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Starkov YG, Dzhantukhanova SV, Zamolodchikov RD, Badakhova AB. [Hybrid laparo-endoscopic access for giant fibrovascular esophageal polyp: a case report]. Khirurgiia (Mosk) 2023:123-132. [PMID: 38010027 DOI: 10.17116/hirurgia2023111123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Fibrovascular polyp is a rare non-epithelial esophageal tumor arising from submucosal layer and consisting of connective and adipose tissue, as well large number of vessels. Large tumors can cause dysphagia, vomiting, chest pain, shortness of breath and/or asthma, while giant neoplasms are potentially life threatening. Despite active introduction of minimally invasive treatment of patients with non-epithelial gastrointestinal tumors, there are still difficulties in surgical treatment of fibrovascular polyps. The patient with a giant fibrovascular esophageal polyp presented with cough, discomfort in the throat, impaired swallowing and episode of tumor migration into oropharynx. Examination confirmed giant highly vascularized esophageal fibrovascular polyp. A novel hybrid surgical technique (endoscopic submucosal dissection with laparoscopic removal of tumor) was applied. Eight-month follow-up revealed no complications. Favorable clinical result was achieved. A hybrid laparo-endoscopic approach in the treatment of patients with large fibrovascular polyps minimizes perioperative risks and improves postoperative outcomes.
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Affiliation(s)
- Yu G Starkov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | | | - R D Zamolodchikov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A B Badakhova
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
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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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Anbarasan S, Mani S, Goel G, Chirom AS. Hazardous giant pharyngoesophageal liposarcoma. BMJ Case Rep 2022; 15:e250085. [PMID: 36357101 PMCID: PMC9660517 DOI: 10.1136/bcr-2022-250085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A man in his early 80s presented to the otorhinolaryngology department with progressively worsening dysphagia to solids and a recent episode of difficulty breathing accompanied by a very brief expulsion of a solid mass from the mouth. Based on the endoscopic appearance of a fatty lesion of an elongated mass with a thick stalk on the posterior pharyngeal wall, a diagnosis of the benign fibrovascular polyp was given after clinical and radiological correlation. The pharyngeal polyp was resected at the base of its pedicle by transoral endoscopy with a thunder beat vessel sealing device. Histopathological examination of the mass revealed a well-differentiated liposarcoma composed of mature adipocytes. Following surgical excision, the patient made a full recovery. This case signifies the integrated role of preoperative biopsy, new surgical technologies and targeted therapies in managing pharyngoesophageal polyps.
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Affiliation(s)
- Subagar Anbarasan
- Department of ENT - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Suresh Mani
- Department of ENT - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Goel
- Department of ENT - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Singh Chirom
- Department of ENT - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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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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Papke DJ, Hornick JL. Recent developments in gastroesophageal mesenchymal tumours. Histopathology 2020; 78:171-186. [PMID: 33382494 DOI: 10.1111/his.14164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 12/19/2022]
Abstract
The pathologist's approach to gastroesophageal mesenchymal tumours has changed dramatically during the last 25 years. In particular, gastrointestinal stromal tumour (GIST) has evolved from a wastebasket mesenchymal tumour category to a precisely defined entity with an increasingly detailed genetic subclassification. This subclassification has brought gastrointestinal mesenchymal neoplasia into the realm of precision medicine, with specific treatments optimised for particular genetic subtypes. Molecular genetic data have also greatly improved our understanding of oesophageal mesenchymal tumours, including the discovery that so-called 'giant fibrovascular polyps' in fact represent a clinically distinctive presentation of well-differentiated liposarcoma. Here, we will focus on gastroesophageal mesenchymal tumours for which there have been recent developments in classification, molecular genetics or tumour biology: granular cell tumour, 'giant fibrovascular polyp'/well-differentiated liposarcoma, plexiform fibromyxoma, gastroblastoma and, of course, GIST.
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Affiliation(s)
- David J Papke
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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6
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McCarthy AJ, Carroll P, Vajpeyi R, Darling G, Chetty R. Well-Differentiated Liposarcoma (Atypical Lipomatous Tumor) Presenting as an Esophageal Polyp. J Gastrointest Cancer 2020; 50:589-595. [PMID: 29349606 DOI: 10.1007/s12029-018-0052-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Aoife J McCarthy
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto General Hospital, 200 Elizabeth Street, 11th Floor, Eaton Wing, Toronto, Ontario, M5G 2C4, Canada. .,University of Toronto, Toronto, Canada.
| | - Paul Carroll
- University of Toronto, Toronto, Canada.,Surgery and Critical Care Program, Departments of Thoracic Surgery and Surgical Oncology, University Health Network and University of Toronto, Toronto, Canada
| | - Rajkumar Vajpeyi
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto General Hospital, 200 Elizabeth Street, 11th Floor, Eaton Wing, Toronto, Ontario, M5G 2C4, Canada.,University of Toronto, Toronto, Canada
| | - Gail Darling
- University of Toronto, Toronto, Canada.,Surgery and Critical Care Program, Departments of Thoracic Surgery and Surgical Oncology, University Health Network and University of Toronto, Toronto, Canada
| | - Runjan Chetty
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto General Hospital, 200 Elizabeth Street, 11th Floor, Eaton Wing, Toronto, Ontario, M5G 2C4, Canada.,University of Toronto, Toronto, Canada
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7
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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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8
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Yamazaki K, Yoshida Y, Maruta A, Shimizu M, Kushima R. Endoscopic resection of a giant fibrovascular esophageal polyp by use of a scissor-type knife. VideoGIE 2019; 4:451-453. [PMID: 31709327 PMCID: PMC6831988 DOI: 10.1016/j.vgie.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Kenji Yamazaki
- Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Yasuyuki Yoshida
- Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Akinori Maruta
- Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Masahito Shimizu
- Department of Gastroenterology, Gifu University School of Medicine, Gifu, Japan
| | - Ryoji Kushima
- Department of Clinical Laboratory Medicine and Diagnostic Pathology, Shiga University of Medical Science, Otsu, Japan
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9
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Polypoid fibroadipose tumors of the esophagus: 'giant fibrovascular polyp' or liposarcoma? A clinicopathological and molecular cytogenetic study of 13 cases. Mod Pathol 2018; 31:337-342. [PMID: 28984298 DOI: 10.1038/modpathol.2017.140] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 12/27/2022]
Abstract
Giant fibrovascular polyp of the esophagus is a descriptive diagnostic term intended to encompass rare, large, polypoid esophageal masses composed of fibroadipose tissue. Despite sometimes dramatic clinical presentations, they have historically been considered to represent reactive, non-neoplastic proliferations. Recently, however, a small number of reports have described well-differentiated liposarcomas of the esophagus, mimicking giant fibrovascular polyps. In order to clarify the relationship between esophageal liposarcoma and giant fibrovascular polyp, we retrieved esophageal cases coded as 'giant fibrovascular polyp,' 'lipoma' and 'liposarcoma' from our archives and re-examined their clinicopathologic features and MDM2 amplification status. Thirteen cases were identified (lipoma (n=1), giant fibrovascular polyp (n=5), well-differentiated liposarcoma (n=3), dedifferentiated liposarcoma (n=3)). The tumors ranged from 5.2 to 19.5 cm and arose predominantly in the cervical esophagus. All consisted chiefly of mature adipose tissue, with a variable component of fibrous septa. In all cases, close inspection of these fibrous septa showed them to contain an increased number of slightly enlarged spindled cells with irregular, hyperchromatic nuclei, similar to those seen in some well-differentiated liposarcomas. Three cases, all previously classified as dedifferentiated liposarcoma, showed in addition solid zones of non-lipogenic spindle cell sarcoma. By fluorescence in situ hybridization (FISH), all cases showed MDM2 amplification, confirming diagnoses as well-differentiated (N=10) and dedifferentiated (N=3) liposarcoma. Clinical follow-up (8 cases, range 22-156 months, median 33 months) showed 3 patients with local recurrences (1 well-differentiated and 2 dedifferentiated liposarcomas), 1 patient with liver metastases (dedifferentiated liposarcoma) and 2 deaths from disease (both dedifferentiated liposarcomas). These results suggest that the great majority of large, polypoid, fat-containing masses of the esophagus represent well and dedifferentiated liposarcoma, rather than 'giant fibrovascular polyps.' We suggest that the diagnosis of 'giant fibrovascular polyp' should be made with great caution in the esophagus, and only after careful morphological study and MDM2 FISH has excluded the possibility of liposarcoma.
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10
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Ioanidis KE, MacNeil SD, Tay KY, Wehrli B. An atypical lipomatous tumor mimicking a giant fibrovascular polyp of the hypopharynx: A case report. Medicine (Baltimore) 2017; 96:e6927. [PMID: 29068974 PMCID: PMC5671807 DOI: 10.1097/md.0000000000006927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Giant fibrovascular polyps (GFVPs) found in the hypopharynx are exceedingly rare. These are benign tumors which are identified by CT or MRI and usually treated based on symptoms. Even more rarely, pathology may identify one of these masses as an atypical lipomatous tumor (ALT). This paper will present a case of an ALT of the hypopharynx that was originally classified as a GFVP, highlighting the difficulty in distinguishing between them and the importance of making the correct diagnosis. PATIENT CONCERNS An 84-year-old man presented to the emergency department with a 6-month history of a pedunculated hypopharyngeal growth, dysphagia, and intermittent dyspnea. DIAGNOSES The mass was characterized as a GFVP by barium swallow and MRI. INTERVENTIONS The hypopharyngeal mass was resected for obstructive symptoms and to confirm the diagnosis. Final pathology found the mass to be more consistent with an atypical lipomatous tumor (ALT). OUTCOMES The patient's dysphagia and dyspnea resolved. He was free of recurrence at 22 months postoperative. LESSONS Both GFVPs and ALTs are very rarely found in the hypopharynx but can be easily misclassified as one another. Imaging is useful to initially characterize the mass, but to definitively differentiate between them, pathological analysis is necessary. Although they are rare, it is important to consider both possibilities on the differential for hypopharyngeal masses. Further, accurate analysis is essential to distinguish between them because their definitive management and follow-up is different.
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Affiliation(s)
| | | | | | - Bret Wehrli
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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11
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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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12
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Cross-Sectional Imaging of the Oesophagus Using CT and PET/Techniques. Dysphagia 2017. [DOI: 10.1007/174_2017_131] [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]
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13
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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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14
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Li P, Wang D, Li H, Chen X, Fang J. Hypopharynx giant fibrovascular polyps. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2017. [DOI: 10.1080/23772484.2017.1379355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Pingdong Li
- Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
| | - Danni Wang
- Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
| | - Haiyang Li
- Department of Otolaryngology, People’s Hospital of Beijing Daxing District, Beijing, People’s Republic of China
| | - Xiaohong Chen
- Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
| | - Jugao Fang
- Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Ministry of Education, Beijing, People’s Republic of China
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15
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Mangiavillano B, Savarese MF, Boeri F, Ruggeri C, Conio M. A rare case of giant fibrovascular polyp endoscopically resected with loop and cut technique. VideoGIE 2016; 2:57-58. [PMID: 29905261 PMCID: PMC5990647 DOI: 10.1016/j.vgie.2016.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
| | | | - Federica Boeri
- Gastroenterology & Gastrointestinal Endoscopy, General Hospital, Sanremo, Italy
| | | | - Massimo Conio
- Gastroenterology & Gastrointestinal Endoscopy, General Hospital, Sanremo, Italy
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16
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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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17
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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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18
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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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19
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Lobo N, Hall A, Weir J, Mace A. Endoscopic resection of a giant fibrovascular polyp of the oesophagus with the assistance of ultrasonic shears. BMJ Case Rep 2016; 2016:bcr-2015-214158. [PMID: 26768708 DOI: 10.1136/bcr-2015-214158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Giant fibrovascular polyps of the oesophagus are rare benign tumours originating from the upper oesophagus. A 58-year-old woman presented with a 6-week history of a sore throat, odynophagia and progressive dysphagia, managing only a soft diet. CT of the neck and thorax, and barium swallow, both demonstrated a giant fibrovascular polyp measuring approximately 7 cm in length arising from the proximal oesophagus. The patient underwent endoscopic resection of the polyp with the assistance of ultrasonic shears. We present the case of a giant fibrovascular polyp and describe our novel technique for successful endoscopic resection using ultrasonic shears.
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Affiliation(s)
- Niyati Lobo
- Department of ENT, Imperial College Healthcare NHS Trust, London, UK
| | - Andrew Hall
- Department of ENT, Imperial College Healthcare NHS Trust, London, UK
| | - Justin Weir
- Department of Pathology, Imperial College Healthcare NHS Trust, London, UK
| | - Alasdair Mace
- Department of ENT, Imperial College Healthcare NHS Trust, London, UK
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20
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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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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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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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Lewis RB, Mehrotra AK, Rodriguez P, Levine MS. From the radiologic pathology archives: esophageal neoplasms: radiologic-pathologic correlation. Radiographics 2014; 33:1083-108. [PMID: 23842973 DOI: 10.1148/rg.334135027] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Esophageal neoplasms have a wide spectrum of clinical features, pathologic findings, and imaging manifestations. Leiomyomas are the most common benign esophageal neoplasm, typically appearing as smoothly marginated intramural masses. Fibrovascular polyps arise in the cervical esophagus, gradually elongating as they are pulled inferiorly by esophageal peristalsis. Granular cell tumors are generally incidental small intramural masses with an appearance similar to that of leiomyomas. Malignant esophageal neoplasms are a common cause of cancer mortality, particularly squamous cell carcinoma (SCC) and adenocarcinoma. Both of these tumors occur in older men, most often appearing as irregular infiltrative lesions at barium examination, with evidence of tumor spread beyond the esophagus at cross-sectional imaging. Adenocarcinoma arises from Barrett esophagus and is much more likely than SCC to involve the gastroesophageal junction. Esophageal involvement by lymphoma is usually secondary to tumor spread from the stomach or mediastinum. Spindle cell carcinoma is a biphasic malignancy with carcinomatous and sarcomatous elements that forms a bulky polypoid intraluminal mass. Neuroendocrine carcinoma is an aggressive neoplasm that may be hypervascular and is usually associated with metastatic disease at presentation. Understanding the imaging appearances and pathologic bases of esophageal neoplasms is essential for their detection, differential diagnosis, staging, and treatment planning.
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Affiliation(s)
- Rachel B Lewis
- American Institute for Radiologic Pathology, 1010 Wayne Ave, Suite 320, Silver Spring, MD 20910, USA.
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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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Cross-Sectional Imaging of the Oesophagus Using CT and PET/Techniques. Dysphagia 2012. [DOI: 10.1007/174_2012_656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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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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Peltz M, Estrera AS. Resection of a Giant Esophageal Fibrovascular Polyp. Ann Thorac Surg 2010; 90:1017-9. [DOI: 10.1016/j.athoracsur.2010.02.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 02/03/2010] [Accepted: 02/15/2010] [Indexed: 11/26/2022]
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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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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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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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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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Iván L, Torkos A, Paczona R, Szentpáli K, Jóri J. Minimally invasive peroral endoscopic removal of a regurgitated giant polysegmented fibrovascular polyp of the esophagus. Dysphagia 2008; 24:230-3. [PMID: 18688676 DOI: 10.1007/s00455-008-9165-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 03/18/2008] [Indexed: 10/21/2022]
Abstract
Giant fibrovascular polyps (FVP) are relatively rare benign neoplasms of the upper part of the esophagus. Without a previous history, their diagnosis might be difficult because the endoscopic findings are sometimes misinterpreted. The present report describes a case in which the patient regurgitated a giant polypoid mass into his mouth and captured it between his teeth and buccal surface until emergency endoscopic removal. Although the adequate therapy for these lesions is open surgical resection, most often via cervical esophagotomy, in our case the polyp was removed successfully by peroral endoscopy with minimally invasive surgery. After 5 years of follow-up the patient is doing well, without recurrence.
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Affiliation(s)
- László Iván
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Szeged, H-6725, Szeged, Hungary.
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Iván L, Paczona R, Szentpáli K, Jóri J. Peroral endoscopic removal: as a minimally invasive long-term surgical treatment of a regurgitated giant polisegmented fibrovascular polyp of the esophagus. Eur Arch Otorhinolaryngol 2008; 266:1031-4. [PMID: 18688632 DOI: 10.1007/s00405-008-0766-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 07/01/2008] [Indexed: 10/21/2022]
Abstract
Giant fibrovascular polyps (FVP) are relatively rare benign neoplasm of the upper part of the esophagus. Without previous history, their diagnosis might be difficult as the endoscopic findings are sometimes misinterpreted. The present report describes a case, in which the patient regurgitated his giant polypoid mass into his mouth and captured it between his teeth and buccal surface until the emergency endoscopic removal. Although the adequate therapy for these lesions is mainly the open surgical resection, most often via cervical esophagotomy, in our case the polyp was removed successfully by peroral endoscopic operation, as a minimally invasive surgical treatment. After 5 years of follow-up, the patient is doing well, without recurrence of his polyp.
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Affiliation(s)
- László Iván
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Szeged, 6725, Szeged, Hungary.
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35
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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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Jakowski JD, Wakely PE. Rhabdomyomatous well-differentiated liposarcoma arising in giant fibrovascular polyp of the esophagus. Ann Diagn Pathol 2008; 13:263-8. [PMID: 19608085 DOI: 10.1016/j.anndiagpath.2008.04.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We report an example of an esophageal giant fibrovascular polyp harboring a well-differentiated liposarcoma with rhabdomyomatous differentiation in a 68 year-old man. Initial imaging studies including fiberoptic endoscopy and 2 computed tomographic examinations, and laparoscopic myotomy failed to demonstrate the polypoid intraluminal nature of the lesion. Thus, alternative diagnoses including a malignant neoplasm and achalasia were entertained. A third computed tomography with contrast showed a pedunculated mass. Surgical resection revealed a 15-cm smooth-surfaced club-shaped mass composed of a well-differentiated liposarcoma demonstrating myoglobin, muscle-specific actin, and myogenin-positive rhabdomyomatous differentiation. To date, no previously reported giant fibrovascular polyp case has described a liposarcoma with rhabdomyomatous change.
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Affiliation(s)
- Joseph D Jakowski
- Department of Pathology, Ohio State University, College of Medicine, Columbus, OH 43210, USA
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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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Affiliation(s)
- Catherine J. Rees
- Center for Voice and Swallowing, University of California–Davis, Sacramento
| | - Peter C. Belafsky
- Center for Voice and Swallowing, University of California–Davis, Sacramento
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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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