Endoscopic resection for giant oesophageal fibrovascular polyp

[Experience of diagnosis and treatment of fibrovascular polyp of the hypopharynx]

Objective:To explore and analyze the imaging examinations, clinical presentation, operative methods complication and the surgical outcomes of fibrovascular polyp of the hypopharynx （hFVP）. Methods:The clinical data of 10 patients with hFVP were analyzed retrospectively from January 2015 to June 2020 at the First Affiliated Hospital of Zhengzhou University.Results: All the 10 cases were sporadic. The locations of pedicle: 5 cases were found in pyriform sinus （4 on the left side, 1 on the right side） ,3 cases were found in lateral pharyngeal wall （on the right side），and 2 cases were found in postcricoid space. Among 10 cases, 8 cases were treated with endoscopic coblation cauterization,1 case had excision of endoscopic laryngeal forcep, and 1 case for endoscopic CO2 laser treatment as well as coblation cauterization. Follow up for 5.9-71.4 （30.9） months showed that 7 cases had no recurrence, 2 cases had no connection, 1 cases had recurrence once. One patient recurred once underwent the last operation with transcervical approach as well as tracheotomy,and no recurrence was found in the follow up of 13.2 months. Conclusion:Fibrovascular polyp of the hypopharynx is rare benign submucosal neoplasm clinically, and endoscopic coblation cauterization is a good choice. Recurrent fibrovascular polyp of the hypopharynx can be treated by endoscopic coblation cauterization again, so that patients with multiple recurrences whose polyps are giant or euangiotic can consider the transcervical approach, if necessary, the tracheotomy will also be given.

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.