Eustachian tube mature teratoma

(a) MRI shows a mass in the posterior of the nasopharynx extending down to the oropharynx, and with no intracranial extension. (b) CT 3-dimension reconstruction showed that lesion with a margin enhancing had core-like structure in the posterior nasopharynx and a pedicle into the significantly widened left Eustachian tube orifice up to the hypotympanum. (c) An air-containing middle ear with a left dilated Eustachian tube. (d) Under light microscopy, the lesion is covered with stratified squamous epithelium and some respiratory epithelium, but contained skin appendages (hair follicles, sebaceous glands and sweat glands), well-differentiated fibroadipose tissue, cartilage and dilated small blood vessels and lymphatic vessels.

(A) Endoscopic examination revealed “hairs” on the surface of the nasopharyngeal mass. (B) Postoperatively the orifice of the left Eustachian tube is intact, but larger than the right side. (C) On gross examination, the lesion was rounded with hair at the nasopharynx end and a pedicle from the Eustachian tube. (D) There was a perforation in the anterior–inferior part of the tympanic membrane after surgery.