Answer: Hairy polyp

Histology: The specimen consists of a pedunculated polypoid mass covered by keratinized squamous epithelium containing hair follicles, sebaceous
glands and sweat glands. The underlying connective tissue is comprised
of mature fat with occasional plates of hyaline cartilage. Immature elements are not identified. Endodermal tissues are not apparent.

Discussion: Hairy polyps are believed to represent a developmental anomaly involving the 1st branchial cleft. Indeed, they might be thought of as a heterotopic accessory external ear. Most arise from the oropharynx (tonsil) or nasopharynx, and they almost always are diagnosed in newborns. Tumor size is highly variable ranging from a few centimeters to 13 cm. Morbidity and mortality is primarily a function of size and location. Large bulky tumors can cause airway obstruction resulting in respiratory distress. Accordingly, airway management is critical in newborns with obstructive lesions. Simple surgical resection is curative, and tumors do not recur when removal is complete.

Dermoid cysts and true teratomas are likewise midline lesions of the oropharynx and nasopharynx that involve newborns. Dermoid cysts do not contain endodermal or mesodermal components. Teratomas, on the other hand, contain components of all 3 germ cell layers. For practical purposes, the distinction between a hairy polyp and a teratoma in not clinically important – at least in children. Teratomas in the pediatric population are uniformly benign, even those tumors that harbor immature elements. On very rare occasions, a teratoma may arise in the head and neck region of an adult. Unlike teratomas of newborns and infants, these are biologically aggressive tumors that are usually malignant.