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Prasad AS, Shanbhogue KP, Ramani NS, Balasubramanya R, Surabhi VR. Non-gastrointestinal stromal tumor, mesenchymal neoplasms of the gastrointestinal tract: a review of tumor genetics, pathology, and cross-sectional imaging findings. Abdom Radiol (NY) 2024; 49:1716-1733. [PMID: 38691132 DOI: 10.1007/s00261-024-04329-1] [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] [Received: 02/16/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 05/03/2024]
Abstract
There is a diverse group of non-gastrointestinal stromal tumor (GIST), mesenchymal neoplasms of the gastrointestinal (GI) tract that demonstrate characteristic pathology and histogenesis as well as variable imaging findings and biological behavior. Recent advancements in tumor genetics have unveiled specific abnormalities associated with certain tumors, influencing their molecular pathogenesis, biology, response to treatment, and prognosis. Notably, giant fibrovascular polyps of the esophagus, identified through MDM2 gene amplifications, are now classified as liposarcomas. Some tumors exhibit distinctive patterns of disease distribution. Glomus tumors and plexiform fibromyxomas exhibit a pronounced affinity for the gastric antrum. In contrast, smooth muscle tumors within the GI tract are predominantly found in the esophagus and colorectum, surpassing the incidence of GISTs in these locations. Surgical resection suffices for symptomatic benign tumors; multimodality treatment may be necessary for frank sarcomas. This article aims to elucidate the cross-sectional imaging findings associated with a wide spectrum of these tumors, providing insights that align with their histopathological features.
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Affiliation(s)
| | | | - Nisha S Ramani
- Department of Pathology, Michael E. DeBakey VA Medical Center, Houston, USA
| | | | - Venkateswar R Surabhi
- Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX, 77030, USA.
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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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Ogunbona OB, Heninger M, Bradley K, Geller R. Sudden death in an adolescent due to undiagnosed classic Hodgkin lymphoma. J Forensic Sci 2021; 67:387-390. [PMID: 34499743 DOI: 10.1111/1556-4029.14879] [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] [Received: 06/08/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 11/29/2022]
Abstract
Few cases of natural sudden death presenting as an undiagnosed lymphoma have been reported in the literature, especially in adolescents. Herein we provide a report of sudden death caused by undiagnosed classic Hodgkin lymphoma (cHL). We describe an 18-year-old female who collapsed after several weeks of weight loss, decreased appetite, and dyspnea. At autopsy, a bulky mass arising in the mediastinum and neck compressed the esophagus and trachea, surrounded the great vessels, obliterated the pericardial sac, and infiltrated the myocardium. The lungs were collapsed and large pleural effusions were present. The tumor burden, which weighed at least 2710 g in aggregate, was entirely above the diaphragm. Microscopic examination of the masses showed features typical for nodular sclerosis cHL including large bands of sclerosis, numerous Hodgkin/Reed-Sternberg (HRS) cells, and an eosinophil-rich mixed inflammatory cell infiltrate. Immunohistochemical stains showed the HRS cells to be uniformly positive for CD30 and CD15 and negative for CD3, CD20, CD45, and PAX5. This case exemplifies a rare sudden natural death due to previously undiagnosed cHL in a young patient.
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Affiliation(s)
- Oluwaseun B Ogunbona
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael Heninger
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Fulton County Medical Examiner, Atlanta, Georgia, USA
| | - Kyle Bradley
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rachel Geller
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,DeKalb County Medical Examiner, Decatur, Georgia, USA
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4
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Sotirović J, Pavićević L, Petrović S, Ristić S, Perić A. Giant Fibrovascular Polyp as an Unusual Cause of Globus Pharyngeus. EAR, NOSE & THROAT JOURNAL 2021; 102:304-306. [PMID: 33781124 DOI: 10.1177/01455613211003989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Differential diagnosis of globus sensation in an otherwise asymptomatic patient should include hypopharyngeal fibrovascular polyp to avoid potentially fatal complications like airway compromise following regurgitation. We present a case of a 74-year-old man with a 13-cm long hypopharyngeal fibrovascular polyp with 9 months history of globus sensation. A narrow stalk of the giant polyp allowed endoscopic removal and complete resection with the CO2 laser. Histopathological examination was conclusive for the fibrovascular polyp.
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Affiliation(s)
- Jelena Sotirović
- Department of Otorhinolaryngology, Faculty of Medicine, 112404Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Ljubomir Pavićević
- Department of Otorhinolaryngology, 112404Military Medical Academy, Belgrade, Serbia
| | - Stanko Petrović
- Department of Gastroenterology and Hepatology, 112404Military Medical Academy, Belgrade, Serbia
| | - Saša Ristić
- Pathology and Forensic Medicine Institute, 112404Military Medical Academy, Belgrade, Serbia
| | - Aleksandar Perić
- Department of Otorhinolaryngology, Faculty of Medicine, 112404Military Medical Academy, University of Defence, Belgrade, Serbia
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5
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Byard RW, Heath K. Variable Mechanisms of Sudden and Unexpected Death in Cases of Occult Carcinoma of the Larynx. Am J Forensic Med Pathol 2021; 42:92-95. [PMID: 32694272 DOI: 10.1097/paf.0000000000000604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
ABSTRACT Two cases of clinically undiagnosed laryngeal squamous cell carcinomas in men aged 57 and 66 years, respectively, are reported that resulted in sudden death from upper airway occlusion. The cause of the terminal event differed between the 2 cases with acute airway narrowing being precipitated by tenacious mucopurulent secretions in case 1 and hemorrhage from surface ulceration with glottic occlusion by blood clot in case 2. At autopsy, the immediate cause of acute airway compromise in cases of space-occupying laryngeal lesions may, therefore, be due to the synergistic effects of different factors.
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Affiliation(s)
- Roger W Byard
- From the Forensic Science SA and School of Medicine, The University of Adelaide, Frome Road, Adelaide, South Australia, Australia
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6
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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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7
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Sestini S, Gisabella M, Pastorino U, Billé A. Presenting symptoms of giant fibrovascular polyp of the oesophagus: case report and literature review. Ann R Coll Surg Engl 2016; 98:e71-3. [PMID: 27087340 PMCID: PMC5227043 DOI: 10.1308/rcsann.2016.0127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2016] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Lipomas of the gastrointestinal tract are rare, slow-growing lesions that comprise 0.4% of all gastrointestinal neoplasms. They can cause dysphagia, dyspnoea or sudden choking. CASE HISTORY Due to rarity of this condition and its uncommon presentation, a literature review was carried out (PubMed). This search revealed 290 articles, of which 74 were considered pertinent and were evaluated. We report a case of a 13cm pedunculated oesophageal lipoma that presented with increasing dysphagia and two episodes of suffocation. The patient underwent curative resection through a cervical approach. CONCLUSIONS Resection is recommended for large (>5 cm) or symptomatic polyps. Outcomes are excellent given that lesions are universally benign and oesophageal resection is not required.
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Affiliation(s)
- S Sestini
- Fondazione IRCCS, Istituto Nazionale dei Tumori , Milan , Italy
| | - M Gisabella
- Fondazione IRCCS, Istituto Nazionale dei Tumori , Milan , Italy
| | - U Pastorino
- Fondazione IRCCS, Istituto Nazionale dei Tumori , Milan , Italy
| | - A Billé
- Thoracic Surgery at Guys Hospital , UK
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8
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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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9
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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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10
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Dhoon TQ, Gerber JL, Tran TB, Mahtabifard A, Sibert KS. An unusual cause of airway obstruction in a patient in the endoscopy suite. ACTA ACUST UNITED AC 2015; 3:15-9. [PMID: 25611017 DOI: 10.1213/xaa.0000000000000040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Taizoon Q Dhoon
- From the Departments of *Anesthesiology, †Surgery, and ‡Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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11
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Maskovyak A, Felo J. Sudden Death Due to Asphyxia by Primary Tracheal Small Cell Carcinoma. Acad Forensic Pathol 2014. [DOI: 10.23907/2014.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Sudden natural asphyxial death in adults due to airway obstruction is an unusual cause of death. A variety of etiologies can cause airway obstruction, including benign or malignant tumors and soft tissue swelling from asthma, infections, or anaphylaxis. Malignant tracheal neoplasms are exceedingly rare with a reported incidence of approximately 2/1 000 000 and the small cell carcinoma subtype accounts for <10% of these tumors. We present a case of a 55-year-old female smoker who was found dead at home. At autopsy an obstructing lesion of the proximal trachea was identified that showed the characteristic cytomorphology of small cell carcinoma. No primary pulmonary lesions were identified. The cause of death was determined to be obstruction of the trachea by small cell carcinoma and the manner, natural.
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Affiliation(s)
- Amanda Maskovyak
- Pathology Resident at the Cleveland Clinic Foundation Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland, OH
| | - Joseph Felo
- Pathology Resident at the Cleveland Clinic Foundation Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland, OH
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12
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Beylergil V, Simmons MZ, Ulaner G, Jurcic J, Hibshoosh H, Carrasquillo JA. FDG PET/CT findings in a rare case of giant fibrovascular polyp of the esophagus harboring atypical lipomatous tumor/well-differentiated liposarcoma. Clin Nucl Med 2014; 39:288-91. [PMID: 24458178 DOI: 10.1097/rlu.0000000000000358] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 70-year-old man with a history of chronic lymphocytic leukemia (CLL) underwent FDG PET/CT scan, which revealed a large polypoid soft tissue lesion in the esophagus with peripheral FDG avidity. An endoscopic biopsy revealed inflammatory changes with scattered CLL cells. The final histopathology demonstrated an 18-cm long and 4-cm wide giant fibrovascular polyp that was removed in 2 pieces. The polyp was composed of atypical adipose tissue with scattered giant cells and spindle-shaped cells as well as foci of CLL. Mouse double minute 2 homolog amplification was noted by fluorescence in situ hybridization diffusely in the giant polyp consistent with well-differentiated liposarcoma in a giant fibrovascular polyp.
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Affiliation(s)
- Volkan Beylergil
- From the *Molecular and Imaging Therapy Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York; †Department of Radiology, Weill Cornell Medical Center, New York, NY; ‡Department of Radiology, Memorial Sloan-Kettering Cancer Center, Basking Ridge, NJ; §Division of Hematology/Oncology, Department of Medicine, and ¶Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY
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13
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Kiho L, Byard RW. Acute fatal upper airway obstruction from an occult cavernous hemangioma of the larynx. J Forensic Sci 2014; 60 Suppl 1:S93-6. [PMID: 25131533 DOI: 10.1111/1556-4029.12587] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 11/17/2013] [Accepted: 12/21/2013] [Indexed: 11/27/2022]
Abstract
A 42-year-old previously well man collapsed while holding his throat. Resuscitation was unsuccessful, and at autopsy, the most significant findings were limited to the larynx, pharynx, and anterior mediastinum where there were multinodular dark blue tumors. Within the larynx, the lower border of the tumor was well demarcated, not extending beyond the vocal cords. A separate large polypoidal tumor mass was attached to the right aryepiglottic fold by a thin fibrous stalk. Histologic examination revealed numerous large, thin-walled cavernous-type vascular spaces typical of a multifocal cavernous hemangioma. Death was due to asphyxiation from obstruction of the upper airways by a cavernous hemangioma of the larynx. Adult laryngeal hemangiomas are rare and are usually supraglottic. This case demonstrates that pedunculated laryngeal cavernous hemangiomas may remain occult until the initiation of an obstructive episode with sudden collapse and death. In such instances, the diagnosis must rely upon an autopsy examination.
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Affiliation(s)
- Liina Kiho
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
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14
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Sen S, Chhabra A, Ganguly A, Baidya DK. Esophageal polyp as a posterior mediastinal mass: Intraoperative dynamic airway obstruction requiring emergency tracheostomy. J Anaesthesiol Clin Pharmacol 2014; 30:97-100. [PMID: 24574604 PMCID: PMC3927304 DOI: 10.4103/0970-9185.125715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Anesthesia in the presence of a mediastinal mass is difficult and challenging as the mass can involve or compress the heart, great vessels, tracheo-bronchial tree and the surrounding structures. We describe a case of severe tracheo-bronchial obstruction requiring emergency tracheostomy during the intraoperative period after an uneventful induction of anesthesia in a patient with a large esophageal polyp presenting as a posterior mediastinal mass.
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Affiliation(s)
- Suvadeep Sen
- Department of Anaesthesia and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
| | - Anjolie Chhabra
- Department of Anaesthesia and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
| | - Arpita Ganguly
- Department of Anaesthesia, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Dalim Kumar Baidya
- Department of Anaesthesia and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
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15
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Park JS, Bang BW, Shin J, Kwon KS, Kim HG, Shin YW, Choi SJ. A Case of Esophageal Fibrovascular Polyp That Induced Asphyxia during Sleep. Clin Endosc 2014; 47:101-3. [PMID: 24570890 PMCID: PMC3928480 DOI: 10.5946/ce.2014.47.1.101] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 03/10/2013] [Accepted: 03/20/2013] [Indexed: 12/29/2022] Open
Abstract
Esophageal fibrovascular polyps are rare, benign, submucosal tumors of the upper digestive tract that usually have an indolent course until the lesion attains a very large size. The most frequent complaints associated with these tumors include dysphagia and foreign body sensation. However, a long pedunculated polyp can regurgitate into the pharynx or oral cavity and cause asphyxia and sudden death if the larynx is occluded. We describe the case of a 51-year-old man who experienced snoring and occasional asphyxia during sleep. Upper endoscopy was performed, which indicated the presence of a pedunculated esophageal polyp that regurgitated into the vocal cords. The polyp was removed using a polypectomy snare and was confirmed to be a fibrovascular polyp based on pathologic examination findings. Three months after the excision of the polyp, the patient was found to be doing well without any further occurrence of asphyxia or sleep disturbances.
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Affiliation(s)
- Jin-Seok Park
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Byoung Wook Bang
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Junyoung Shin
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Kye Sook Kwon
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Hyung Gil Kim
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Yong Woon Shin
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Suk Jin Choi
- Department of Pathology, Inha University School of Medicine, Incheon, Korea
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16
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Manchanda S, Devitt PG, Thompson SK. Endoscopic removal of a giant oesophageal polyp. ANZ J Surg 2012; 81:654-5. [PMID: 22295417 DOI: 10.1111/j.1445-2197.2011.05769.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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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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18
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Iino M, O’Donnell C. Postmortem Computed Tomography Findings of Upper Airway Obstruction by Food. J Forensic Sci 2010; 55:1251-8. [DOI: 10.1111/j.1556-4029.2010.01430.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Boghossian E, Tambuscio S, Sauvageau A. Nonchemical Suffocation Deaths in Forensic Setting: A 6-Year Retrospective Study of Environmental Suffocation, Smothering, Choking, and Traumatic/Positional Asphyxia. J Forensic Sci 2010; 55:646-51. [DOI: 10.1111/j.1556-4029.2010.01351.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Poli D, Solarino B, Di Vella G, Tattoli L, Strisciullo G, Goldoni M, Mutti A, Gagliano-Candela R. Occupational asphyxiation by unknown compound(s): Environmental and toxicological approach. Forensic Sci Int 2010; 197:e19-26. [DOI: 10.1016/j.forsciint.2009.12.058] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 12/15/2009] [Accepted: 12/18/2009] [Indexed: 11/28/2022]
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22
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Abstract
In the investigation of sudden death in adults, channelopathies, such as long QT syndrome, have risen to the fore in the minds of forensic pathologists in recent years. Examples of these disorders are touched upon in this review as an absence of abnormal findings at postmortem examination is characteristic and the importance of considering the diagnosis lies in the heritable nature of these conditions. Typically, a diagnosis of a possible channelopathy is evoked as an explanation for a 'negative autopsy' in a case of apparent sudden natural death. However, the one potential adverse effect of this approach is that subtle causes of sudden death may be overlooked. The intention of this article is to review and discuss potential causes of sudden adult death (mostly natural) that should be considered before resorting to a diagnosis of possible channelopathy. Nonetheless, it becomes apparent that many of the potential causes of sudden death can have a genetic basis. Thus, it becomes an important consideration that there may be a genetic basis to sudden death that extends beyond the negative autopsy.
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23
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Been MJ, Hinsely ML, Hartig GK. Fibrovascular polyp of the cervical esophagus. Am J Otolaryngol 2009; 30:134-6. [PMID: 19239955 DOI: 10.1016/j.amjoto.2008.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Accepted: 02/18/2008] [Indexed: 10/21/2022]
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24
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Blacha MM, Sloots CE, Van Munster IP, Wobbes T. Dysphagia caused by a fibrovascular polyp: a case report. CASES JOURNAL 2008; 1:334. [PMID: 19019249 PMCID: PMC2602996 DOI: 10.1186/1757-1626-1-334] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 11/19/2008] [Indexed: 11/10/2022]
Abstract
A 73-year old man presented with dysphagia for liquid and solid food. Barium contrast study of the esophagus and esophagoscopy demonstrated a fibrovascular polyp. This, almost 10 cm benign esophageal tumor, was removed surgically by a cervical esophagotomy. A fibrovascular polyp is a rare benign tumor of the esophagus, which, however, may give serious complications as asphyxia resulting from laryngeal obstruction leading to sudden death.
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Affiliation(s)
- Marielle Mj Blacha
- Department of Surgery, Radboud University Nijmegen Medical Center, the Netherlands.
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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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Tanguay J, Pollanen M. Sudden death by laryngeal polyp: a case report and review of the literature. Forensic Sci Med Pathol 2008; 5:17-21. [PMID: 19291432 DOI: 10.1007/s12024-008-9061-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2007] [Accepted: 09/26/2007] [Indexed: 11/28/2022]
Abstract
Sudden unexpected death in the context of bizarre or unusual behavior usually relates to acute drug intoxication or excited delirium. We report the case of a man who died suddenly while running naked on a public street. Although the initial death investigation was indicative of excited delirium or drug intoxication, autopsy revealed glottic obstruction by an inflammatory laryngeal polyp. Toxicologic studies were negative and investigation revealed presentation at a hospital the day before death with stridor. It is believed he developed airway obstruction while dressing at home and ran out on the street to find assistance. This case illustrates the importance of a thorough death investigation and a broad differential diagnosis when approaching a forensic autopsy.
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Affiliation(s)
- Jeff Tanguay
- Provincial Forensic Pathology Unit, Office of the Chief Coroner, Department of Laboratory Medicine and Pathobiology, University of Toronto, 26 Grenville Street, Toronto, ON, Canada M7A 2G9
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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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Affiliation(s)
- Jamil N Al-Swiahb
- Department of Otorhinolaryngology, Head & Neck Surgery, King Abdulaziz University Hospital, Riyadh, Saudi Arabia.
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Abstract
A 65-year-old woman with a sore throat and cough suddenly collapsed. She regained spontaneous circulation following resuscitation, but hypoxic encephalopathy was identified. Her vocal cords and the results of chest radiography were normal and no obstructive mass was identified in the neck on computed tomography (CT), but she demonstrated signs of obstructive upper airway. Bronchoscopy revealed tracheal stenosis. Chest CT showed tracheal compression by an esophageal tumor. Investigation of the trachea and surrounding organs by bronchoscopy and CT is important even when a patient with suspected respiratory arrest displays normal findings on chest radiography.
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Affiliation(s)
- Youichi Yanagawa
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Japan.
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Porzionato A, Macchi V, Rodriguez D, De Caro R. Airway obstruction by laryngeal masses in sudden and homicidal deaths. Forensic Sci Int 2007; 171:e15-20. [PMID: 17573217 DOI: 10.1016/j.forsciint.2007.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2006] [Revised: 04/19/2007] [Accepted: 05/06/2007] [Indexed: 11/21/2022]
Abstract
We present two cases of autopsy detection of laryngeal masses with medico-legal implications. The first is a 56-year-old man who died suddenly of asphyxia due to upper airway obstruction caused by a large glosso-epiglottic retention cyst and glottic oedema. Hypothesis of medical liability was raised, due to delayed tracheotomy as the result of repeated failed attempts at oral intubation by various physicians. Difficult oral intubation due to the presence of a laryngeal mass in an asphyxiating subject requires rapid tracheotomy. The second case deals with a 43-year-old woman who died of asphyxia due to airway obstruction, as a result of injury of a cavernous laryngeal haemangioma after homicidal manual strangulation, with severe haemorrhagic infiltration of the surrounding soft tissues. Damage to laryngeal/hypopharyngeal masses should be considered as a possible sign of manual strangulation, as well as neck skin bruises/abrasions and laryngeal haemorrhages.
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Affiliation(s)
- Andrea Porzionato
- Department of Human Anatomy and Physiology, University of Padova, Via Gabelli 65, 35127 Padova, Italy
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Alobid I, Vilaseca I, Fernández J, Bordas JM. Giant fibrovascular polyp of the esophagus causing sudden dyspnea: endoscopic treatment. Laryngoscope 2007; 117:944-5. [PMID: 17473701 DOI: 10.1097/mlg.0b013e318033310f] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A 76-year-old man with sudden dyspnea was admitted to our department. A fleshy mass was visualized in the labial commissure, and the flexible esophagoscopy showed the polyp prolapsed into the oropharynx, partially obstructing the airway. The polyp was encircled with a large oval snare and Endoloop, which was adjusted to stalk-basis before tightening. Pure coagulation was used to transect the lesion, which was then retrieved. The polyp measured 10 x 2.5 cm. To our knowledge, our case is the first large esophageal giant fibrovascular polyps causing sudden dyspnea in the literature that has been resected endoscopically without complications.
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Affiliation(s)
- Isam Alobid
- ENT Department, Institut Clinic d'Especialitats Méquiques i Quirúrgiques, Hospital Clinic Barcelona, Barcelona, Spain.
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Abstract
An increasing death rate as a result of violence constitutes a large group in medicolegal autopsies. Specially, deaths due to asphyxia are one of the most important causes in violence deaths. During the 21-year period from January 1984 to October 2004, there were 134 asphyxial deaths autopsied by the Department of Forensic Medicine, Trakya University, Edirne, Turkey. Asphyxial deaths comprise 15.7% of all forensic autopsies; 20.8% of the cases are aged between 30 and 39 years, and the average age was 41.9 years. Males constitute 79.8% of all the cases. The most frequent method of asphyxiation death is hanging (56 cases, 41.8%), followed by drowning (30.5%) and carbon monoxide poisoning (8.2%). More violent methods, such as ligature or manual strangulations, constitute 2.9% and 2.3% of all asphyxial deaths, respectively. Although it was varying according to the methods of asphyxiation, suicide was found to be the manner of death in the majority of the cases.
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Affiliation(s)
- Derya Azmak
- Department of Forensic Medicine, Trakya University, Medical Faculty, Edirne, Turkey
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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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