Hairy Polyp Arising From the Nasal Vestibule

A 3-year-old male patient reported with a left nasal mass found at birth. There were no underlying systemic diseases, congenital malformations, or history of nasal surgery. The nasal mass was between the columella and the left nasal vestibule (Figure 1). A radiologic assessment was not performed because the mass could be observed with the naked eye. The mass was excised at the base of its lesion and cauterized under general anesthesia. Pathological examination revealed a polypoid lesion with benign hair follicles, which was consistent with a hairy polyp (Figure 2). The patient has been regularly visiting the outpatient clinic and has not had a recurrence a year after surgery.

Figure 1.

Nasal endoscopy shows a nasal mass between the columella and the left nasal vestibule.

Figure 2.

Pathological examination reveals a polypoid lesion with benign hair follicles (arrows), which is consistent with a hairy polyp (H-E stain, ×40).

A hairy polyp is a rare congenital tumor that contains ectoderm and mesoderm. Hairy polyps occur in newborns and infants, and there is usually a female predominance. The most common site for hairy polyps is the nasopharynx, but they can also arise from the soft palate, hard palate, Eustachian tube, middle ear cavity, and the tonsils. ¹ Depending on the size and location of hairy polyps, they may be complicated by disorders related to airway obstruction such as dyspnea and feeding difficulties. Magnetic resonance imaging is useful for assessing the origin of nasopharyngeal and oropharyngeal lesions; it may help delineate the degree of soft tissue extension.

Histopathologically, a hairy polyp comprises tissues derived from mesoderm and ectoderm. Mesoderm is usually composed of fibroadipose tissue and cartilage, while ectoderm is composed of squamous epithelium with skin appendages such as hair follicles. ² Hence, the mass was named as a hairy polyp. Histopathologically, lesions to be distinguished from hairy polyps are teratomas, harmatomas, dermoid cysts, and choristomas. ³ A teratoma is composed of all 3 germinal cell layers. A hamartoma is a type of benign tumor comprising normal mature cells that function normally but proliferate abnormally. A dermoid cyst contains squamous epithelium filled with keratinous substances. A choristoma is a normal tissue located away from its original location.

Surgical excision is the recommended treatment for a hairy polyp. To the best of our knowledge, this study is the first case of a hairy polyp arising from the nasal vestibule.