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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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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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Nie D, Zong Y, Li J. Difficult endoscopic resection of a giant esophageal fibrovascular polyp: case report and literature review. J Int Med Res 2021; 49:3000605211039801. [PMID: 34459277 PMCID: PMC8408901 DOI: 10.1177/03000605211039801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Esophageal fibrovascular polyp is rare in esophageal neoplasms and usually very large. Here, we present a case of giant esophageal fibrovascular polyp. The patient had dysphagia and choking sensation at presentation. She underwent positron emission-computed tomography (PET-CT), endoscopy, endoscopic ultrasonography, and fine needle aspiration. She was clinically diagnosed as having an esophageal benign tumor and underwent endoscopic submucosal dissection. The polyp was successfully resected; however, the process was very difficult, and the lesion was too large to pass through the upper esophagus. Finally, we removed the lesion surgically. Fibrovascular polyps are often large, and if endoscopic resection is chosen, it is necessary to consider the difficulties that may be encountered during resection, before initiating treatment.
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Affiliation(s)
- Dan Nie
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Ye Zong
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Jielin Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
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Acar N, Acar T, Cengiz F, Şuataman B, Tavusbay C, Haciyanli M. Endoscopic resection for giant oesophageal fibrovascular polyp. Ann R Coll Surg Engl 2020; 102:e89-e90. [PMID: 31964152 DOI: 10.1308/rcsann.2020.0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A fibrovascular polyp is a rare benign pseudotumour of the oesophagus and hypopharynx. Although patients usually present with dysphagia, aspiration related mortality may occur. If the tumour is too large and/or located in the proximal oesophagus, it may protrude from the mouth. The general approach to treatment is complete reconstruction with cervicotomy. We present our experience of a giant oesophageal fibrovascular polyp that was protruding from the mouth and treated with endoscopic resection. A 55-year-old man was admitted to our outpatient clinic complaining of a mass protruding from his mouth when he coughed. Endoscopy and bronchoscopy both revealed a 15-18cm long polypoid mass originating from the proximal oesophagus (at the level of the hypopharynx). Complete resection was performed via endoscopy.
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Affiliation(s)
- N Acar
- Department of General Surgery, Izmir Katip Çelebi University Atatürk Training and Research Hospital
| | - T Acar
- Department of General Surgery, Izmir Katip Çelebi University Atatürk Training and Research Hospital
| | - F Cengiz
- Department of General Surgery, Izmir Katip Çelebi University Atatürk Training and Research Hospital
| | - B Şuataman
- Department of General Surgery, Izmir Katip Çelebi University Atatürk Training and Research Hospital
| | - C Tavusbay
- Department of General Surgery, Izmir Katip Çelebi University Atatürk Training and Research Hospital
| | - M Haciyanli
- Department of General Surgery, Izmir Katip Çelebi University Atatürk Training and Research Hospital
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Mehdorn AS, Schmidt F, Steinestel K, Wardelmann E, Greulich B, Palmes D, Senninger N. Pedunculated, well differentiated liposarcoma of the oesophagus mimicking giant fibrovascular polyp. Ann R Coll Surg Engl 2017; 99:e209-e212. [PMID: 28853590 DOI: 10.1308/rcsann.2017.0117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We present a rare case of a big oesophageal liposarcoma causing dysphagia and weight loss in a 75-year-old patient. Endoscopically, a pedunculated lesion with subtotal obstruction of the oesophageal lumen had been detected and thoracoabdominal oesophageal resection with gastric sleeve reconstruction was performed. Surprisingly, a liposarcoma of the oesophagus was revealed on histopathological analysis, showing MDM2 overexpression. Oncological follow-up has been uneventful and the patient remains in good clinical shape at 15 months after surgery.
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6
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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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7
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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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8
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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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9
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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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10
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Ryan ML, Zhuge Y, Smothers CD, Zhang J, Huang EY. Intraluminal esophageal teratoma in a neonate. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.09.003] [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] Open
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11
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Madeira FP, Justo JWR, Wietzycoski CR, Burttet LM, Kruel CDP, da Rosa AP. Giant fibrovascular polyp of the esophagus: a diagnostic challenge. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 26:71-3. [PMID: 23702877 DOI: 10.1590/s0102-67202013000100017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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12
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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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13
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Yu Z, Bane BL, Lee JY, Pitha JV, Peyton M, Houck J, Li S. Cytogenetic and comparative genomic hybridization studies of an esophageal giant fibrovascular polyp: a case report. Hum Pathol 2011; 43:293-8. [PMID: 21835434 DOI: 10.1016/j.humpath.2011.04.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 03/14/2011] [Accepted: 04/04/2011] [Indexed: 01/12/2023]
Abstract
Esophageal giant fibrovascular polyps are rare and are thought to represent redundant tumorlike or hamartomatous esophageal folds. Although most patients present with slowly evolving dysphagia, a minority present with acute respiratory distress or even death caused by asphyxia. We present the pathologic and cytogenetic findings of an 18-cm esophageal giant fibrovascular polyp in a 49-year-old woman who presented with odynophagia and dysphagia. The histologic findings are that of classic esophageal giant fibrovascular polyp as previously described in the literature. Cytogenetic study revealed an abnormal karyotype, and comparative genomic hybridization analysis showed regional amplifications of chromosomes 3 and 12 and a possible loss of 22q13.3-qter. The significance of these cytogenetic findings is unclear but may suggest a neoplastic process in the pathogenesis of esophageal giant fibrovascular polyps.
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Affiliation(s)
- Zhongxin Yu
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
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14
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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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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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16
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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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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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18
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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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Vasseur Maurer S, Schwab G, Osterheld MC, Reinberg O, Joseph JM. A 16-month-old boy vomits a double tongue: intraluminal duplication of the cervical esophagus in children. Dis Esophagus 2008; 21:186-8. [PMID: 18269657 DOI: 10.1111/j.1442-2050.2007.00755.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A 16-month-old boy presented with a story of stridor, solid dysphagia and a history of spectacular protrusion underneath his tongue which was mistaken by the parents for a snake's tongue! The radiological examinations showed a filling defect of the upper and middle third esophagus which compressed the cervical trachea. This was found to be an intraluminal tubular esophageal duplication. Treatment by cervicotomy and unusual histological facts are presented.
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Affiliation(s)
- S Vasseur Maurer
- Pediatric Surgery, University Hospital of Lausanne (CHUV), Switzerland.
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20
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Abstract
Fibrovascular polyps of the esophagus and hypopharynx are benign tumors of the upper digestive tract. The majority of these polyps are located in the upper part of the esophagus but the hypopharyngeal fibrovascular polyps are only rarely seen. Most of them are surgically treated and this is usually done through a cervical incision, although some of them have been removed endoscopically. The authors report here on a case of a 63-yr-old-man with a giant fibrovascular polyp of the hypopharynx that extended into the stomach; this polyp was removed through simultaneous transcervical and transabdominal approaches because of the huge size of the polyp. The man presented with progressive dysphagia of 1 yr duration. The preoperative assessment revealed a giant polyp arising from the left arytenoid and extending into the stomach. The dimension of the polyp was about 26 x 10 x 4 cm. The complete resection of the polyp with the simultaneous transcervical and transabdominal approaches was successful, and it was diagnosed as a fibrovascular polyp. The patient has been followed up without any recurrence for 6 month postoperatively.
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Affiliation(s)
- Hoseok I
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Jin Sun Kim
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
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21
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Abstract
Abstract
Giant fibrovascular polyps of the esophagus are rare, benign, “tumorlike” lesions that typically present as large pedunculated growths arising in the cervical esophagus. The predominant histologic component of these lesions is variable, often resulting in misdiagnosis. Clinically, these polyps present with nonspecific symptoms and are often undiagnosed or misdiagnosed until they are significant in size. Diagnosis is best made by upper endoscopic evaluation; surgical excision is the definitive treatment. Although rare, asphyxia resulting from obstruction of the glottis is the most serious complication. We describe a case of asphyxiation caused by laryngeal occlusion by a giant esophageal polyp and we provide a review of the literature.
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Affiliation(s)
- Rachel L Sargent
- Department of Pathology and Laboratory Medicine, Hospital of The University of Pennsylvania, Philadelphia, PA, USA
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22
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Carrick C, Collins KA, Lee CJ, Prahlow JA, Barnard JJ. Sudden death due to asphyxia by esophageal polyp: two case reports and review of asphyxial deaths. Am J Forensic Med Pathol 2005; 26:275-81. [PMID: 16121086 DOI: 10.1097/01.paf.0000178098.33597.de] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Asphyxia, not an uncommon cause of sudden death, may result from numerous etiologies. Foreign-body aspiration and strangulation are 2 extrinsic causes. Airway obstruction may also be caused by laryngeal edema, asthma, infection, or anaphylaxis. Chronic causes of asphyxia include musculoskeletal diseases (eg, muscular dystrophy, amyotrophic lateral sclerosis), neurologic disorders (eg, myasthenia gravis, multiple sclerosis), respiratory disease (eg, emphysema, chronic bronchitis), or tumors. The manner of death in cases of asphyxiation may be natural, accidental, homicide, or suicide. For the death investigator, determining the cause and manner of death can often be quite challenging. We report here 2 cases of an esophageal fibrovascular polyp causing sudden asphyxial death, review of the literature, and discussion of other differential diagnoses in the case of asphyxial death.
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Affiliation(s)
- Christina Carrick
- Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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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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Escarda A, Reyes J, Ginard D, Barranco L, Bonet L, Roldán J, Lloret J, Llompart A, Gayá J, Obrador A. [Giant esophageal fibrovascular polyp]. GASTROENTEROLOGIA Y HEPATOLOGIA 2004; 27:431-2. [PMID: 15461946 DOI: 10.1016/s0210-5705(03)70495-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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