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Dzhantukhanova S, Avetisyan LG, Badakhova A, Starkov Y, Glotov A. Hybrid laparo-endoscopic access: New approach to surgical treatment for giant fibrovascular polyp of esophagus: A case report and review of literature. World J Gastrointest Endosc 2023; 15:666-675. [DOI: 10.4253/wjge.v15.i11.666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/03/2023] [Accepted: 09/22/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Fibrovascular polyps are rare type of esophageal submucosal neoplasms. They are highly vascularized and can cause difficulty swallowing and even fatal complications such as uncontrolled bleeding and death caused by asphyxiation in case of tumor migration to oropharynx. In the article we describe a novel hybrid technique to surgical treatment – an endoscopic submucosal dissection with laparoscopic removal of the tumor.
CASE SUMMARY The patient with a giant fibrovascular esophageal polyp presented with cough, discomfort in the throat, difficulty swallowing, and an episode of tumor migration into oropharynx. The patient was investigated with several imaging studies and was diagnosed with a giant highly vascularized esophageal fibrovascular polyp. The follow-up period of eight months accompanied with no complications.
CONCLUSION This method has been shown to have comparable rates of recurrence and a low risk of complications.
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Affiliation(s)
- Seda Dzhantukhanova
- Department of Surgical Endoscopic, The Vishnevsky National Medical Research Center of Surgery, Moscow 115093, Russia
| | | | - Amina Badakhova
- Department of Surgical Endoscopic, The Vishnevsky National Medical Research Center of Surgery, Ministry of Health of Russia, Moscow 115093, Russia
| | - Yury Starkov
- Department of Surgical Endoscopic, The Vishnevsky National Medical Research Center of Surgery, Ministry of Health of Russia, Moscow 115093, Russia
| | - Andrey Glotov
- Department of Morphologist, The Vishnevsky National Medical Research Center of Surgery, Ministry of Health of Russia, Moscow 115093, Russia
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2
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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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3
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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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4
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Starkov YG, Dzhantukhanova SV, Zamolodchikov RD, Badakhova AB. [Hybrid laparo-endoscopic access for giant fibrovascular esophageal polyp: a case report]. Khirurgiia (Mosk) 2023:123-132. [PMID: 38010027 DOI: 10.17116/hirurgia2023111123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Fibrovascular polyp is a rare non-epithelial esophageal tumor arising from submucosal layer and consisting of connective and adipose tissue, as well large number of vessels. Large tumors can cause dysphagia, vomiting, chest pain, shortness of breath and/or asthma, while giant neoplasms are potentially life threatening. Despite active introduction of minimally invasive treatment of patients with non-epithelial gastrointestinal tumors, there are still difficulties in surgical treatment of fibrovascular polyps. The patient with a giant fibrovascular esophageal polyp presented with cough, discomfort in the throat, impaired swallowing and episode of tumor migration into oropharynx. Examination confirmed giant highly vascularized esophageal fibrovascular polyp. A novel hybrid surgical technique (endoscopic submucosal dissection with laparoscopic removal of tumor) was applied. Eight-month follow-up revealed no complications. Favorable clinical result was achieved. A hybrid laparo-endoscopic approach in the treatment of patients with large fibrovascular polyps minimizes perioperative risks and improves postoperative outcomes.
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Affiliation(s)
- Yu G Starkov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | | | - R D Zamolodchikov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A B Badakhova
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
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5
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Włodarczyk J, Smęder T. Less Invasive Transoral Resection of Esophageal Fibrovascular Polyps. Clin Endosc 2021; 55:683-687. [PMID: 34865340 PMCID: PMC9539291 DOI: 10.5946/ce.2021.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/16/2021] [Indexed: 11/14/2022] Open
Abstract
We report five patients treated for esophageal fibrovascular polyps using a minimally invasive technique. Esophageal fibrovascular polyps are benign pedunculated submucosal tumors of considerable size. The treated polyps size ranged from 1.5 to 13 cm. The polyps were removed by relocation to the oral cavity under endoscopic control. No perioperative complications occurred after the treatment. The follow-up of patients after surgery was 9–89 months, with no evidence of polyp recurrence. Thus, the described treatment is safe but requires experience with endoscopy as well as esophageal surgery.
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Affiliation(s)
- Janusz Włodarczyk
- Department of Thoracic and Surgical Oncology, Jagiellonian University Collegium Medicum, John Paul II Hospital, Cracow, Poland
| | - Tomasz Smęder
- Department of Thoracic and Surgical Oncology, Jagiellonian University Collegium Medicum, John Paul II Hospital, Cracow, Poland
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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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Dhingra S. The Curious Case of a "Second Tongue". Turk Arch Otorhinolaryngol 2020; 58:200-202. [PMID: 33145507 DOI: 10.5152/tao.2020.5825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/16/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Shruti Dhingra
- Department of Ear, Nose and Throat, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, India
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8
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Rare Giant Pedunculated Liposarcoma of the Hypopharynx: Case Report and Review of Literature. J Gastrointest Cancer 2017; 47:449-453. [PMID: 26449226 DOI: 10.1007/s12029-015-9767-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Liposarcoma is considered the most common soft tissue sarcoma in adults. It represents approximately 20 % of all mesenchymal malignancies, and most frequently it involves the retroperitoneum, trunk, and extremities. Hypopharyngeal localization of liposarcoma is extremely rare. METHODS We report a new rare case of giant pedunculated liposarcoma arising from the left antero-lateral wall of the hypopharyngeal-esophageal junction, and we present a complete review of the literature. RESULTS An 81-year-old man presented with a 5-month history of dysphagia and 30-kg weight loss, due to a giant pedunculated liposarcoma of the hypopharynx, which is resected with cervical approach. CT scan imaging revealed a 25-cm-long pedunculated heterogeneous mass with fat-like density originating from the anterior wall of hypopharyngeal-esophageal junction protruding into the lumen. The polypoid mass was identified as well as the stalk, and it was completely delivered through the cervical incision. Histopatological examination showed a dedifferentiated liposarcoma, without positive or close margins. No further chemoradiation therapy was performed due to the patient's age, comorbidities, negative margins, and absence of distant metastases. Dysphagia solved 1 month after surgery. No evidence of tumor recurrence was seen in the 12 months following surgery. CONCLUSIONS When base of the tumor is located in hypopharynx or cervical portion of the esophagus, and tumor is not aggressive, cervical approach is better, irrespective of the tumor size, except for cases in which an endoscopic approach is feasible.
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Riva G, Sensini M, Corvino A, Garzaro M, Pecorari G. Liposarcoma of Hypopharynx and Esophagus: a Unique Entity? J Gastrointest Cancer 2017; 47:135-42. [PMID: 26875081 DOI: 10.1007/s12029-016-9808-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Liposarcoma is the most common soft tissue sarcoma in adults. It represents approximately 20 % of all mesenchymal malignancies. It most frequently involves retroperitoneum, trunk, and extremities. Hypopharyngeal and esophageal localization of liposarcoma is extremely rare. METHODS We performed a systematic review of literature and reported 26 and 33 cases of hypopharyngeal and esophageal liposarcoma. We analyzed natural history, imaging features, histology, treatment, and prognosis, with a specific focus to similarities and differences between tumors of hypopharynx and esophagus. RESULTS Hypopharyngeal and esophageal liposarcomas have more similarities than differences. Incidence has a peak at 6th and 7th decades. The diagnostic procedures are barium swallow, endoscopic examination, and CT/MR imaging. Well-differentiated liposarcoma represents the most frequent histological subtype. Surgical excision is the main treatment. Endoscopic resection can be useful for pedunculated tumors of hypopharynx and cervical esophagus. Differences between hypopharyngeal and esophageal liposarcoma are represented by local recurrence rate (greater for hypopharyngeal tumors), number of giant tumors, and time to recurrence (greater for esophageal tumors). Finally, liposarcomas of distal esophagus need more extended approaches. CONCLUSIONS Liposarcomas of hypopharynx and cervical esophagus could be considered a unique pathological entity, with similar features and treatment options. Survival rate is dependent on histological type and location. Local recurrence is common, especially for hypopharyngeal liposarcoma, while the risk of lymph node or distant metastasis is very low. Patients should undergo regular examinations to rule out local recurrence, also for a long time, especially for esophageal tumors.
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Affiliation(s)
- Giuseppe Riva
- 1st ENT Division, Surgical Sciences Department, University of Turin, Via Genova 3, 10126, Turin, Italy.
| | - Matteo Sensini
- 1st ENT Division, Surgical Sciences Department, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Andrea Corvino
- 1st ENT Division, Surgical Sciences Department, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Massimiliano Garzaro
- 1st ENT Division, Surgical Sciences Department, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Giancarlo Pecorari
- 1st ENT Division, Surgical Sciences Department, University of Turin, Via Genova 3, 10126, Turin, Italy
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10
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Mangiavillano B, Savarese MF, Boeri F, Ruggeri C, Conio M. A rare case of giant fibrovascular polyp endoscopically resected with loop and cut technique. VideoGIE 2016; 2:57-58. [PMID: 29905261 PMCID: PMC5990647 DOI: 10.1016/j.vgie.2016.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
| | | | - Federica Boeri
- Gastroenterology & Gastrointestinal Endoscopy, General Hospital, Sanremo, Italy
| | | | - Massimo Conio
- Gastroenterology & Gastrointestinal Endoscopy, General Hospital, Sanremo, Italy
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11
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Abstract
Fibrovascular polyps of the esophagus are rare, benign, and submucosal tumor-like lesions, their course is usually indolent until reaching enormous proportions. The most frequent symptoms are dysphagia, vomiting, and weight loss. Surgical excision is the treatment of choice, since endoscopic removal is not always feasible. We report a case of a 59-year-old man with a giant fibrovascular polyp who complained of progressive dysphagia. The lesion was resected by left cervical approach. The patient remains symptom-and recurrence-free within one-year of follow-up.
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Affiliation(s)
- Hao Zhang
- Department of Cardiothoracic Surgery, Xiangyang Central Hospital, Hubei University of Arts and Science, Xiangyang, Hubei, China. E-mail.
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12
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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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13
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Postendoscopic intraoral prolapse of a giant esophageal fibrovascular polyp. FORMOSAN JOURNAL OF SURGERY 2016. [DOI: 10.1016/j.fjs.2016.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Lobo N, Hall A, Weir J, Mace A. Endoscopic resection of a giant fibrovascular polyp of the oesophagus with the assistance of ultrasonic shears. BMJ Case Rep 2016; 2016:bcr-2015-214158. [PMID: 26768708 DOI: 10.1136/bcr-2015-214158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Giant fibrovascular polyps of the oesophagus are rare benign tumours originating from the upper oesophagus. A 58-year-old woman presented with a 6-week history of a sore throat, odynophagia and progressive dysphagia, managing only a soft diet. CT of the neck and thorax, and barium swallow, both demonstrated a giant fibrovascular polyp measuring approximately 7 cm in length arising from the proximal oesophagus. The patient underwent endoscopic resection of the polyp with the assistance of ultrasonic shears. We present the case of a giant fibrovascular polyp and describe our novel technique for successful endoscopic resection using ultrasonic shears.
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Affiliation(s)
- Niyati Lobo
- Department of ENT, Imperial College Healthcare NHS Trust, London, UK
| | - Andrew Hall
- Department of ENT, Imperial College Healthcare NHS Trust, London, UK
| | - Justin Weir
- Department of Pathology, Imperial College Healthcare NHS Trust, London, UK
| | - Alasdair Mace
- Department of ENT, Imperial College Healthcare NHS Trust, London, UK
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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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Nascimento SBD, Santos FC, Pinheiro MDNSM. Giant fibrovascular polyp of the larynx. Int Arch Otorhinolaryngol 2014; 18:325-7. [PMID: 25992115 PMCID: PMC4297007 DOI: 10.1055/s-0033-1364171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 11/24/2013] [Indexed: 12/23/2022] Open
Abstract
Introduction Fibrovascular polyps (FVPs) are rare benign tumors originating in the cervical esophagus, and, rarely, in the hypopharynx. A case of FVP from the larynx has not yet been described in the literature. Objectives To discuss a unique case of FVP originating in the larynx. Resumed Report A 58-year-old woman presented with a 6-month history of progressive dysphagia. Endoscopic exams identified an elongated polypoid lesion originating from the mucosa of the epiglottis and the right pharyngoepiglottic fold. Excision of this mass under direct laryngoscopy revealed an 11.5 × 0.8-cm polypoid lesion, histologically diagnosed as an FVP. Conclusion The location of this FVP is important because, despite being a benign tumor, it carries a potentially lethal risk of upper airway obstruction.
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Pallabazzer G, Santi S, Biagio S, D’Imporzano S. Difficult polypectomy-giant hypopharyngeal polyp: Case report and literature review. World J Gastroenterol 2013; 19:5936-5939. [PMID: 24124343 PMCID: PMC3793151 DOI: 10.3748/wjg.v19.i35.5936] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/11/2013] [Accepted: 05/19/2013] [Indexed: 02/06/2023] Open
Abstract
Giant esophageal and hypopharyngeal polyps are benign tumors rarely encountered in clinical practice. In most cases, they are completely asymptomatic; however, despite the rarity of these tumors, interest in giant esophageal polyps derives from their degree of growth (characterized by slow growth into the esophageal lumen) and their mobility. In fact, if regurgitation occurs, they can ascend into the oral cavity and be aspirated into the airways, with potentially lethal consequences. The removal of these giant polyps is recommended. An adequate preoperative evaluation to identify the correct origin of the stalk is mandatory for a successful endoscopic or surgical treatment. A 60-year-old man was admitted to our hospital for anemia. The patient underwent gastroscopy, contrast computed tomography and endoscopic ultrasound. At the conclusion of the procedure, during the extraction of the echoendoscope, the patient began retching and regurgitated the polyp, without experiencing respiratory distress. The patient underwent a left cervicotomy and polyp dissection via a pharyngotomy.
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19
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Pajor A, Maciaszczyk K, Wągrowska-Danilewicz M, Pazurek M, Murlewska A. [Rare case of giant fibrovascular polyp of the esophagus]. Otolaryngol Pol 2013; 67:176-9. [PMID: 23719276 DOI: 10.1016/j.otpol.2012.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Accepted: 12/05/2011] [Indexed: 11/20/2022]
Abstract
The benign lesions of esophagus constitutes small part of all esophageal tumors and among them giant esophageal polyps are exceptionally rarely reported. The authors present the uncommon case of pedunculated giant fibrovascular polyp (lenght 12cm and diameter 2cm) in the esophagus in a 79-years-old woman who was admitted to our department because of hoarseness, throat discomfort during swallowing and endoral tumor regurgitation during cough. The polyp was removed by minimally invasive approach by endoscopic procedure which was particularly important in our patient because of her advanced age. No recurrence was observed during follow-up.
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Affiliation(s)
- Anna Pajor
- I Katedra Otolaryngologii Uniwersytetu Medycznego w Łodzi, Uniwersytecki Szpital Kliniczny nr 1 im. N. Barlickiego, Poland.
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Lee EJ, Hong SG, Baek HR, Lee CB, Choi SM, Kim SJ, Chae BG, Choi CY. A case of large fibrovascular polyp of the stomach. Clin Endosc 2013; 46:186-8. [PMID: 23614131 PMCID: PMC3630315 DOI: 10.5946/ce.2013.46.2.186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 05/30/2012] [Accepted: 06/20/2012] [Indexed: 01/19/2023] Open
Abstract
A fibrovascular polyp is a rare benign disease of the upper digestive tract and is usually located in the esophagus. To our knowledge, this is the first case of gastric fibrovascular polyp presenting with melena reported in the English literature. The polyp was well visualized on endoscopy and removed with laparoscopic wedge resection. Histology confirmed fibrovascular polyp of the stomach.
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Affiliation(s)
- Eun Ji Lee
- Department of Internal Medicine, SAM Medical Center, Anyang, Korea
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21
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Dali H, Barry B, Wassef M, Mansouri D, Hourseau M, Hénin D, Soufan R. [Pharyngeal fibrovascular polyp]. Ann Pathol 2011; 31:211-3. [PMID: 21737004 DOI: 10.1016/j.annpat.2011.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 12/08/2010] [Accepted: 02/09/2011] [Indexed: 12/14/2022]
Abstract
The giant fibrovascular polyp of the hypopharynx is a rare and benign tumor. We report one case in a 46-year-old man. This lesion, usually unique, affects predominantly men with an average age of 53 years. These polyps are located predominantly in the upper esophagus and rarely in the hypopharynx. They are usually asymptomatic and small, detected by endoscopy. They can grow to considerable length and cause digestive or respiratory symptoms. Histologically, fibrovascular polyps consist of a various mixture of fibrous and lipomatous elements with abundant vascularisation and they are covered by normal squamous epithelium. The lack of muscular support and the pressure difference in the peristaltic wave contribute to polyp formation.
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Affiliation(s)
- Hayet Dali
- Service d'anatomie et de cytologie pathologiques, université Paris 7, hôpital Bichat Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
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22
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Goenka AH, Sharma S, Ramachandran V, Chattopadhyay TK, Ray R. Giant fibrovascular polyp of the esophagus: report of a case. Surg Today 2010; 41:120-4. [PMID: 21191703 DOI: 10.1007/s00595-009-4212-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 10/20/2009] [Indexed: 11/25/2022]
Abstract
A fibrovascular polyp is a peculiar nonepithelial tumor of the esophagus that invariably arises in the cervical esophagus at the level of the thoracic inlet and grows distally into a massive elongated, pedunculated, intraluminal lesion. Although it is a benign lesion that is eminently resectable, it is a dramatic entity owing to its tendency to cause bizarre complications such as asphyxia and sudden death when it regurgitates into the pharynx and causes laryngeal impaction. This report describes the multimodality imaging appearance of an archetypal case of a giant fibrovascular polyp in a patient with a seemingly innocuous presentation for the size of the lesion. The essential role of cross-sectional imaging in establishing a prompt diagnosis, defining the tissue elements of the mass, and delineation of the exact extent of the lesion in guiding the treatment approach is highlighted. The appearance of fibrovascular polyp in a single patient with a combination of barium swallow, multidetector computed tomography, and high-resolution contrast-enhanced magnetic resonance imaging has not been reported previously.
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Affiliation(s)
- Ajit Harishkumar Goenka
- Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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23
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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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24
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Wang L, Wang XW, Fan CQ, Tian XX, Li YH, Zhao XY. Resection of gigantic esophageal polyp using argon plasma coagulation. J Dig Dis 2010; 11:319-21. [PMID: 20883429 DOI: 10.1111/j.1751-2980.2010.00456.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Lei Wang
- Department of Gastroenterology, Xinqiao Hospital of Third Military Medical University, Chongqing, China.
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25
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Pardo RL, Vázquez AM, Krasniqi G, Ortega AR, Merlo RR. [Two cases of complications due to a giant fibrovascular polyp of the oesophagus]. Cir Esp 2010; 88:425-7. [PMID: 20546719 DOI: 10.1016/j.ciresp.2010.03.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 03/01/2010] [Accepted: 03/02/2010] [Indexed: 10/19/2022]
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26
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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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27
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Lee SY, Chan WH, Sivanandan R, Lim DTH, Wong WK. Recurrent giant fibrovascular polyp of the esophagus. World J Gastroenterol 2009; 15:3697-700. [PMID: 19653354 PMCID: PMC2721250 DOI: 10.3748/wjg.15.3697] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Giant fibrovascular polyps of the esophagus and hypopharynx are rare benign esophageal tumors. They arise most commonly in the upper esophagus and may, rarely, originate in the hypopharynx. They can vary significantly in size. Even though they are benign, they may be lethal due to either bleeding or, rarely, asphyxiation if a large polyp is regurgitated. Patients commonly present with dysphagia or hematemesis. The polyps may not be well visualized on endoscopy and imaging plays a vital role in aiding diagnosis as well as providing important information for pre-operative planning, such as the location of the pedicle, the vascularity of the polyp and the tissue elements of the mass. They can also be recurrent in rare cases, especially if the resection margins of the base are involved. We review the recent literature and report a case of a 61-year-old man with a recurrent giant esophageal fibrovascular polyp with illustrative contrast barium swallow, CT and intra-operative images, who required several surgeries via a combination of endoscopic, trans-oral, trans-cervical, trans-thoracic and trans-abdominal approaches.
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28
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Chourmouzi D, Drevelegas A. Giant fibrovascular polyp of the oesophagus: a case report and review of the literature. J Med Case Rep 2008; 2:337. [PMID: 18957112 PMCID: PMC2585102 DOI: 10.1186/1752-1947-2-337] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 10/28/2008] [Indexed: 11/23/2022] Open
Abstract
Introduction We present a case of fibrovascular polyp, a rare submucosal tumour of the oesophagus that has been reported only sporadically in the literature. The biapproach for surgical removal of fibrovascular polyp has only been mentioned once in the literature. Case presentation A 65-year-old Greek man presented with a 9-month history of gradually progressive intermittent dysphagia. Radiologic work-up with oesophagogram and computed tomography revealed a large, sausage-shaped intraluminal polyp extending from the level of the cervical oesophagus to the level of the upper body of the stomach. The diagnosis of giant fibrovascular polyp was made radiographically and confirmed by endoscopic biopsy. The polyp was removed using a biapproach surgical technique: pharyngotomy and subsequent gastrostomy. Conclusion Fibrovascular polyp is a rare submucosal tumour. Proper treatment depends on accurate assessment of the origin, size, and vascularity of the pedicle and the size of the tumour. Choice of the appropriate surgical approach depends on the correct diagnosis, which can usually be indicated radiographically by the presence of a smooth, sausage-shaped defect with a discrete bulbous tip.
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Affiliation(s)
- Danai Chourmouzi
- Department of Diagnostic Radiology, Interbalcan Medical Center, Panorama, Thessaloniki, Greece.
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29
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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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30
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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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31
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Pham AM, Rees CJ, Belafsky PC. Endoscopic Removal of a Giant Fibrovascular Polyp of the Esophagus. Ann Otol Rhinol Laryngol 2008; 117:587-90. [DOI: 10.1177/000348940811700806] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Giant fibrovascular polyps of the esophagus are rare benign tumors originating from the proximal esophagus. These pedunculated lesions can grow to “giant” proportions. Asphyxiation from aspiration of the regurgitated polyp is a well-described cause of death. Traditional excision has involved a transcervical vertical esophagotomy. This report describes the successful endoscopic removal of a giant fibrovascular polyp of the esophagus. Results: A 63-year-old man with dwarfism and obstructive sleep apnea was referred for evaluation of an esophageal mass that was intermittently regurgitated into the hypopharynx. Office esophagoscopy demonstrated a 10-cm giant fibrovascular polyp originating just below the cricoid cartilage. During endoscopic removal, the base of the lesion was exposed with a Weerda bivalved laryngoscope. Bipolar cautery combined with a snare was used to transect the base with excellent hemostasis. No esophageal leak was noted on an esophagogram on postoperative day 3. The patient then resumed a liquid diet and was discharged home, resuming a regular diet within a week. Conclusions: Giant fibrovascular polyps of the esophagus are life-threatening because of potential airway obstruction. This report describes the successful endoscopic removal of a giant fibrovascular polyp, avoiding the potential morbidity associated with a transcervical vertical esophagotomy.
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