Adult Adenoid Hypertrophy Mimicking a Nasopharyngeal Mass: A Diagnostic Challenge

Abstract

The adenoids, also known as the nasopharyngeal tonsils, come from lymphoid tissue in the pharyngeal mucosa. They are part of Waldeyer’s ring, which is a circular arrangement of lymphoid tissue. This ring includes the pharyngeal (adenoid), palatine, lingual, and tubal tonsils. These tonsils are located at the entrance of the aerodigestive tract. They play an important role in mucosal immunity during early life by trapping inhaled pathogens and helping with antigen presentation. This contributes to both humoral and cell-mediated immune responses. Adenoid hypertrophy is predominantly a pediatric condition and rarely persists into adulthood due to physiological involution after puberty. When present in adults, it may clinically and radiologically mimic various nasopharyngeal pathologies, including malignancy. We report a case of a 51-year-old woman presenting with long-standing left-sided nasal obstruction. She also presented with snoring, mouth breathing and headache. Clinical examination revealed a deviated nasal septum and a suspected nasopharyngeal mass. Radiological evaluation demonstrated a soft tissue lesion in the nasopharynx, raising suspicion of a neoplasm, for which a biopsy was performed. Histopathological examination revealed respiratory epithelium overlying dense lymphoid tissue with well-formed follicles and prominent germinal centers, consistent with reactive lymphoid hyperplasia, without evidence of atypia or malignancy. This case highlights the importance of considering adenoid hypertrophy in adult nasopharyngeal masses and underscores the essential role of histopathology in ensuring accurate diagnosis and appropriate management.