Giant fibrovascular polyp of the esophagus: report of a case

Hybrid laparo-endoscopic access: New approach to surgical treatment for giant fibrovascular polyp of esophagus: A case report and review of literature

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.

Esophageal Lipoma and Liposarcoma: A Systematic Review

BACKGROUND

Esophageal lipomatous tumors, also reported as fibrovascular polyp, fibrolipoma, angiolipoma, and liposarcoma, account for less than 1% of all benign mesenchymal submucosal tumors of the esophagus. Clinical presentation and therapy may differ based on location, size, and morphology. A comprehensive and updated systematic review of the literature is lacking.

METHODS

A systematic review of the literature was performed according to PRISMA guidelines. Pubmed, Embase, Cochrane, and Medline databases were consulted using MESH keywords. Non-English written articles and abstracts were excluded. Sex, age, symptoms at presentation, diagnosis, tumor location and size, surgical approach and technique of excision, pathology, and morphology were extracted and recorded in an electronic database.

RESULTS

Sixty-seven studies for a total of 239 patients with esophageal lipoma or liposarcoma were included in the qualitative analysis. Among 176 patients with benign lipoma, the median age was 55. The main symptoms were dysphagia (64.2%), transoral polyp regurgitation (32.4%), and globus sensation (22.7%). The majority of lipomas (85.7%) were intraluminal polyps, with a stalk originating from the upper esophagus. Overall, 165 patients underwent excision of the mass through open surgery (65.5%), endoscopy (27.9%), or laparoscopy/thoracoscopy (3.6%). Only 5 (3%) of patients required esophagectomy. Of the 11 untreated patients with an intraluminal polyp, 7 died from asphyxia. Overall, liposarcoma was diagnosed in 63 patients, and 12 (19%) underwent esophagectomy.

CONCLUSION

Esophageal lipomatous tumors are rare but potentially lethal when are intraluminal and originate from the cervical esophagus. Modern radiological imaging has improved diagnostic accuracy. Minimally invasive transoral and laparoscopic/thoracoscopic techniques represent the therapeutic approach of choice.

Esophageal Lipoma and Liposarcoma: A Systematic Review

Background

Esophageal lipomatous tumors, also reported as fibrovascular polyp, fibrolipoma, angiolipoma, and liposarcoma, account for less than 1% of all benign mesenchymal submucosal tumors of the esophagus. Clinical presentation and therapy may differ based on location, size, and morphology. A comprehensive and updated systematic review of the literature is lacking.

Methods

A systematic review of the literature was performed according to PRISMA guidelines. Pubmed, Embase, Cochrane, and Medline databases were consulted using MESH keywords. Non-English written articles and abstracts were excluded. Sex, age, symptoms at presentation, diagnosis, tumor location and size, surgical approach and technique of excision, pathology, and morphology were extracted and recorded in an electronic database.

Results

Sixty-seven studies for a total of 239 patients with esophageal lipoma or liposarcoma were included in the qualitative analysis. Among 176 patients with benign lipoma, the median age was 55. The main symptoms were dysphagia (64.2%), transoral polyp regurgitation (32.4%), and globus sensation (22.7%). The majority of lipomas (85.7%) were intraluminal polyps, with a stalk originating from the upper esophagus. Overall, 165 patients underwent excision of the mass through open surgery (65.5%), endoscopy (27.9%), or laparoscopy/thoracoscopy (3.6%). Only 5 (3%) of patients required esophagectomy. Of the 11 untreated patients with an intraluminal polyp, 7 died from asphyxia. Overall, liposarcoma was diagnosed in 63 patients, and 12 (19%) underwent esophagectomy.

Conclusion

Esophageal lipomatous tumors are rare but potentially lethal when are intraluminal and originate from the cervical esophagus. Modern radiological imaging has improved diagnostic accuracy. Minimally invasive transoral and laparoscopic/thoracoscopic techniques represent the therapeutic approach of choice.

An esophageal tumor unlike others: The fibrovascular polyp

A fibrovascular polyp is a rare benign pseudotumor of the esophagus or the hypopharynx. It comes to light through dysphagia and can lead to death by asphyxiation. CT scan and MRI suggest this diagnosis by highlighting a lobed endoluminal tumor primarily composed of adipose tissue and pedicled on a vessel. Anatomo-pathological analysis of biopsies can exclude liposarcoma, the main differential diagnosis. Treatment consists in complete reconstruction by cervicotomy.

Pedunculated, well differentiated liposarcoma of the oesophagus mimicking giant fibrovascular polyp

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.

Presentation and Management of Giant Fibrovascular Polyps of the Hypopharynx and Esophagus

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.

Gastroscopic removal of a giant fibrovascular polyp from the esophagus

Giant polyps in the esophagus are rarely occurring benign tumors and may contain lipomas, fibrovascular polyps, fibrolipomas or neurofibromas polyps. Clinical symptoms include dysphagia, vomiting, retrosternal pain, shortness of breath, and asthma. In some cases, the polyps are regurgitated into the oral cavity and represent a spectacular manifestation. The reported case in this study was of a 50-year-old man who complained of emesia for half a year and dysphagia for one month before being hospitalized. Occasionally, a fleshly mass reached into his mouth. The results of endoscopic ultrasonography, barium swallow in the upper digestive tract, and a computed tomography scan demonstrated a giant polyp in the esophagus, which was subsequently removed by gastroscopy. Pathological examination determined a fibrovascular polyp.

An unusual cause of airway obstruction in a patient in the endoscopy suite

A 74-year-old man presented for outpatient endoscopy because of dysphagia and the sensation of a mass in the back of his throat. Esophagogastroduodenoscopy demonstrated a soft tissue mass in the proximal esophagus that prolapsed into the hypopharynx on withdrawal of the endoscope. Complete airway obstruction ensued, requiring emergent tracheotomy. The patient was transferred to the hospital for further treatment. Surgical resection revealed a rare giant fibrovascular polyp, which may be associated with asphyxiation and sudden death.

Giant fibrovascular polyp of the esophagus: a novel technical approach

Fibrovascular polyps (FVPs) of the esophagus are rare, and their course is usually indolent until reaching enormous proportions. It is a dramatic entity owing to its tendency to cause bizarre complications. We describe a 49-year-old female patient with sudden dyspnoea that required digital maneuvers to clear the airway. After diagnosing, an FVP of the esophagus, a video-assisted endocavitary surgery was made. Histopathological examination revealed a fibrovascular polyp. Endoscopic controls after excision show no mass or symptoms recurrence.