４０１１本小児放射線学会雑誌￣

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MihoOkamoto,YasushiOhki,Yukihir()Ｙ()shizawa,RenmMiyazawa,TomokoSuzuki1
MasahikoTabata,MakotoKuwashima,HarumitsuTakeuchi
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Ab`SWpC／lHailypolypofthenas()pharynxisanuncomm()ndevelopmentalmallbrmati()nthatis

mostfrequentlyseenasapedllncu1ate(ＩＩｕｍ()rinlheneonate・Wereportafemaleneonalewi(hLhis
lesi()nshowingintermittentrespirat()1ｙ〔listresssL1ccesslullvtreatedwithsurgicalcxcisiolLMR
showedtheprecisetissuecharacterislicsandlocati()nsinthecaseofourpatien[belOre[ｈｅsurgery・

Inanewbornwithanaso-oropharyngealmass,MRisrecommendedtoprospective1ydiflerenUaIea
beniRnfafcontaininRmassfiDmacystorlesionoIvascularorneurogenicorigin．
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protrudeintothemouthwhenshewascrying[ｌｎｄａ［ｔｈｅｔｉｍｅｏｆａｐｐｌｙｉｎｇｏｒｏｐｈａｒｙｎｇｅａ］

Hairypolypinlheupperaerodiges(ivelrac（ｉｓａｎｕｎｃｏｍｍｏｎｄｅｖｅｌ()ｐｍｅｎｔａｌａｎ()Illalyc()nsistingofectodel-ma］ａｎｄｍｅｓ()〔1〔､rmalsucli()n.ALothertimes,i1wasbarelyvisible（)、〔1irec（ｉｎspectionofthemouthThemasswask)11,(Itobeamobilepedunculatedlesion.Ｔｈｅp(，(1ｉｃｌｅｓＧｅｍｅｄｔｏａｔｔａｃｈｔｈｅｍａｓｓｔ(）ｔｈｅｌｅ｢ｔpedunculatedmobilemmor,anditlnaycause
in(el-mittentairwayobstruclionｉｎｔｈｅｎｅｗｂｏｌ.n．
Wereportherethemagneticresonanceimaging(ＭＲ）hndingsonanasopharyngealhailyp()lypｓｉｄｅｏ[theoropharynx、inaneonate

ｉｍａｇｅｓｏＩＬｈｅｍａｓｓshowedahyperintense

lissuc1）．ＩＬｍｏｓｔｆｒｅｑｕｅ１１ｔｌｙｏｃｃｕｒｓａｓ【lCasereport
Alemaleinhlntweiｇｈｔｉｎｇ３１０１８ｇｗａｓｂ()mbyspontaneousvaginaldeliverya（３８weeks
gesta(ion・Shedevelopedintermittentcyan()licepisodessoonafterbirth・Afteradmissionlo()ur
hospital，shehadsuccessiveepisodesofapnca
andcyanosisrelievedbyvigorouscrying・Her
respiratorydistressdisappearedimmedialGly
aHerendotrachealintubaUon、

Around-shapedwhitishmasswasseenl(）

MRimageswereobtainedwhile［hemass
waspulledandfixedintheoralcavitybymeanso［sulures、Axia］ａｎｄｓａｇｉｔｔａ］Ｔ１－ｗｅｉｇｈｔｅｄ

signal（Iatintensily）surroundinganisointense(musclcintensity)center(Fig.１，２)Jtseemedtohavecontinuilytotheleitlateraloropharyn‐gealwalLThesefindingsallowedaconfiden(1)reoperativediagnosisoIabenignhl[‐containingteratoidpo]yp・
Duringsulgery,itwasnotedlhatthelesion
was3cＩ１ｌｉｎｄｉａｍｅｔｅｒａｎｄｓｋｉｎ－ｃｏｖｅｒｅ(Iwilh

numerouslinehairs・Thepolypiscoveredwith
keraliniｚｅｄｓｋｉｎ，ａｎｄｈａｄａｃ()ｌ－ｅ（)ｆｌｉｂｒ〔)‐musculartissuesurroundedbymatu1℃adil)OＳＧ

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tissue(Fig.3)．Ｉｔｈａｄａｌ〕edicleattachedtothe

ｔｉｓｓｕｅｃｏｖｅｒｅｄｂｙｓｑｕａｍ()usepithelium

leftuppersurIaceoIthesoHpalate・Themass
wassuccesshlllyexcised,al1dtheinflntmadean

includinghairfolliclesandsebaceousglands(Fig.4b)．

uneventlillrecovely・Ｓｈｅｂａｓｄｏｎｅｗｅｌｌ［OrlO
monthspostoperativelyWith(〕ulcomplications・HistologicalexaminaIiollshowedllbr()ｍus‐
cularbundleswithcarljlageatthecenterofthe
polyp（Fig.4a).Thcpolyl)ｃ()nsistedoffatty

Ｄｉｓｃｕｓｓｉｏｎ

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uncommondevelopn1enialmallbrmation・ItwaS
observedmostii｡e〔luel〕tlyil］theneonatalperiod

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SagittalT1-weighte〔1(a）ａｎ(1T2-weighted(b）MRimagesshowalnass（a1.r()ＷＳ）withlal
intensitysurroundingthGc〔)rewithmuscleintensily．

＃ザ縮【●１－‐‐諄□Fig2AxialT1-weighted(a）andT2-weighted(b）MRimages

Similarlothesagittalimages,fatintensitysunDundstheInuscleintensity-core・
Theｍａｓｓ（arrows）seemstohavecontinuiwtothe]enlateraloropharyngealwall
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４２n本小児放射線学会雑誌

andapproximatelyl40caseswerereporLedin

Englishliteraturel).Theclinicalpresentation
dependｓｏｎｔｈｅｓｉｚｅ，shape,andlocaUonofthe

lesionLargelesionscancauseacllteairway
obstrucｔｉｏｎａｎｄ，ｌｅｓｓｃｏｍｍｏｎｌｙ，feeding
difficulty，hemoptysis，unilatera］nost1-il
drainage・Thelateralwallofthenasopharynx
andtheuppersulfaceofthesoftpalatearelhelnostcommonsitesoforigilL
Inearlierreports,hairypolypwasreIerredto
as“teratomas"，“dermoids"１０ｒ“hamartomas、９０

Ｔｈｅconfilsednomenclamrefordevelol)ｍｅｎｔａｌ
ｔｕｍｏｒｓｈａｓｂｅｅｎｃｌａｒｉｆｉｅｄｂｙBatsakis・He
classifiedthemintonvesubRI-oupslhamartoma，

choristoma,embryoma,teratoma,anddermoid2)．
Themostappropriatedesignationfol-thehairypo]ypisachol-istoma，sinceitiscolnposedof
tissueforeｉｇｎｔｏｔｈｅｓｉｔｅｂｕｔｉｔｉｓｏｔｈｅｒｗｉｓｅ
ｈｉstologicallynormalasinourcase・Hamartoma
issimilarmalformationｓｂｕｔｄｉｌｆｅｒｉｎｂｅｉｎｇ
ｃｏｍｐｏｓｅｄｏｎｌｙｔissuesindigenoustothesite・
Teratomaisregardedastrueneoplasm,which
differentiatetowardstissueso［allthreegel-mlayers・Dermoidcystiscomposedofenclaved
ectoderma］ｔｉｓｓｕｅａｎｄｉｓｌｏｕｎｄａｔｐｏｉｎｔｏｆ
ｄｅvelopmentallilsion・ExceptfO]-ａｓｍａ]lpartof
lheteratomas,thesedevelopmental（umorsdo
nothavegrowU1ormalignantpotentiaLHistolo‐gica1ly，ｈａｉｒｙｐｏｌｙｐｉｓｃｏｖｅｒｅｄｂｙｓｑｕａｍｏｕｓ
ｅpitheliumincludinghairfblliclesandsebaceous

glands､Thedeeperpal-tsareconsistedoffatty
connectivetissuewithsmoothandstriatedmuscle､minorsa】ivaryglands,nerves,cartilage，

鑑
Fig.３Crosssectionalappearanceofthe
PolypThepolypiscovel-edwithkeratinizedskin，
andhadacoreofIibromusculartissue

surroundedbymatureadiposetissue．

andbone3).Surgica1excisionresultsinacomplete
curePreoperativeradiologicalsLudiesarecruciaI
todelilleaUngthelocation,extent,andcharac-

teristicofthelesiolLThedifferentialdiagnosisol
nasopharyngealmassintheneonateincludes
teratoma,hemangioma,neuroblastoma,glioma，
meningoencephalocele，andIOregut,ｔｈｙｍｉｃ，
thyroglossal,andlingualcvsts・Ｉｎｏｕｒｃａｓｅ,ＭＲ

【●．

召’

Figo4Photomicrographsofthespecimenstainedwithhematoxylinandeosin

Thecentralpartofthemasscontainscartilaginous[issue(a).Thecoreofadiposetissueis

coveredwithkeratinizedepiderlnisanddermis､T1Iisconlainshairfo]liclesandsebaceous
glands(b)．

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2）BatsakisJ(｝：Nomcnclature()｢(ievel()l)111(､nlalllIm()rs・AI1I1（)[()ＩＲｈｉｎ()ｌＬａＩｙｎｇ()］１９Ｍ；９３：

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ｃａｓｅ1℃I〕()l1withspeculationol〕、()sology・ＡｍＪＩ)erma【()I)nlh()１１９９０；１２：294-298.
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obstl･ucti()ｌｌｂｕｌｃａｎｂｃｃｏｍｐｌｅＭｙｃＬｌｒｅ〔Ibysurgicalexcisi()I】、ＩｎａｎｅｗｂｏｒnwiIhallas()‐4５