Journal of Postgraduate Medicine Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India ISSN: 0022-3859 EISSN: 0972-2823 Vol. 55, Num. 4, 2009, pp. 288-289

Journal of Postgraduate Medicine, Vol. 55, No. 4, October-December, 2009, pp. 288-289

Images in Pathology

Fibroepithelial polyp arising from the inferior nasal turbinate

Perić A, Matković-Jožin S, Vukomanović-Đurđević B¹

Clinic for Otorhinolaryngology, ¹ Department of Pathology, Military Medical Academy, 11040 Belgrade, Serbia

Correspondence Address: Dr. Aleksandar Perić, Clinic for Otorhinolaryngology, Military Medical Academy, 11040 Belgrade, Serbia, alexneta@sezampro.rs

Date of Submission: 05-May-2009
Date of Decision: 24-Jul-2009
Date of Acceptance: 31-Aug-2009

Code Number: jp09092

PMID: 20083881

DOI: 10.4103/0022-3859.58938

Fibroepithelial polyps (FEPs) are benign polypoid lesions arising from the mesodermal tissue and composed of varying amounts of stroma covered by squamous epithelium. ^[1] Most of them present in males between 40 and 70 years of age, although cases of women and children have been previously described. ^[1],[2],[3] They are often seen in the skin (head and neck, axilla, inframammary region) and, also in the gastrointestinal, low respiratory and genitourinary system. ^[2],[4],[5] Upper airway FEP is a rare lesion. We present the second reported case in the world literature of a patient with an FEP originating from the nasal cavity. Only one case of FEP has been previously described by Firat et al. ^[5]

A 69-year-old woman presented to the ENT service with a six-month history of slowly progressive right-sided nasal obstruction and intermittent mucopurulent rhinorrhea. Except arterial hypertension, she had no other health problems. Nasal endoscopy demonstrated a lobular mass which filled the right vestibule. This pedunculated lesion was attached to the anterior tip of the right inferior turbinate. Computed tomography (CT) scan showed a soft-tissue opacity that filled the right nasal vestibule without any sinus invasion and bony destruction [Figure - 1]. The polyp was excised endoscopically under local anesthesia. On endoscopic examination mucosa of the inferior nasal concha seemed healthy. The patient's nasal breathing improved immediately after surgery. Macroscopic examination showed a ball-shaped, pink-colored soft-tissue mass, measuring 10 mm in diameter, which had a thin pedicle. It seemed to be covered with healthy nasal mucosa. Histological analysis (H and E) revealed a fibrous stroma with numerous dilated, hyalinized vessels containing red blood cells and focal hyaline trombi. Adipose tissue constituted a major portion of the stroma [Figure - 2]a. The polyp was covered by squamous epithelium with pseudostratified respiratory epithelium and glandular epithelium remnants [Figure - 2]b. The fields of reactive epithelial changes including acanthosis and hyperkeratosis were also found. These findings suggested the diagnosis of fibroepithelial polyp. About three months after the excision of the polyp, the patient's nasal breathing was good. Endoscopic finding was normal.

Etiology of FEP is unknown. A few theories exist regarding the cause of these tumors. The first one is a theory of development secondary to focal losses of elastic tissue. ^[6] The second theory is that FEP is a mixture of different tissue elements which could represent hamartoma of the lamina propria that slowly enlarge. ^[4] Lloyd et al. ^[1] described the case of the development of chondroid metaplasia within an FEP situated on the tongue. Toma and Fisher ^[7] reported a case of an osteoma arising from the tissue of an FEP. This metaplasia in FEP is unclear but it may occur as a defensive reaction and originate from multipotential mesenchymal cells. ^[1] Traditionally, FEPs have been thought to occur after mucosal trauma. In our case, there was no history of mucosal irritation. The main histological characteristic of FEP is tissue polymorphism. In our patient, we could see three different tissues of mesenchymal origin in one small tumor stroma: fibrous, adipose and vascular. On the tumor surface, we found three different kinds of epithelium: respiratory, glandular, and squamous. Agir et al. ^[8] described the case of a patient with an aggressive gross dermal squamous cell carcinoma arising from a large pedunculate-type FEP located at the lower limb. Although FEPs are benign, slowly-growing tumors, they need excision and histopathological examination because of possibility of tissue metaplasia and malignant transformation.

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