Dermal choristoma of nasopharynx

Abstract

The dermal choristoma of the nasopharynx is a developmental tumor that has been reported under a variety of different terms, including accessory auricle, hairy polyp, and dermoid. Although the majority of these lesions arise from the vault of the nasopharynx near the region of the eustachian tube orifice, they have also been reported to arise within the eustachian tube itself, from the nasopharyngeal surface of the soft palate, the oropharynx in the tonsillar region, and, rarely, in the middle ear and mastoid area. We report a case of an otherwise healthy 15-month-old female who presented with a 1-year history of right-sided clear rhinorrhea. Nasopharyngoscopy revealed a 1-cm firm, pinkish-white, smooth-surfaced, spherical, pedunculated mass arising from the left nasopharyngeal wall. The left-sided lesion acted as a ball valve to produce intermittent right-sided obstruction of the nasal passage. Imaging studies demonstrated a homogenous solid mass of the density of adipose tissue. It was excised without complication using cautery. Histopathologic examination revealed a solid mass of fibroadipose tissue that was surfaced by essentially normal skin. The keratinized stratified squamous epithelial surface exhibited a granular layer and numerous dermal appendage structures, including hair follicles, sebaceous glands, and sweat glands. The lesion did not exhibit elastic cartilage. These clinical and histologic findings support the diagnosis of dermal choristoma, a lesion that should be included in the differential diagnosis of nasopharyngeal masses in young individuals.