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Sadidi H, Ahmadi G, Mehri A, Nouri Dalouee M. A giant quiet esophageal polyp: A case report. Clin Case Rep 2023; 11:e6823. [PMID: 36654695 PMCID: PMC9834610 DOI: 10.1002/ccr3.6823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
Fibrovascular polyps of the esophagus are rare, benign, intraluminal submucosal tumors. In this report, we present a case of esophageal polyp in a young woman and discuss its diagnostic and surgical aspects.
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Affiliation(s)
- Hossein Sadidi
- Department of Thoracic SurgeryFaculty of Medicine, Mashhad University of Medical SciencesMashhadIran
| | - Ghazale Ahmadi
- Endoscopic and Minimally Invasive Surgery Research CenterMashhad University of Medical SciencesMashhadIran
| | - Ali Mehri
- Endoscopic and Minimally Invasive Surgery Research CenterMashhad University of Medical SciencesMashhadIran
| | - Marzie Nouri Dalouee
- Cardiothoracic Surgery and Transplant Research CenterEmam Reza Hospital, Faculty of Medicine, Mashhad University of Medical SciencesMashhadIran
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Yang L, Zhao R, Lu D, Zhang Y, Hu A, Huang S. Giant Fibrovascular Polyp of Hypopharynx: A Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2023:1455613221148311. [PMID: 36625500 DOI: 10.1177/01455613221148311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Fibrovascular polyps (FVPs) are rare benign submucosal tumor-like lesions originating in the cervical esophagus and sporadically in the hypopharynx. In this article, we report a rare case of FVPs of the hypopharynx (hFVPs) with a mass measuring 16.0 × 4.0 × 1.8 cm in size, discussed its surgical strategy, and additionally reviewed relevant literature on important factors, such as age, sex, symptoms, size, treatments, and recurrence, associated with hFVPs.
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Affiliation(s)
- Liyun Yang
- Department of Otolaryngology, Gongli Hospital, The Second Military Medical University, Shanghai, China
| | - Runyu Zhao
- Postgraduate Training Base at Shanghai Gongli Hospital, Ningxia Medical University, Shanghai, China
| | - Dan Lu
- Department of Otolaryngology, Gongli Hospital, The Second Military Medical University, Shanghai, China
| | - Yi Zhang
- Department of Otolaryngology, Gongli Hospital, The Second Military Medical University, Shanghai, China
| | - An Hu
- Department of Otolaryngology, Gongli Hospital, The Second Military Medical University, Shanghai, China
| | - Shuixian Huang
- Department of Otolaryngology, Gongli Hospital, The Second Military Medical University, Shanghai, China
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3
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Martin EC, Muhonen EG, Wang B, Lin HW, Verma SP. Well-Differentiated Hypopharyngeal Liposarcoma-Associated Airway Obstruction. JAMA Otolaryngol Head Neck Surg 2022; 148:891-893. [PMID: 35900745 DOI: 10.1001/jamaoto.2022.1982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Elaine C Martin
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange
| | - Ethan G Muhonen
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange
| | - Beverly Wang
- Department of Pathology, University of California, Irvine, Orange
| | - Harrison W Lin
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange
| | - Sunil P Verma
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange
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4
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Li WX, Bai JQ, Dong YB, Liu LF. Diagnosis and Management of Giant Esophageal Fibrovascular Polyp With Hypopharyngeal Pedicle. EAR, NOSE & THROAT JOURNAL 2021; 101:374-378. [PMID: 34842469 DOI: 10.1177/01455613211046461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Fibrovascular polyps (FVPs) with hypopharyngeal pedicles (hFVPs) are the rare intraluminal benign tumours of the upper aerodigestive tract, and their accurate diagnosis and optimal management are challenging. Purpose: The present retrospective study attempted to explore the optimal diagnosis and treatment of hFVPs. Research Design: The clinical records of 2 patients with giant, irregularly shaped hFVPs, who underwent several failed surgical procedures after inaccurate diagnosis, were reviewed. Finally, the patients were correctly diagnosed and successfully treated at Capital Medical University Beijing Friendship Hospital in different years, 2018 and 2020. Results: Case 1 was of a 43-year-old woman with 2 months of progressive dysphagia. Gastroenterologists overlooked the origin of her FVP, and decided to sever its narrowest point in the oesophagus through endoscopy. However, upon unsuccessful removal of the mass, a gastrotomy procedure was performed to extract the mass 7 days later. Symptoms recurred 3 months after the treatment, and a fibreoptic laryngoscopy confirmed hFVP in the patient at our department. A transcervical approach was used to sever the hypopharyngeal pedicle, achieve haemostasis and remove the oesophageal tumour. No recurrence was detected during the 2-year follow-up period after the treatment. Case 2 was of a 32-year-old man with dysphagia who had previously undergone transthoracic and transcervical oesophagotomy procedures within a gap of 3 months for the removal of FVP causing dysphagia. The hypopharyngeal pedicle was not diagnosed in the patient. The symptoms of dysphagia recurred 4 years after the treatment, and a fibreoptic laryngoscope confirmed hFVP at our department. The tumour was removed successfully through the transcervical approach. No recurrence was detected during the 6-months follow-up after surgery. Conclusion: In conclusion, the transcervical approach is suitable for achieving haemostasis and removing giant, irregularly shaped hFVPs.
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Affiliation(s)
- Wan-Xin Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, 26455Capital Medical University, Beijing, China
| | - Jia-Qi Bai
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, 26455Capital Medical University, Beijing, China
| | - Yan-Bo Dong
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, 26455Capital Medical University, Beijing, China
| | - Liang-Fa Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, 26455Capital Medical University, Beijing, China
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Khamaysi I, Asbeh YA. Endoscopic resection of giant esophageal fibrovascular polyp. TURKISH JOURNAL OF GASTROENTEROLOGY 2021; 31:276-278. [PMID: 32343242 DOI: 10.5152/tjg.2020.19237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Iyad Khamaysi
- Department of Gastroenterology and Hepatology, Technion-Israel Institute of Technology, Rappaport School of Medicine, Haifa, Israel
| | - Yousef Abu Asbeh
- Department of Chest Surgery, Rambam Health Care Campus, Haifa, Israel
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Polypoid fibroadipose tumors of the esophagus: 'giant fibrovascular polyp' or liposarcoma? A clinicopathological and molecular cytogenetic study of 13 cases. Mod Pathol 2018; 31:337-342. [PMID: 28984298 DOI: 10.1038/modpathol.2017.140] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 12/27/2022]
Abstract
Giant fibrovascular polyp of the esophagus is a descriptive diagnostic term intended to encompass rare, large, polypoid esophageal masses composed of fibroadipose tissue. Despite sometimes dramatic clinical presentations, they have historically been considered to represent reactive, non-neoplastic proliferations. Recently, however, a small number of reports have described well-differentiated liposarcomas of the esophagus, mimicking giant fibrovascular polyps. In order to clarify the relationship between esophageal liposarcoma and giant fibrovascular polyp, we retrieved esophageal cases coded as 'giant fibrovascular polyp,' 'lipoma' and 'liposarcoma' from our archives and re-examined their clinicopathologic features and MDM2 amplification status. Thirteen cases were identified (lipoma (n=1), giant fibrovascular polyp (n=5), well-differentiated liposarcoma (n=3), dedifferentiated liposarcoma (n=3)). The tumors ranged from 5.2 to 19.5 cm and arose predominantly in the cervical esophagus. All consisted chiefly of mature adipose tissue, with a variable component of fibrous septa. In all cases, close inspection of these fibrous septa showed them to contain an increased number of slightly enlarged spindled cells with irregular, hyperchromatic nuclei, similar to those seen in some well-differentiated liposarcomas. Three cases, all previously classified as dedifferentiated liposarcoma, showed in addition solid zones of non-lipogenic spindle cell sarcoma. By fluorescence in situ hybridization (FISH), all cases showed MDM2 amplification, confirming diagnoses as well-differentiated (N=10) and dedifferentiated (N=3) liposarcoma. Clinical follow-up (8 cases, range 22-156 months, median 33 months) showed 3 patients with local recurrences (1 well-differentiated and 2 dedifferentiated liposarcomas), 1 patient with liver metastases (dedifferentiated liposarcoma) and 2 deaths from disease (both dedifferentiated liposarcomas). These results suggest that the great majority of large, polypoid, fat-containing masses of the esophagus represent well and dedifferentiated liposarcoma, rather than 'giant fibrovascular polyps.' We suggest that the diagnosis of 'giant fibrovascular polyp' should be made with great caution in the esophagus, and only after careful morphological study and MDM2 FISH has excluded the possibility of liposarcoma.
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Cockbain AJ, England R, Dexter SPL, Sarela AI. Surveillance Is Important After Surgical Excision of Giant Fibrovascular Polyps of the Esophagus. Ann Thorac Surg 2017; 104:e341-e343. [PMID: 28935332 DOI: 10.1016/j.athoracsur.2017.05.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 05/14/2017] [Indexed: 11/17/2022]
Abstract
Giant fibrovascular polyps of the esophagus are rare benign tumors arising from the cervical esophagus or hypopharynx. Radiologic and endoscopic investigation may struggle to identify a stalk or to delineate the tumor as luminal or submucosal in origin. Excision is advised, although the diagnosis, and therefore the optimal operative approach, may not be apparent until the time of operation. Individual case reports describe the technical success of surgical excision but rarely include follow-up. Our case series highlights the range of approaches for surgical excision and also the importance of long-term follow-up because of the risk of recurrence and potential for airway obstruction.
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Affiliation(s)
- Andrew J Cockbain
- Department of Upper Gastrointestinal Surgery, St. James's University Hospital, Leeds, United Kingdom; Department of Radiology, St. James's University Hospital, Leeds, United Kingdom.
| | - Ruth England
- Department of Upper Gastrointestinal Surgery, St. James's University Hospital, Leeds, United Kingdom
| | - Simon P L Dexter
- Department of Upper Gastrointestinal Surgery, St. James's University Hospital, Leeds, United Kingdom
| | - Abeezar I Sarela
- Department of Upper Gastrointestinal Surgery, St. James's University Hospital, Leeds, United Kingdom
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Ward MA, Beard KW, Teitelbaum EN, Sharata AM, Dunst CM, Swanstrom LL, Reavis KM. Endoscopic resection of giant fibrovascular esophageal polyps. Surg Endosc 2017. [PMID: 28643073 DOI: 10.1007/s00464-017-5664-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Giant fibrovascular esophageal polyps are rare benign intraluminal tumors that originate from the submucosa of the cervical esophagus [Owens et al. (JAMA 103: 838-842, 1994), Totten et al. (JAMA 25:606-622, 1953)]. Due to their indolent course, these tumors tend to reach enormous proportions before patients develop symptoms. Accurately diagnosing these tumors is difficult, as endoscopy may miss 25% of these lesions because these polyps exhibit normal intact esophageal mucosa [Levine et al. (JAMA 166: 781-787, 1996)]. METHODS Surgical resection has been the treatment of choice. We present a video that illustrates the feasibility of an endoscopic approach. TECHNIQUE/CASE A 62-year-old man presented to our clinic with a pedunculated esophageal mass. During this time, he developed progressive dysphagia to solid foods. A complete workup confirmed the presence of a giant polyp and endoscopic resection under general anesthesia was planned. Using an endoscopic snare-technique, a 16 cm × 3 cm polyp was amputated and retracted out of the oropharynx. Upon repeat endoscopy a second 7 cm × 3 cm polyp was discovered originating proximal to the larger polyp. Again, removal of this polyp was attempted using a snare-technique. Following amputation of the polyp, a broad-based component of the polyp remained. Given its proximal location in the esophagus, we were able to use a snare to pull the broad base of the remaining polyp into the oropharynx and remove it at its origin. Postoperative endoscopy and endoscopic ultrasound confirmed that the polyps were completely removed and the muscular resection bed was hemostatic. Clinically, the patient's symptoms resolved and he encountered no adverse sequela as a result of the operation. CONCLUSION Giant fibrovascular esophageal polyps are rare benign intraluminal tumors that can lead to obstructive symptoms. Surgical resection is the treatment of choice, and may be possible with an endoscopic approach. An endoscopic snare technique can be used to resect these lesions while minimizing patient morbidity.
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Affiliation(s)
- Marc A Ward
- Department of Surgery, Providence Portland Medical Center, Portland, OR, USA.
| | - Kristin W Beard
- Department of Surgery, Providence Portland Medical Center, Portland, OR, USA
| | - Ezra N Teitelbaum
- Department of Surgery, Providence Portland Medical Center, Portland, OR, USA
| | - Ahmed M Sharata
- Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA
| | - Christy M Dunst
- Department of Surgery, Providence Portland Medical Center, Portland, OR, USA.,Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA
| | - Lee L Swanstrom
- Department of Surgery, Providence Portland Medical Center, Portland, OR, USA.,Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA
| | - Kevin M Reavis
- Department of Surgery, Providence Portland Medical Center, Portland, OR, USA.,Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA
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Ongkasuwan J, Anzalone CL, Salazar E, Donovan DT. Presentation and Management of Giant Fibrovascular Polyps of the Hypopharynx and Esophagus. Ann Otol Rhinol Laryngol 2017; 126:29-35. [DOI: 10.1177/0003489416672872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Objective:Fibrovascular polyps of the hypopharynx and esophagus are rare, with few case reports in the literature. In this article, we present our institutional experience with a focus on airway and surgical management.Study Design:Case series.Setting:Tertiary academic institution.Methods:A retrospective review was conducted of 4 patients that presented to a tertiary medical center with fibrovascular polyps between 1990 and 2012. Patient demographics, clinical presentation, diagnostic studies, and surgical approaches were reviewed. A review of the published literature was also performed.Results:The average age at presentation was 72 years (range, 59-85 years). Among the 4 patients, 2 presented with airway compromise requiring tracheotomy. All patients had removal of the polyp shortly after presentation; 2 underwent transcervical approaches with lateral pharyngotomy/esophagotomy, and the other 2 had endoscopic removal. The polyps arose from the hypopharynx in 3 patients and upper esophagus in 1. Three patients had complete resolution of their symptoms and remained disease free. One patient had recurrence of the polyp 2 years later and is currently being observed.Conclusion:Fibrovascular polyps are rare tumors of the hypopharynx/esophagus that present in older adults. Although benign, they can cause life-threatening airway compromise that may necessitate tracheotomy. We present 4 cases of fibrovascular polyps and discuss our evolving surgical management, including endoscopic removal.
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Affiliation(s)
- Julina Ongkasuwan
- Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - C. Lane Anzalone
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Esperanza Salazar
- Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Donald T. Donovan
- Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
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Oka M, Ueha R, Nito T, Yamasoba T. Giant fibrovascular polyp in the hypopharynx: a case report and review of the literature. SPRINGERPLUS 2016; 5:1443. [PMID: 27652019 PMCID: PMC5005220 DOI: 10.1186/s40064-016-3144-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/24/2016] [Indexed: 11/24/2022]
Abstract
Introduction Fibrovascular polyps (FVPs) are benign tumors that commonly occur in the cervical esophagus. Few cases of FVPs of the hypopharynx have been reported, but there has been no English review concerning hypopharyngeal FVPs (hFVPs). Here, we report a case of a vast hFVP, and we also review 13 hFVP cases found in the English literature (PubMed search) including our case. Case description A 41-year-old man with respiratory distress and regurgitation of a mass was referred to our hospital. Endoscopic and radiographic evaluations were required for diagnosis. The tumor originated from the hypopharynx and covered almost the entire larynx, which caused the airway to narrow. An emergency surgical removal was performed under general anesthesia with orotracheal intubation, and the tumor was completely removed transorally using a laryngeal endoscope. Pathological examination revealed that the mass was a FVP. Discussion and Evaluation We investigated patient characteristics, symptoms, polyp size, treatments, and recurrence of 13 hFVP cases. Regurgitation of a mass, dyspnea, and dysphagia were frequently reported symptoms at presentation. All patients were treated by surgical excision with no recurrence. Airway management is critical and tracheotomies were needed in some cases. Conclusions FVPs are often asymptomatic, and they can suddenly cause respiratory distress from laryngeal blockage. Therefore, we emphasize that when such cases are encountered, airway management and surgical treatment should be considered as early as possible.
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Affiliation(s)
- Mineko Oka
- Department of Otolaryngology Head and Neck Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524 Japan
| | - Rumi Ueha
- Department of Otolaryngology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Takaharu Nito
- Department of Otolaryngology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
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Lee JW, Kim GH, Kim JK, Park CH, Song BG, Shin DH, Ha DW, Song GA. A Case of Giant Fibrovascular Polyp of the Esophagus, Treated Successfully by Endoscopic Resection. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 67:253-256. [DOI: 10.4166/kjg.2016.67.5.253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jong Wook Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Joong Keun Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Chul Hong Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Byeong Gu Song
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Dong Hun Shin
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Dong Woo Ha
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
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Giant Hypopharyngeal Fibrovascular Polyp: A Case Report and Review of the Relevant Literature. Case Rep Otolaryngol 2015; 2015:670302. [PMID: 26697252 PMCID: PMC4677193 DOI: 10.1155/2015/670302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 11/24/2015] [Indexed: 12/11/2022] Open
Abstract
Fibrovascular polyps occur most commonly in the cervical esophagus and are extremely rare in the hypopharynx. In this paper, we report a case of fibrovascular polyp of a 52-year-old female, who presented with progressive dysphagia and weight loss and regurgitating a mass from her mouth. By the endoscopic examination, a polyp covered by normal mucosa with a wide stalk was detected at the hypopharynx. The pedicle of the mass was identified under general anesthesia and the 13 × 3 × 2 cm mass was completely resected perorally. Histopathological examination of the tumor showed oedematous subepithelial fibrous stroma, surrounded by squamous epithelium and containing many congested vascular structures. No recurrence was detected over one year of follow-up. This case highlights the need for clinicians to be aware of this rare entity and to develop the best approach to patient management.
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Giant fibrovascular polyp on aryepiglottic fold. Auris Nasus Larynx 2015; 43:212-5. [PMID: 26299198 DOI: 10.1016/j.anl.2015.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 07/20/2015] [Accepted: 08/03/2015] [Indexed: 11/23/2022]
Abstract
Polyps are common lesions in pharynx and larynx. A 46-year-old woman was transferred to our department because of the huge laryngeal mass, which was incidentally detected during routine health screening. On laryngoscopic exam, both vocal folds were not visualized due to the mass but she had no symptom such as hoarseness, dysphagia, and dyspnea. Awake intubation was safely performed using flexible bronchoscope without tracheostomy. A 4-cm sized mass on the left aryepiglottic fold was removed with trans-oral approach and discharged without complication. The pathologic diagnosis was reported as 'fibrovascular polyp'. Herein, we describe a unique case of giant fibrovascular polyp on aryepiglottic fold, which is the first report in the English literature.
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15
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Millás-Gómez T, Benito-Orejas JI, Morais-Pérez D, Fernández-Salazar L, Álvarez-Quiñones Sanz M. Hamartomatous Polyp of the Hypopharynx. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011. [DOI: 10.1016/j.otoeng.2010.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Giant fibrovascular polyp of the hypopharynx: per-oral endoscopic removal. The Journal of Laryngology & Otology 2011; 125:1087-90. [PMID: 21729452 DOI: 10.1017/s0022215111001034] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We report an extremely rare case of giant fibrovascular polyp of the hypopharynx. METHOD We present a 49-year-old man who had increasing difficulty swallowing, advanced respiratory distress and weight loss, as well as a hypopharyngeal mass protruding from his mouth. RESULTS Diagnosis was confirmed by endoscopic examination and computed tomography. A tracheostomy was required due to laryngeal obstruction by the regurgitated mass. The giant polyp was removed via per-oral endoscopic excision under general anaesthesia. CONCLUSION Fibrovascular polyps occur most commonly in the cervical oesophagus, and are extremely rare in the hypopharynx. They can grow to a very large size over several years. We discuss the symptoms, diagnosis and surgical treatment techniques for upper aerodigestive tract fibrovascular polyps, in the light of the literature.
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Millás-Gómez T, Benito-Orejas JI, Morais-Pérez D, Fernández-Salazar L, Alvarez-Quiñones Sanz M. [Hamartomatous polyp of the hypopharynx]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011; 62:472-4. [PMID: 21195996 DOI: 10.1016/j.otorri.2010.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 09/27/2010] [Accepted: 10/03/2010] [Indexed: 11/19/2022]
Abstract
We present the clinical case of a polyp in the hypopharynx discovered incidentally while performing an upper digestive endoscopy in a middle aged woman. Endoscopic resection was performed, and the histological result was a hamartomatous polyp. We review the diagnosis and treatment of this rare entity.
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Affiliation(s)
- Teresa Millás-Gómez
- Servicio de Otorrinolaringología, Hospital Clínico Universitario, Valladolid, España
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18
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Jose P, Scott N, Sarela AI. Two-stage removal of giant fibrovascular polyp of the oesophagus. BMJ Case Rep 2010; 2010:2010/oct18_2/bcr0520103011. [PMID: 22791489 DOI: 10.1136/bcr.05.2010.3011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A patient presented with several months' history of dysphagia, chest pain, symptoms of regurgitation and weight loss. He underwent an upper gastrointestinal endoscopy, which revealed a giant polyp of the oesophagus. After confirming the diagnosis of giant fibrovascular polyp of the oesophagus, the patient underwent a two-stage division of the stalk and retrieval of the polyp. The postoperative period was uneventful and the patient was asymptomatic at the time of discharge. He is being followed up with a plan for surveillance endoscopy in a year.
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Affiliation(s)
- Paul Jose
- Department of Upper GI Surgery, St James's University Hospital, Leeds, UK.
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Abstract
The so-called "giant fibrovascular polyps" of the esophagus and hypopharynx typically present as sausage-like pedunculated structures that protrude into the lumen and cause obstructive symptoms. Most are cured by local resection but they may recur. Microscopically, they display an admixture of fibrovascular and adipose tissue that is coated by unremarkable squamous mucosa. Here, we report a case that had scattered hyperchromatic cells and lipoblasts within the adipose tissue component. In other anatomic sites similar appearing lesions have been interpreted as pedunculated liposarcomas/atypical lipomatous tumors that are more prone to local recurrences than classic giant fibrovascular polyps. Reports of dedifferentiation and metastases are lacking thus raising the possibility that the cytologic findings in such lesions are degenerative. To confirm our suspicion of liposarcomatous differentiation, we performed immunohistochemistry for MDM2 and p53, 2 markers that are known to be negative in benign lipomatous lesions and positive in well-differentiated liposarcomas/atypical lipomatous tumors. The scattered atypical hyperchromatic cells and the lipoblasts both exhibited strong nuclear staining for both markers and supported the diagnosis of pedunculated giant hypopharyngeal atypical lipomatous tumor.
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Giant fibrovascular polyp of the esophagus - imaging techniques can localize, preoperatively, the origin of the stalk and designate the way of surgical approach: a case report. CASES JOURNAL 2009; 2:6854. [PMID: 19829872 PMCID: PMC2740314 DOI: 10.4076/1757-1626-2-6854] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Accepted: 05/25/2009] [Indexed: 11/26/2022]
Abstract
Fibrovascular polyps of the esophagus are rare benign lesions that arise from the cervical esophagus and can reach very big size before they become symptomatic. Surgical excision is the treatment of choice, since endoscopic removal is not always feasible. We present this case in order to emphasize the significance of localizing, preoperatively, the exact origin of the pedicle in planning the way of surgical approach. We consider the accurate pre-operative assessment of the origin of the pedicle essential for the proper surgical treatment of such a polyp. In respect to this, imaging provides important information concerning the exact location of the pedicle, the vascularity of the polyp and even tissue elements of the mass.
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21
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Tanguay J, Pollanen M. Sudden death by laryngeal polyp: a case report and review of the literature. Forensic Sci Med Pathol 2008; 5:17-21. [PMID: 19291432 DOI: 10.1007/s12024-008-9061-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2007] [Accepted: 09/26/2007] [Indexed: 11/28/2022]
Abstract
Sudden unexpected death in the context of bizarre or unusual behavior usually relates to acute drug intoxication or excited delirium. We report the case of a man who died suddenly while running naked on a public street. Although the initial death investigation was indicative of excited delirium or drug intoxication, autopsy revealed glottic obstruction by an inflammatory laryngeal polyp. Toxicologic studies were negative and investigation revealed presentation at a hospital the day before death with stridor. It is believed he developed airway obstruction while dressing at home and ran out on the street to find assistance. This case illustrates the importance of a thorough death investigation and a broad differential diagnosis when approaching a forensic autopsy.
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Affiliation(s)
- Jeff Tanguay
- Provincial Forensic Pathology Unit, Office of the Chief Coroner, Department of Laboratory Medicine and Pathobiology, University of Toronto, 26 Grenville Street, Toronto, ON, Canada M7A 2G9
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Iván L, Torkos A, Paczona R, Szentpáli K, Jóri J. Minimally invasive peroral endoscopic removal of a regurgitated giant polysegmented fibrovascular polyp of the esophagus. Dysphagia 2008; 24:230-3. [PMID: 18688676 DOI: 10.1007/s00455-008-9165-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 03/18/2008] [Indexed: 10/21/2022]
Abstract
Giant fibrovascular polyps (FVP) are relatively rare benign neoplasms of the upper part of the esophagus. Without a previous history, their diagnosis might be difficult because the endoscopic findings are sometimes misinterpreted. The present report describes a case in which the patient regurgitated a giant polypoid mass into his mouth and captured it between his teeth and buccal surface until emergency endoscopic removal. Although the adequate therapy for these lesions is open surgical resection, most often via cervical esophagotomy, in our case the polyp was removed successfully by peroral endoscopy with minimally invasive surgery. After 5 years of follow-up the patient is doing well, without recurrence.
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Affiliation(s)
- László Iván
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Szeged, H-6725, Szeged, Hungary.
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23
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Iván L, Paczona R, Szentpáli K, Jóri J. Peroral endoscopic removal: as a minimally invasive long-term surgical treatment of a regurgitated giant polisegmented fibrovascular polyp of the esophagus. Eur Arch Otorhinolaryngol 2008; 266:1031-4. [PMID: 18688632 DOI: 10.1007/s00405-008-0766-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 07/01/2008] [Indexed: 10/21/2022]
Abstract
Giant fibrovascular polyps (FVP) are relatively rare benign neoplasm of the upper part of the esophagus. Without previous history, their diagnosis might be difficult as the endoscopic findings are sometimes misinterpreted. The present report describes a case, in which the patient regurgitated his giant polypoid mass into his mouth and captured it between his teeth and buccal surface until the emergency endoscopic removal. Although the adequate therapy for these lesions is mainly the open surgical resection, most often via cervical esophagotomy, in our case the polyp was removed successfully by peroral endoscopic operation, as a minimally invasive surgical treatment. After 5 years of follow-up, the patient is doing well, without recurrence of his polyp.
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Affiliation(s)
- László Iván
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Szeged, 6725, Szeged, Hungary.
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24
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McLean JN, DelGaudio JM. Endoscopic resection of a giant esophageal polyp: case report and review of the literature. Am J Otolaryngol 2007; 28:115-7. [PMID: 17362817 DOI: 10.1016/j.amjoto.2006.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- J Nicolas McLean
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, GA 30322, USA
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25
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Nuyens MR, Bhatti NI, Flint P. Multiple synchronous fibrovascular polyps of the hypopharynx. ORL J Otorhinolaryngol Relat Spec 2005; 66:341-4. [PMID: 15668534 DOI: 10.1159/000081892] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2004] [Accepted: 06/17/2004] [Indexed: 11/19/2022]
Abstract
PURPOSE OF THE STUDY To evaluate the clinical, radiological presentation and surgical management of fibrovascular polyps of the hypopharynx. METHODS Retrospective medical analysis of a case report. We report the case of a 66-year-old man, who presented with an incarcerated left inguinal hernia, vomiting and regurgitation of a large mass into the oral cavity resulting in syncope. MRI and cine-esophagram demonstrated a large mass in the cervical esophagus. At the time of herniorrhaphy, endoscopy revealed an 11.8-cm hypopharyngeal mass that completely obstructed the oropharynx. RESULTS The airway was secured by tracheostomy and the lesion was subsequently removed via open pharyngotomy. Postoperatively, a second polyp was found ball-valving into the airway, and an endoscopic resection was performed prior to decannulation. Histopathology of both lesions confirmed the diagnosis of a fibrovascular polyp. CONCLUSION Fibrovascular polyps are rare benign intraluminal esophageal lesions resulting in mild symptoms of dysphagia that may also cause significant morbidity such as syncope and asphyxia. This is the first report of synchronous fibrovascular polyps of the hypopharynx.
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Affiliation(s)
- Michel R Nuyens
- Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Md. 21287-0910, USA
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26
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Affiliation(s)
- Jose Pedro Zevallos
- Division of Otolaryngology-Head and Neck Surgery, UMDNJ-New Jersey Medical School, Newark, New Jersey, USA.
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27
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Fries MR, Galindo RL, Flint PW, Abraham SC. Giant fibrovascular polyp of the esophagus. A lesion causing upper airway obstruction and syncope. Arch Pathol Lab Med 2003; 127:485-7. [PMID: 12683881 DOI: 10.5858/2003-127-0485-gfpote] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Giant fibrovascular polyp of the esophagus is a rare but dramatic entity. These large polyps arise in the proximal esophagus and can cause airway obstruction secondary to mechanical pressure on the larynx, or they can present as a mass that is regurgitated into the oral cavity. We present a 66-year-old man who complained of nausea and vomiting that were associated with a fibrovascular polyp protruding into the mouth. He had also experienced several episodes of syncope resulting from intermittent airway obstruction. He underwent an open resection of an 11.8-cm fibrovascular polyp and an endoscopic resection of a second fibrovascular polyp 2 days later. Histopathologically, both masses were composed of a mixture of mature adipose tissue lobules and fibrovascular tissue, lined by reactive squamous epithelium. Despite their large size, giant fibrovascular polyps should be recognized radiologically and pathologically as benign lesions. However, they can result in significant morbidity.
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Affiliation(s)
- Matthew R Fries
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Md, USA
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28
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Nóbrega BBD, Figueirêdo SDS, Cavalcante LP, Ribeiro RE, Teixeira KISS, Paula CID. Pólipo fibrovascular do esôfago: relato de caso e revisão da literatura. Radiol Bras 2002. [DOI: 10.1590/s0100-39842002000400013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O pólipo fibrovascular do esôfago é um tumor benigno raro, pedunculado e intraluminal. Relata-se um caso desta entidade, discutindo seus achados ao esofagograma e tomografia computadorizada. Em virtude da excelente correlação entre as características patológicas e de imagem, os estudos de tomografia computadorizada e ressonância magnética são considerados específicos e úteis em sua elucidação diagnóstica.
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Schuhmacher C, Becker K, Dittler HJ, Höfler H, Siewert JR, Stein HJ. Fibrovascular esophageal polyp as a diagnostic challenge. Dis Esophagus 2001; 13:324-7. [PMID: 11284984 DOI: 10.1046/j.1442-2050.2000.00141.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Fibrovascular polyps are rare benign esophageal tumors that usually arise from the proximal third of the esophagus. We present the case of a 48-year-old man with a history of dysphagia and 7-kg weight loss over a period of 2 months. A barium swallow showed a distended esophagus with a tumor extending from the upper esophageal sphincter to the cardia. On a thoracic computed tomographic scan, a homogeneous intramural mass with a density of 22 Hounsfield units was seen, which extended throughout the entire esophagus. Fiberoptic endoscopy confirmed the presence an intramural tumor beginning at the upper esophageal sphincter and reaching to the cardia. The tumor was completely covered with mucosa, except for an ulcerated area at its distal end, which herniated into the stomach. On endoscopic ultrasound, the tumor appeared to grow submucosally and to respect the muscularis propria. Endoscopic biopsies from the ulcerated distal aspect of the tumor suggested a leiomyoma. None of the imaging modalities used revealed evidence of a polyp or intraluminal esophageal tumor. Rather, a potentially malignant extensive intramural tumor was suspected, and an esophagectomy was performed. Only at the time of removal of the specimen did it become evident that the tumor mass was located intraluminally with a pedicle in the region of the upper esophageal sphincter. The final pathological diagnosis was a giant fibrovascular polyp of the esophagus.
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Affiliation(s)
- C Schuhmacher
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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30
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Koyuncu M, Tekat A, Sesen T, Tanyeri Y, Unal R, Karagoz F, Simsek M. Giant polypoid tumor of the esophagus. Auris Nasus Larynx 2000; 27:363-6. [PMID: 10996498 DOI: 10.1016/s0385-8146(99)00064-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A patient with a giant polypoid tumor of the esophagus, measuring 22 cm in length is described in this report. The patient presented with cough attacks and respiratory distress. Diagnostic and therapeutic intervention required aggressive airway management, radiographic and endoscopic evaluation, and definitive surgical treatment. Benign esophageal tumors are rarely seen and originate from the upper third of esophagus, frequently close to the cricopharyngeus muscle. They may attain giant proportions. A variety of clinical presentations are described, the most serious being asphyxia secondary to laryngeal obstruction. We observed a giant esophageal tumor which was interpreted as angiofibromyolipoma that caused laryngeal obstruction. We present the clinical picture and histopathological findings of the tumor.
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Affiliation(s)
- M Koyuncu
- Department of Otolaryngology, University Hospital Ondokuz Mayis University Medical School, 55139, Samsun, Turkey
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31
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Abstract
We report a patient with a plexiform schwannoma located in the cervical part of the esophagus. A large pedunculated intraluminal polyp, originating in the postcricoid region and protruding into the oropharynx, was found in association with multiple submucosal nodules. Both the intraluminal polyp and submucosal nodules consisted of cellular schwannomatous tissue. The patient showed no signs of neurofibromatosis or schwannomatosis. Plexiform schwannomas are uncommon tumors, mainly confined to the dermis and subcutis of trunk, head, and neck region and upper extremities. Visceral examples are vanishingly rare, and a location in the esophagus has not yet been described. The intruiging mode of presentation in the present case, mimicking that of so-called giant esophageal fibrovascular polyp, probably relates to mechanical factors inherent to the unique esophageal location, Int J Surg Pathol 8(4):353-357, 2000
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Affiliation(s)
- K. Cokelaere
- Department of Pathology, University Hospital Gasthuisberg, Catholic University of Leuven, Belgium
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32
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Seshul MJ, Wiatrak BJ, Galliani CA, Odrezin GT. Pharyngeal fibrovascular polyp in a child. Ann Otol Rhinol Laryngol 1998; 107:797-800. [PMID: 9749551 DOI: 10.1177/000348949810700911] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fibrovascular polyp of the upper aerodigestive tract is an uncommon tumor that may present in pediatric patients with symptoms ranging from dysphagia to asphyxiation and death. We present a unique case of a pediatric patient with an asymptomatic fibrovascular polyp noted as an incidental finding on a cervical ultrasound evaluation. This lesion extended from the posterior tonsillar pillar and prolapsed freely into the nasopharynx and esophagus. The literature relevant to this case is reviewed, and the etiology, pathophysiology, and management principles are discussed.
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Affiliation(s)
- M J Seshul
- Department of Surgery, University of Alabama at Birmingham, USA
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33
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Eliashar R, Saah D, Sichel JY, Elidan J. Fibrovascular polyp of the esophagus. Otolaryngol Head Neck Surg 1998; 118:734-5. [PMID: 9591884 DOI: 10.1177/019459989811800534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- R Eliashar
- Department of Otolaryngology-Head and Neck Surgery, Hadassah University Hospital, Jerusalem, Israel
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34
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Santana-Hernandez DJ, Ell SR, Da Costa P, Macklin CP, Hussain SS. Giant hamartoma of the oropharynx. J Laryngol Otol 1996; 110:480-2. [PMID: 8762324 DOI: 10.1017/s0022215100134048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Giant polypoidal hamartomas of the pharynx and oesophagus are rare benign tumours of unknown origin, exceptionally arising from the oropharynx. We report the case of a 74-year-old man who developed sudden nausea and a foreign body sensation. Shortly afterwards he regurgitated a 25 x 3 x 1.5 cm pedunculated fleshy mass, still attached to the inside of his thorat. The patient was anaesthetised, the mass traced to the right tonsillar fossa and adjacent oropharyngeal wall. The pedicle was clamped and the lesion excised. Histology was consistent with a giant oropharyngeal hamartoma. We discuss the pathogenesis and potential complications of this condition. The literature is reviewed.
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