Managing a Fibroepithelial Polyp of the Tonsil

Case Report

A 17-year-old man was noted to have a left tonsil mass when he attended his family physician with tonsillitis. Following treatment with a course of penicillin his tonsillitis resolved but the mass persisted albeit asymptomatic. Review by an ENT specialist confirmed a smooth oval pedunculated mass arising from the superior pole of the left tonsil (Figure 1 and Figure 2). The mass was freely mobile and rested at the tongue base. The rest of the ENT examination was normal. The management options discussed included observation, excision biopsy and a left tonsillectomy. The patient chose to be observed and was reviewed at three months. Due to the persistence of the tonsil mass, an excision biopsy under general anaesthetic was proposed. The procedure was straightforward and the patient recovered well (Figure 3). The final histology confirmed a benign fibroepithelial polyp with no dysplasia or malignancy. The patient was reassured and discharged from the clinic.

A number of benign growths can arise from the tonsil and those more frequently reported include Fibroma, Lymphoid polyp, Lymphangiomatous polyp, Lymphangiectatic fibrolipomatous polyp, Hairy polyps (dermoids), Haemangiomatous hamartoma, Fibrovascular polyp, Lipoma, Neurofibroma and Schwannoma [1]. A fibroepithelial polyp arising from the tonsil, in an adult, is extremely rare and we have noted only one other case published in the English literature [1]. The exact aetiology of this interesting benign pathology is unknown [2]. A large tonsil polyp can cause throat irritation, dysphagia, sleeping problems and potentially upper airway obstruction [3]. The surgical excision of the tonsil mass with or without tonsil is advisable for diagnostic and therapeutic purposes [4].

Learning Points

1. Patients can present with asymptomatic growths arising from the tonsil.

2. A number of benign growths can arise from the tonsil including a fibroepithelial polyp.

3. The surgical excision of the tonsil mass with or without tonsil is advisable for diagnostic and therapeutic purposes.

References

1. Farboud A, Trinidade A, Harris M, et al. (2010) Fibroepithelial polyp of the tonsil: Case report of a rare, benign tonsillar lesion. J Laryngol Otol 124: 111-112.
2. Eads TJ, Chuang TY, Fabre VC, et al. (1996) The utility of submitting fibroepithelial polyps for histological examination. Arch Dermatol 132: 1459-1462.
3. Mangar W, Jiang D, Lloyd RV (2004) Acute presentation of a fibroepithelial pharyngeal polyp. J Laryngol Otol 118: 727-729.
4. Balatsouras DG, Fassolis A, Koukoutsis G, et al. (2011) Primary lymphangioma of the tonsil: A case report. Case Rep Med 2011: 183182.