title: Congenital hairy polyp of the oropharynx presenting as an esophageal mass in a neonate, a case report and literature review.
abstract: OBJECTIVE
  To review the literature of congenital hairy polyps and describe the clinical presentation, operative management, and histologic findings of a congenital hairy polyp arising from the palatopharyngeus muscle in a neonate with recurrent choking episodes.
  
  
  METHODS
  Chart review of a 2-month-old male referred to a tertiary care pediatric hospital.
  
  
  RESULTS
  We present a case of a 2-month-old male who presented to the emergency room with recurrent episodes of choking and vomiting. The patient was previously healthy with no prior medical or neonatal history. The parents noted a small fleshy mass in the patient's oropharynx that he would chew on and swallow after several minutes. However, on physical exam, there was no evidence of oropharyngeal mass. The patient did not have respiratory distress. Imaging revealed a 22×7×11mm oblong, fatty mass in the lower cervical and upper thoracic esophagus with a thin stalk extending proximally to the upper collapsed esophagus. Intraoperative recorded laryngoscopy revealed a pedunculated soft palate mass attached to the right superior palatopharyngeus muscle. Histopathology revealed ectodermal and mesodermal elements in a polypoid structure lined by keratinizing squamous epithelium with adnexal structures and central mature adipose tissue, consistent with congenital hairy polyp resembling an accessory tragus of the ear and branchial anomaly. At 6-week follow up, the patient was doing well and gaining weight appropriately with no further choking episodes. There was no evidence of velopharyngeal dysfunction on follow up exam. The surgical site was completely healed and there was no evidence of recurrence.
  
  
  CONCLUSIONS
  Congenital hairy polyps of the naso- and oropharynx are rare but may present as airway or esophageal masses, causing respiratory distress or choking episodes in a pediatric patient. The pathologic findings of keratinizing squamous epithelium, adnexal structures, adipose and cartilage tissues resemble congenital accessory tragus and may be considered a branchial arch anomaly.
authors.affiliation: Bobby R. Alford Department of Otolaryngology, Head and Neck Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States. Electronic address: alrichte@bcm.edu.
authors.forename: Amy
authors.initials: A
authors.lastname: Richter
authors.affiliation: Department of Pediatric Gastroenterology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Krupa
authors.initials: K
authors.lastname: Mysore
authors.affiliation: Department of Pediatric Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Deb
authors.initials: D
authors.lastname: Schady
authors.affiliation: Department of Pediatric Otolaryngology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Binoy
authors.initials: B
authors.lastname: Chandy
mesh_terms: D000402:Airway Obstruction / Q000209:etiology; D001934:Branchial Region / Q000002:abnormalities*; D004848:Epithelium / Q000473:pathology; D006801:Humans; D007223:Infant; D007828:Laryngoscopy; D008297:Male; D009960:Oropharynx; D010608:Pharyngeal Diseases / Q000151:congenital* / Q000473:pathology / Q000601:surgery; D010609:Pharyngeal Muscles; D011127:Polyps / Q000151:congenital* / Q000473:pathology / Q000601:surgery; D014839:Vomiting / Q000209:etiology
keywords: Airway; Branchial anomaly; Congenital hairy polyp; Esophageal mass; Oropharynx; Palatopharyngeus