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Exophytic papilloma - squamous subtype

Case contributed by Henry Knipe
Diagnosis certain

Presentation

Follow-up previously treated extensive SCC of head and neck 20 years ago with primary chemotherapy/radiation therapy. Also has known right multinodular goiter.

Patient Data

Age: 60
Gender: Female

Soft tissue density mass arising from the posterior wall of the nasopharynx. 

Centered in the midline of the posterior nasopharynx is a 28 x 18 x 17 mm soft tissue mass, which is hyperintense on T2, hyperintense on T1 with mildly heterogeneous post-contrast enhancement. It abuts the pre-vertebral fracture with no evidence of deep extension.

Asymmetric soft tissue thickening is some enhancement is seen in the region of the left tonsillar fossa, presumably secondary to previously treated SCC. Right-sided goiter with deviation but no narrowing of the trachea.

The patient proceeded to panendoscopy and received a core biopsy of the nasopharyngeal mass. 

Histopathology:

MICROSCOPIC DESCRIPTION:

The biopsies show exophytic lesions with underlying stroma comprising broad papillae lined by stratified squamous mucosa. There is prominent surface erosion and numerous intraepithelial neutrophils and lymphocytes. There is no dysplasia and no evidence of malignancy.

DIAGNOSIS: Right and left nasopharynx: Benign squamous papilloma(s).

Case Discussion

Exophytic squamous papillomas, along with inverted and oncocytic papillomas, are a type of Schneiderian papilloma. The main differential in this case of nasopharyngeal carcinoma, especially given the history of previous HNSCC. Given the enhancement of the mass, sinonasal polyps should not be considered. 

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