Benign Tumors of Fauces and Oral Pharynx
The great majority of benign tumors of the oral
pharynx are of connective tissue origin; small epithelial papillomas of the
tonsillar pillars and soft palate, though not rare, are less often seen,
because they are generally symptomfree and are detected only accidentally on
routine examination. The small papillary masses can be removed at the base with
a forceps; after cauterization, they rarely recur.
Squamous papilloma is a common
benign nonneoplastic lesion of the oropharynx. It consists of nonkeratinized
squamous epithelium within a fibrovascular connective tissue stroma. It is seen
in association with human papillomavirus serotypes 6 and 11. Although it can be
found on all intraoral mucosal sites, it has a predilection for the hard and
soft palate and uvula. Verruca vulgaris, the common wart, can be seen in the
same oropharyngeal regions and is also associated with human papillomavirus
infection but with serotypes 2 and 4.
Small adenomas of the soft
palate and the posterior pharyngeal wall are seldom seen and are best treated
by excision.
The more frequent types of
tumors are the sessile, connective tissue tumors of angiomatous origin. Hemangioma
of the oral pharynx is usually congenital but may go unnoticed until later
in life. The bluish purple discoloration of the tumor through the overlying
distended mucosa is characteristic and permits the diagnosis without further
microscopic examination. The mass is soft and collapsible on pressure. Many of
these tumors are symptom-free and only rarely do they produce bleeding.
Hemangiomas of the pharynx are occasionally associated with similar lesions on
the lip, tongue, or cheek and elsewhere in the gastrointestinal tract. No
therapy is indicated unless the lesions become large and symptomatic. Surgical
excision is the treatment of choice.
Mixed tumors of the
pharyngeal wall present
as smooth, rather firm, submucosal bulges. They are occasionally seen in the
retrotonsillar region behind the soft palate, on the posterior pharyngeal wall,
or in the substance of the soft palate itself. Diagnosis may be made by needle
biopsy. More frequently, excisional biopsy of the whole tumor with a safe
margin of mucosa on the free edges establishes the diagnosis and provides
surgical excision of the lesion. Mixed tumors have a tendency to recur unless
they are widely excised. If the tumor is br ken or incompletely removed,
recurrence is common.
Neurofibroma of the
hypopharynx presents as a
sessile, nodular, submucosal tumor frequently extending in a linear fashion
along the posterior or lateral pharyngeal wall. These tumors may be associated
with diffuse neurofibromatosis. They are encapsulated tumors that protrude into
the hypopharynx. Diagnosis may be suspected from aspiration biopsy, but
excisional biopsy with a wide margin of mucosa is more reliable.
Other less frequent types of
tumors of connective tissue origin, occasionally seen in the oral pharynx, include
lipomas, myoblastomas (especially on the posterior aspect of the tongue), and
fibromas of the pharyngeal mucosa. Rarely, a myoblastoma may develop as a
result of a trauma and submucosal hemorrhage. These tumors, characterized by
polygonal cells with highly granular cytoplasm, can be felt as a deep mass
below the mucosa. They are not as firm as carcinoma and have no tendency to
ulcerate. All these neoplasms are best treated by local excision, which both
establishes the diagnosis and effects a cure.
