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

Neoplasms of the middle pharynx make up, according to various authors, from 0.5 to 5% of all human tumors. Like neoplasms of other localizations, tumor lesions of the oropharynx are divided into 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. Papillomas are the most common benign tumors. They are often localized on the palatine arches, tonsils, mucous membrane of the soft palate and rarely on the back wall of the pharynx. Pharyngeal papillomas are single formations, the diameter of which rarely exceeds 1 cm.

Papilloma is quite common among benign tumors of the pharynx. Squamous cell papillomas of the palatine arches, tonsils, uvula and free edge of the soft palate are usually isolated.

Papilloma is a formation with a grayish tint, uneven edges and a granular surface, mobile, since most often it has a thin base (pedicle). The mucous membrane around the papilloma is unchanged.

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

A common tumor of the oropharynx is hemangioma. It has many varieties, but in the middle part of the pharynx, cavernous diffuse and deep capillary hemangiomas predominate. Much less often, you can encounter branched venous or arterial vascular tumors.

Hemangioma in the middle part of the pharynx is encountered somewhat less frequently than papilloma.

Deep capillary hemangioma is covered with unchanged mucous membrane, its contours are unclear

The tumor is difficult to distinguish from neurinoma and other neoplasms localized in the thickness of tissues by its appearance. Cavernous and venous hemangiomas are most often located superficially. They are bluish, the surface of these tumors is bumpy, the consistency is soft. Encapsulated cavernous hemangiomas have clear boundaries. Branched arterial hemangioma, as a rule, pulsates, and this pulsation is noticeable during pharyngoscopy. The surface of the tumor may be bumpy. Arterial hemangioma must be differentiated primarily from aneurysm (using angiography).

The boundaries of a hemangioma are difficult to determine. This is due to the fact that the tumor spreads not only on the surface, but also deep into the tissues, often reaching the vascular-nerve bundle of the neck, filling the submandibular region or appearing as a swelling, most often in front of the sternocleidomastoid muscle.

A mixed tumor is found in the middle pharynx as often as a hemangioma. It develops from the minor salivary glands. In terms of occurrence frequency, this neoplasm is second only to papilloma. Due to its high 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, less commonly, posterior walls of the middle pharynx. Since the tumor occurs and develops deep in the tissues, on the surface of the pharynx walls it is visible as a well-defined swelling of dense consistency, painless on palpation, with an uneven surface. The mucous membrane above the tumor is unchanged. It is not possible to distinguish a mixed tumor from other neoplasms of this localization (neurinoma, neurofibroma, adenoma) by appearance. The final diagnosis is established based on the results of a histological examination.

Tumors such as lipoma, lymphangioma, etc., are rarely encountered in the middle part of the pharynx. Of these tumors, only osteoma can be diagnosed without histological examination. It is radiopaque, but the final diagnosis is still established based on the results of histological examination, which allows determining 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 do not manifest themselves in any way for a certain period of time, for several years. In 20-25% of patients, benign neoplasms of the pharynx are discovered by chance.

In most patients with neoplasms of the oropharynx, the first signs of the disease are a sensation of a foreign body in the throat, a sore throat, or other paresthesias. Patients often complain of dryness in the throat, and sometimes of mild pain in the morning when swallowing saliva ("empty swallow").

Such neoplasms as papillomas, fibromas, cysts located on the palatine arches or tonsils may not cause any symptoms for years; only when the tumor reaches a large size (1.5-2 cm in diameter) does a sensation of a foreign body in the throat arise. Dysphagia is more typical for tumors of the soft palate. Violation of the tightness of the nasopharynx during swallowing leads to a disorder of the act of swallowing, the entry of liquid food into the nose. Such patients sometimes speak nasal. The sensation of a foreign body in the throat and other paresthesias appear very early in neoplasms of the root of the tongue and valleculae. These tumors can cause difficulty swallowing, including choking when taking liquid food.

Painful sensations are not typical for benign neoplasms of the oropharynx. Pain during swallowing or independently of swallowing may occur with neurinomas, neurofibromas and very rarely with ulcerated vascular tumors.

Bleeding and blood in sputum and saliva are characteristic only of hemangiomas, as well as ulcerated and disintegrating malignant tumors.

Diagnosis of benign tumors of the oropharynx

Physical examination

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

In early diagnostics, the oncological alertness of clinic doctors is of great importance. 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 waste time. The duration of the period from the first visit of the patient to the establishment of the diagnosis and the beginning of treatment should be minimal. Often in clinics, and especially in oncology dispensaries, when a tumor is suspected, the patient is prescribed a number of studies. Only upon receiving the results of numerous studies, a smear-print is taken for cytological or a piece of tissue for histological examination, while these manipulations could have been performed among the first, thereby reducing the duration of the examination period and diagnosis by 10-12 days.

Instrumental research

The main method of examining the pharynx is pharyngoscopy. It allows determining the localization of the tumor focus, the appearance of the neoplasm, and the mobility of individual fragments of the pharynx.

Angiography, radionuclide examination and CT can be used as auxiliary methods of examination for hemangiomas. Angiography is the most informative, allowing to determine 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 phase, and branched arterial hemangiomas - in the arterial phase of angiography. The diagnosis of hemangioma is usually established without histological examination, since biopsy can cause intense bleeding. The histological structure of the tumor is most often learned after surgical intervention.

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