Giant Fibrovascular Polyp of the Oropharynx

The case of a 49-year-old woman who presented with a 1-year history of mild dyspnea and recent onset of occasional difficulty swallowing.

A, Sagittal T1-weighted MR image shows a sausage-shaped hyperintense mass extending inferiorly from the oropharynx, posterior to the base of the tongue, to the cervical esophagus along the posterior pharyngeal wall and postcricoid space (arrows).

B, Axial T1-weighted MR image shows the site of origin of the pedicle in the posterior aspect of the right palatine tonsil and the medially directed stalk (arrow).

C, Axial T1-weighted MR image, obtained at the level of the supraglottic larynx, shows the position of the polyp behind the right aryepiglottic fold, medial to the pyriform sinus (arrow).

D, Axial T1-weighted image, obtained at the level of the first tracheal ring, shows a hyperintense mass filling the lumen of the proximal cervical esophagus (arrows).

E, Axial contrast-enhanced fat-saturated T1-weighted image, obtained at the same level as that shown in figure 1D, shows loss of signal and confirms its fatty nature.

F, Intraoperative photograph showing the fibrovascular polyp being delivered into the oral cavity through gentle traction. Note the origin of the pedicle from the body of the right palatine tonsil.

G, Photograph of the surgical specimen after resection shows a 9-cm sausage-shaped lesion covered by wrinkled mucosa.

H, Photomicrograph of a longitudinal section through the body of the polyp (hematoxylin and eosin stain; original magnification, ×100) shows a central core of dilated vascular spaces surrounded by a matrix of fibrous connective and adipose tissue covered by normal squamous epithelium, with no evidence of hyperplastic or dysplastic changes.