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.