The Laryngoscope VC 2013 The American Laryngological, Rhinological and Otological Society, Inc. Case Report Nasopharyngeal Lymphangioma in an Adult: A Rarity Mehmet Haksever, MD; Davut Akduman, MD; S€ und € us Aslan, MD; Semih Yazla, MD; H€ ulya Haksever, MD Abstract: Lymphangiomas are rare congenital tumors of the lymphatic system, most often encountered during child- hood. Although the most frequent locations for lymphangioma are the head and neck region, isolated involvement of the nasopharynx is very rare and only two cases have been reported since 1969. We report a case of a 60-year-old male with a nasopharyngeal mass that presented with nasal obstruction. The surgical excision of mass was performed by a combined transoral and transnasal endoscopic approach. Histopathological evaluation revealed the diagnosis as lymphangioma. After a follow-up of 18 months the patient is free of recurrence. Key Words: Lymphangioma; nasopharynx; nasal obstruction. Laryngoscope, 123:2972–2975, 2013 INTRODUCTION Lymphangiomas are rare congenital tumors of the lymphatic system. They consist of abnormal development of the lymphatic system in localized centers. Lymphangio- mas are classified as microcystic (capillary hemangiomas), macrocystic (cavernous hemangiomas), and cystic hygromas according to the size of the lymphatic cavities incorporated. 1 They are usually diagnosed in infancy (50% of all lesions are noted at birth) and develop by 2 years of age and early childhood. They have a marked predilection for the head, neck, oral cavity, axilla, and abdomen. 1,2 But isolated involvement of the nasopharynx with lymphangioma is very rare. Our literature search for nasopharyngeal lymphangioma displayed no new cases in the last 40 years. Two unique case had been reported in Russian in 1966 and 1969 (no abstract avail- able). 3,4 We report the case of a 60-year-old male with the diagnosis of nasopharyngeal lymphangioma. CASE REPORT A 60-year-old nonsmoker male was referred to an outpatient clinic with complaints of difficulty in nasal breathing. Endoscopic nasal examination revealed a polypoid mass arising from the nasopharynx that narrows the nasal airway. The mass had a smooth globu- lar surface, originating from the right posterolateral nasopharyngeal wall and reaching to the upper pole of the right tonsil (Fig.1), which appeared by direct oropha- ryngeal inspection. There was no cervical lymphadenop- athy or otologic and blood abnormality. A magnetic resonance imaging (MRI) of the naso- pharynx was carried out. It revealed a soft tissue density at the nasopharyngeal space. The mass was constricting the airway asymmetrically and reaching to the base of tongue. The dimensions of the mass were measured 18 3 21 millimeters (Fig. 2) and the histopathologic analy- sis was suggested in the assessment of MR. The physical examination and imaging study of the mass indicated that it could be a benign lesion. A total exci- sion of the mass was performed with combined transoral and transnasal approaches under endoscopic view. The operation was carried out with general anesthesia, and a (  ) degree 4 mm telescope was used to visualize the mass transnasally. The mass was excised from the posterior nasopharyngeal wall with the use of bipolar cautery with- out significant bleeding. A transoral approach, as in tonsil- lectomy (rose position) was used to excise the elongated component, which reached the upper pole of right tonsil. A rubber catheter was passed through one of the nares and brought out into the pharynx. The catheter was used to retract the soft palate; a clamp on the rubber catheter at the level of the tip of the nose helped accomplish this. The total excision of the mass was completed without any com- plications. Hemostasis was ensured, and there was no need for packing of the surgical area. Patient was discharged from the hospital at the postoperative second day. The patient was followed up for 18 months. He healed well and reported significant relief of symptoms postoperatively. Histopathological examination of the specimen revealed multiple cystically dilated channels lined by a flattened endothelium. Scattering lymphocyte was Presented at the 34th Turkish National Otorhinolaryngology and Head–Neck Congress, Antalya, Turkey, October 10–14, 2012. The authors have no funding, financial relationships, or conflicts of interest to disclose. From the Department of Otorhinolaryngology (M.H., D.A., S.A., S.Y.), Bursa Sevket Yilmaz Training and Research Hospital; and the Department of Pathology (H.H.), Bursa Turkan Akyol Chest Diseases Hospital, Bursa, Turkey. Editor’s Note: This Manuscript was accepted for publication April 30, 2013. Send correspondence to Mehmet Haksever, MD, Bursa Sevket Yilmaz Training and Research Hospital, Department of Otorhinolaryngol- ogy, 16800 Yıldırım, Bursa, Turkey. E-mail: drmehmethaksever@gmail.com DOI: 10.1002/lary.24214 Laryngoscope 123: December 2013 Haksever et al.: Nasopharyngeal Lymphangioma 2972