Benign tumors of the oropharynx: causes, symptoms, diagnosis, treatment

Neoplasms of the middle pharynx make, according to different authors, from 0.5 to 5% of all human tumors. As well as neoplasms of other localizations, tumor lesions of the oropharynx are liable to tumor-like formations and true tumors. True tumors can be benign and malignant.

They are diagnosed 1.5-2 times more often than malignant ones. Of benign tumors, papillomas are the most common. They are often located on the palatine arch, tonsils, mucous membrane of the soft palate and rarely on the back wall of the pharynx. Papillomas of the pharynx are single formations, whose diameter rarely exceeds 1 cm.

Papilloma among benign tumors of the pharynx is met quite often. The squamous papillomas of the palatine arch, tonsils, tongue and free edge of the soft palate, as a rule, are single.

Papilloma - formation with a grayish tinge, uneven edges and a granular surface, mobile, as it often has a thin base (leg). The mucous membrane around the papilloma is not changed.

The final diagnosis is established based on the results of the histological examination.

Frequent swelling of the oropharynx is hemangioma. It has many varieties, but the middle section of the pharynx is dominated by cavernous diffuse and deep capillary hemangiomas. Significantly less common can be branched venous or arterial vascular tumors.

Hemangiomas in the middle section of the pharynx are met somewhat less frequently than the papilloma.

Deep capillary hemangioma is covered with unaltered mucous membrane, its contours are not clear

In appearance, the tumor is difficult to distinguish from neurinoma and other neoplasms localized in thicker tissues. Cavernous and venous hemangiomas are usually superficially located. They are cyanotic, the surface of these tumors is tuberous, the consistency is soft. Encapsulated cavernous hemangiomas have clear boundaries. Branchy arterial hemangioma, as a rule, pulsates, and this pulsation is noticeable in pharyngoscopy. The surface of the tumor can be bumpy. Arterial hemangioma must be differentiated first of all from an aneurysm (with the help of angiography).

The boundaries of hemangioma are difficult to determine. This is due to the fact that the tumor spreads not only over the surface, but also into the depths of tissues, often reaching the neurovascular bundle of the neck. Filling the mandibular area or appearing as a swelling, more often anterior to the sternocleidomastoid muscle.

Mixed tumors are found in the middle section of the pharynx as often as hemangiomas. It develops from small salivary glands. According to the frequency of occurrence, this neoplasm is second only to papilloma. In connection with a large polymorphism, it is commonly called a mixed tumor or polymorphic adenoma. In the oropharynx, a mixed tumor can be localized in the thickness of the soft palate, on the lateral and, rarely, posterior walls of the middle part of the pharynx. Since the tumor arises and develops in the depth of tissues, on the surface of the pharyngeal walls it is visible in the form of a well-defined swelling of a dense consistency, painless in palpation, with an uneven surface. The mucous membrane over the tumor is not changed. In appearance, it is not possible to distinguish a mixed tumor from other neoplasms of a given localization (neurinoma, neurofibroma, adenoma). The final diagnosis is established based on the results of the histological examination.

Such tumors as lipoma, lymphangioma, etc., are rarely seen in the middle section of the pharynx. Of these tumors, only osteoma can be diagnosed without histological examination. It is radiopaque, but the final diagnosis is nevertheless established on the basis of the results of a histological study, which makes it possible to determine the morphological structure of the tumor focus.

Symptoms of benign tumors of the oropharynx

The clinical symptoms of benign tumors of the middle pharynx are not very diverse. Both tumor-like formations and benign tumors for a certain time, for several years. Do not show themselves. In 20-25% of patients, benign tumors of the pharynx are detected by chance.

In most patients with neoplasms of the oropharynx, the first signs of the disease are the sensation of a foreign body in the pharynx, perspiration or other paresthesia. Often, patients complain of dryness in the throat, and sometimes of mild pain in the morning when swallowing saliva ("empty mouthful").

Such neoplasms as papillomas, fibromas, cysts, localized on the palatine arch or tonsils, may not cause any symptoms for years; only when the tumor reaches a large size (1.5-2 cm in diameter) there is a sensation of a foreign body in the pharynx. Dysphagia is more typical of tumors of the soft palate. Infringement of tightness of a nasopharynx during a pharynx leads to frustration of the certificate of swallowing, hit of liquid nutrition in a nose. Such patients sometimes nasal. The sensation of a foreign body in the pharynx and other paresthesia appear very early in neoplasms of the root of the tongue and valleculus. These tumors can cause difficulty in swallowing, including tearing while taking liquid food.

Painful sensations for benign neoplasms of the oropharynx are uncharacteristic. Pain during swallowing or regardless of swallowing can occur with neurinomas, neurofibromas and very rarely - with ulcerative vascular tumors.

Bleeding and impurity blood in sputum and saliva are characteristic only for hemangiomas, as well as for ulcerated and decaying malignant tumors.

Diagnosis of benign tumors of the oropharynx

Physical examination

In the diagnosis of neoplasms of the ENT organs in general and the oropharynx in particular, a carefully collected history is of no small importance. From the anamnestic data are important information about the patient's age, bad habits, the order of the onset of symptoms. Tumors are characterized by a steady increase in symptoms.

In the early diagnosis of great importance is the oncological alertness of doctors in polyclinics. It is very important to suspect a tumor in a timely manner and conduct a targeted examination, and only the most necessary and informative, so as not to lose time. The length of the period from the first treatment of the patient to the establishment of the diagnosis and the initiation of treatment should be minimal. Often in polyclinics, and especially in oncologic dispensaries with suspicion of a tumor, a patient is assigned a series of studies. Only when the results of numerous studies are obtained, a smear-imprint is taken, for a cytological or piece of tissue for histological examination, while these manipulations could be performed among the first, thereby shortening the duration of the examination period and establishing a diagnosis for 10-12 days.

Instrumental research

The main method of pharyngeal research is pharyngoscopy. It allows to determine the localization of the tumor focus, the appearance of the tumor, the mobility of individual fragments of the pharynx.

As an auxiliary research methods for hemangiomas, angiography, radionuclide and CT can be used. The most informative is angiography, which allows you to identify the vessels from which the tumor receives blood. In the capillary phase of angiography, the contours of capillary hemangiomas are clearly visible. Cavernous and venous hemangiomas are better seen in the venous, and branched arterial hemangiomas - in the arterial phase of angiography. The diagnosis of hemangioma, as a rule, is established without histological examination, as a biopsy can cause intensive bleeding. The histological structure of the tumor is most often recognized after surgery.

[1], [2], [3]