Pathological Case of the Month FREE

A 9-DAY-OLD boy presented to the pediatric emergency department with a 1-day history of intermittent stridor and difficulty feeding. The patient, a 2920-g infant, was born at 40-weeks' gestation following an uncomplicated pregnancy, labor, and delivery. He spent 6 hours in the newborn intensive care unit because of jitteriness and mild respiratory distress. The symptoms resolved except for an intermittent "squeaky, high-pitched cry." One day before admission to the hospital, he became increasingly irritable and also had decreased oral intake. Physical examination on the day of admission revealed an infant with soft, intermittent inspiratory stridor occurring during feedings or while quietly lying supine. The stridor resolved when he held his neck in a hyperextended position or when he was placed prone. A 1- to 2-cm, red-purple ulcerated mass over the right posterior soft palate and pharyngeal arch was seen. A radiograph of the lateral aspect of the neck confirmed a large mass in the oropharynx behind the soft palate (Figure 1). It did not appear to originate from the posterior wall as a nasogastric feeding tube could be seen between the polyp and the posterior wall of the oropharynx on the x-ray film. Soon after admission, the infant began choking and coughed out a piece of tissue. The gross specimen demonstrated a 1×1-cm, in greatest diameter, red-tan polypoid mass. The tissue was examined histopathologically (Figure 2).