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A newborn twin girl was referred to the pediatric otolaryngology clinic at a tertiary pediatric hospital for evaluation of a left-sided nasal mass causing nasal obstruction and difficulty breathing, especially with feeding (Figure 1A). She was born at 36 weeks’ gestation and spent 10 days in the neonatal intensive care unit. Her parents noted that the lesion was present at birth and she always seemed congested on the left side. There was no report of clear drainage. Physical examination showed an approximately 1-cm, firm, pedunculated polypoid mass in the anterior nasal cavity at the vestibule. The base was located just anterior to the septum and encompassed nearly the entire left nasal cavity. There was no fluid in the mass, and there was a negative Furstenberg sign. Nasal endoscopy was performed in the clinic, and there were no additional masses or mucosal abnormalities. The choana was patent. The patient was also noted to have left eye ptosis and left preauricular branchial remnants but no other significant abnormalities on examination. Magnetic resonance imaging was performed (Figure 1B) and showed a 0.8 × 0.5–cm hyperintense mass on T1-weighted images, suggesting a fatty component and no intracranial tract.
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B. Hairy polyp
Congenital midline nasal masses are rare and occur in only 1 of 20 000 to 40 000 births.1 The differential diagnosis includes nasal dermoids, encephaloceles, and gliomas, which represent the most common causes. All of the previously listed masses may have intracranial extension.1 Hairy polyps are epithelial-lined polypoid masses that usually arise from the oropharynx or the nasopharynx.2
Hairy polyps have keratinizing squamous epithelium on the surface and surround underlying pilosebaceous units and a fibrofatty core (Figure 2A and B). Mature adipose tissue makes up the core (Figure 2C). Hairy polyps differ from mature teratomas (dermoids) histopathologically because they lack endodermal elements. Both hairy polyps and mature teratomas contain ectodermal and mesodermal contents. Hairy polyps may contain mesodermal elements, such as cartilage, bone, or muscle, but they lack endodermal elements and are not true teratomas. A hairy polyp is classified as a type of choristoma, which is a nonneoplastic mass composed of mature heterotopic tissue.3,4 Reported cases of hairy polyps have occurred mainly in the nasopharynx and oropharynx, including the soft palate, hard palate, tonsils, eustachian tube, middle ear cavity, and tongue.5,6 To our knowledge, there is only one other case report of a hairy polyp in the nasal cavity.1
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Corresponding Author: Peter S. Karempelis, MD, Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Phillips Wangensteen Bldg, 516 Delaware St, SE, Ste 8A, Minneapolis, MN 55455 (firstname.lastname@example.org).
Published Online: December 6, 2018. doi:10.1001/jamaoto.2018.3123
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient’s mother for granting permission to publish this information.
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