from the oropharynx. On dynamic inspection, the soft, but not friable, lesion invaded the oral cavity, occupying almost the entire oropharynx. Magnetic resonance imaging revealed a bulky lesion with cystic components, hyperintense on T1-weighted and hypointense on T2-weighted images, of approximately 8.0 cm in its largest diameter on the sagittal section, extending from the nasopharynx to the oropharynx, reaching the region of the epiglottis. Endonasal and oral endoscopic resection was indicated, and the polyp was dissected and removed from the nasopharynx, which, because of its size, was removed through the oral cavity. The procedure was uneventful during or after surgery, and he was discharged after 48 hours. The anatomopathological study revealed an inflammatory polyp, with intense interstitial edema and an inflammatory infiltrate rich in eosinophils, with no signs of malignancy. The patient has been followed up for ten months with no recurrence and no pharyngeal, nasal or oral complaints. Discussion: Primary non-neoplastic inflammatory polyps of the nasopharynx are rare, representing 4 to 6% of nasal polyps. There is still no evidence about its pathogenesis, but it is believed that both the adaptive and innate immune response could be involved. The present case is of great importance because of its rarity, the site of involvement of the benign inflammatory polyp, as well as the size of the lesion. This rare pathology should be added to the list of differential diagnoses of nasopharyngeal mass lesions between nasoangiofibroma and nasopharyngeal carcinoma. Clinically, there is a benign course of this lesion despite the extensive volume. Therefore, regarding neurological manifestations, literature confirms that acute sinus inflammatory damages can possibly result in nerve hypersensitivity Final comments: In the approach of nasopharyngeal and oropharyngeal masses in young and adult patients, primary inflammatory polyps are among the diagnoses to be considered. Despite the small number of cases, the radiological and pathological features of this lesion should be remembered, minimizing the risk of being misdiagnosed.

Palavras Chave

Nasopharyngeal polyp; Polypoid lesion; Oropharynx; Inflammatory polyps.