Fibrovascular Polyp: A Rare Cause of Dysphagia

Abstract

Introduction: Fibrovascular polyps of the esophagus are rare benign esophageal tumors. They are pedunculated, often arise from the upper esophagus, and are very rare causes of dysphagia. We present a case of fibrovascular polyp causing dysphagia. Case Presentation: A 55-year-old woman with history of gastroesophageal reflux (GERD) was referred for dysphagia. She complained of initial solid food dysphagia which progressed to liquids associated with a 28-pound weight loss. She also stated that she was coughing up a sausageshaped mass occasionally which was visible in her mouth but could not be vomited out and she had to swallow it back. Esophagogastroduodenoscopy (EGD) was performed to evaluate her dysphagia. The esophagus showed a mobile sausage like structure with a pedunculated stalk extending below the upper esophageal sphincter (UES) to the proximal esophagus. She was referred to ENT for removal of this lesion due to the proximity to UES and difficult endoscopic removal. Patient was taken to the operating room and esophagoscopy was performed followed by snare cautery removal of this mass in its entirety through the esophagus, pharynx, and oral cavity. Postoperative pathology showed benign fibrovascular polyp with chronic inflammation. Discussion: Fibrovascular polyps of the esophagus are rare causes of dysphagia. They often arise from the upper esophagus or hypopharynx near the level of the cricopharyngeus at the pharyngoesophageal junction. This area is known as Laimer's triangle. The pathogenesis of these polyps is thought to originate from the loose and redundant submucosal tissue near the Laimer's triangle. This mobile tissue, due to lack of muscular support, through years of esophageal peristalsis, traction, and swallowing, is dragged, elongated, and enlarged intraluminally. Though fibrovascular polyps are benign, they may be lethal due to bleeding or asphyxiation if a large polyp is regurgitated. Dysphagia is the most common complaint, followed by respiratory symptoms. Diagnosis is made by history and investigations such as endoscopy, barium swallow, endoscopic ultrasound (EUS), CT, and magnetic resonance imaging (MRI). Barium studies can show a smooth intraluminal sausage-shaped mass. EUS can be a useful adjunct for assessing size, origin of the stalk, and vascularity of the polyp. The mainstay of treatment is surgical excision due to potential risk of respiratory compromise and bleeding. Surgery also serves to exclude cancer and avoid the small risk of malignant transformation. Esophagotomy via thoracotomy should be considered for good control of hemostasis and providing adequate exposure for resection of the pedicle's origin and any redundant mucosa around the pedicle.