Esophageal Fibrovascular Polyp Research Articles

Choked for Over a Decade: A Rare Case of Huge Esophageal Fibro-vascular Polyp Causing Dysphagia

Introduction: Esophageal fibro-vascular polyps (EFVPs) are rare benign tumors that can arise from the submucosa of the esophagus. They are usually asymptomatic but can cause obstruction and dysphagia in some cases. The diagnosis of EFVPs can be challenging due to their rarity and nonspecific symptoms. Delayed diagnosis can result in significant morbidity, as in the case of our patient who suffered from difficulty swallowing for over a decade before being accurately diagnosed. We present a case of a 42-year-old male patient with a 12-year history of difficulty swallowing, who was eventually diagnosed with a huge fibro-vascular polyp after undergoing thoracotomy esophagostomy and excision of the polyp. Case Presentation: A 42-year-old male patient presented to Hallelujah General Hospital, with a 12-year history of difficulty swallowing, associated with symptoms such as weight loss, fatigue, and asphyxiation while vomiting. The patient had visited several health centers but was unable to receive an accurate diagnosis or effective treatment. Initial investigations revealed a large, smooth, and mobile mass in the mid-esophagus, which was obstructing the lumen and causing difficulty swallowing. A CT scan of the chest and abdomen showed a large polypoid mass in the upper and mid-esophagus, measuring 25 cm in length and 10 cm in diameter, which was confirmed to be an esophageal fibro-vascular polyp upon surgical excision and biopsy. Conclusion: EFVPs are rare, benign tumors of the esophagus that can cause significant morbidity if not diagnosed and treated promptly. The diagnosis of EFVPs can be challenging, and imaging studies such as CT scans, MRI, and endoscopic ultrasound can be helpful in diagnosing the condition. However, a definitive diagnosis usually requires histological examination of the excised mass. Surgical excision is the treatment of choice for EFVPs, and the prognosis is usually excellent. This case report highlights the importance of considering rare conditions in the differential diagnosis of common symptoms, particularly if the patient does not respond to initial treatment. It also emphasizes the importance of early diagnosis and prompt surgical intervention in preventing complications and improving outcomes for patients with EFVPs.

S2837 Giant Fibrovascular Esophageal Polyp Resected by Endoscopic Submucosal Dissection

Introduction: Esophageal lipomas are rare, accounting for 1% of all benign esophageal neoplasms. Fibrovascular polyps are a subset of esophageal lipomas that can present with dysphagia, hematemesis, melena and/or profound anemia. We describe a case of a giant esophageal fibrovascular polyp (GFVP) which was treated with endoscopic submucosal dissection (ESD). Case Description/Methods: A 62-year-old man presented for evaluation of a two-month history of dysphagia to solids and liquids, 4 kg weight loss, and melena. Examination revealed a chronically ill pale man with no palpable neck masses, a nontender, nondistended, soft abdomen, and melena confirmed by digital rectal exam. Blood work showed hemoglobin of 4.7g/dL, MCV of 78.1 fL and albumin of 3.6 g/dL. A Chest CT with IV contrast showed a soft tissue mass filling the entire length of the esophagus (Figure A). Differential diagnosis included esophageal carcinoma, pedunculated fibrovascular polyp, and leiomyomatosis. Barium esophagram showed smooth lobular defects filling the entire esophageal lumen (Figure B). Upper endoscopy and endoscopic ultrasound (EUS) revealed a near circumferential large stalk starting at the upper esophageal sphincter and diverging into 3 separate stalks measuring 15, 18, and 20 cm respectively with a small distal hematoma (Figure C). Because neither a 33mm snare nor endoloop could encircle the polyp heads, a technically complex ESD was performed using ERBE I knife and Endo Cut Q for submucosal incision. Standard SB knife was used for submucosal release before dissection with DryCut and the Olympus ITknife2. Hematoxylin & eosin staining confirmed the diagnosis of a GFVP. On one month follow up, the patient’s dysphagia had resolved completely, he had no recurrence of melena, and hemoglobin was stable. Discussion: Patients with GVFPs present with dysphagia, coughing, and a sensation of throat fullness. There are rare reports of large upper esophageal polyps regurgitating into the oropharynx and leading to subsequent asphyxiation. Prompt removal via cervicotomy or thoracotomy are the most common interventions, but upper endoscopy with ESD is a minimally invasive option that may facilitate improved recovery. ESD was chosen over endoscopic mucosal resection in this case due to multiple factors: less risk of intra and post procedural bleeding, technical difficulty for loop ligation since the polyp heads were large, and for superiority of ESD at achieving complete resection.Figure 1.: A: Sagital CT chest reveals entire esophageal lumen filled with soft tissue mass. B: Water soluble esophogram showing smooth lobar filling defects throughout the esophageal lumen. C: Endoscopic appearance of the large stalk of the multilobulated giant fibrovascular polyp inserting at the upper esophageal sphincter.

Esophageal Fibrovascular Polyp Presenting as an Esophageal Mass

Esophageal Fibrovascular Polyp Presenting as an Esophageal Mass

Thyroid Ultrasound Pitfalls: Esophageal Fibrovascular Polyp Mimicking Thyroid Nodule.

Background. Ultrasound (US) is the most accurate tool in the diagnosis of thyroid nodules if performed by expert physician. Misdiagnosis due to extrathyroidal lesions mimicking thyroid nodules is reported in literature. We describe the first case of an esophageal fibrovascular polyp misdiagnosed as a thyroid nodule on US examination. Patient Findings. A 54-year-old woman presented to emergency department for headache and underwent carotid Doppler extended to neck ultrasound with incidental finding of a nodule in the posterior side of the left thyroid lobe. A following thyroid US performed by an endocrinologist allowed the characterization of the lesion as an esophageal pathology, considering the extrathyroidal position, the typical peripheral hyperechoic spots and hypoechoic rim, the connection to the esophagus, and the swallowing connected movement. The patient was addressed to further investigations and finally to anterior pharyngotomy with histological diagnosis of esophageal fibrovascular polyp. Summary. Differential diagnosis between thyroid nodules and other neck lesions is important to prevent an unnecessary fine needle aspiration biopsy and to treat the extrathyroidal pathology. In this case, an US performed by an expert endocrinologist allowed detecting an esophageal fibrovascular polyp requiring surgical removal. In conclusion, the possibility of an esophageal pathology, and even fibrovascular polyp, should be considered during US thyroid examination.

残胃癌に併存した食道fibrovascular polypの1例

残胃癌に併存した食道fibrovascular polypの1例

One-step endoscopic removal of a giant double esophageal fibrovascular polyp

A 51-year-old woman was evaluated because of mass regurgitation through the mouth (Fig. 1A ), which she held in place by swallowing repeatedly. On upper endoscopy, two long polypoid lesions (Fig. 1B) extended from the cervical oesophagus, below the cricopharyngeal muscle, into the stomach. Multidetector computed tomography showed normal vascularity. After consultation with the surgeon we decided to remove the polyps endoscopically. The procedure was performed in the operating room with the patient under general anaesthesia, using an operative, single channel endoscope. We were able to trap the polyps in the snare and, with gentle twisting movements, we pulled back the endoscope, reached the base, and cut the stalk using blended current (Fig. 1C). No bleeding was observed. The pathologist described a double-elongated mass, with the same base, of 20 cm in length with most areas of myxoid tissue on the cut surfaces. Histologically the polyp was covered by benign squamous epithelium and the core of the lesion consisted of loose myxoid to collagenous fibrous tissue admixed with adipose tissue; focal lymphoplasmacytic infiltrates were also identified. The pathologist finally diagnosed a giant FP without malignancy (Fig. 1D). The patient was discharged 5 days later, with regular oral intake. At follow-up a small residual stalk was seen. Fig. 1(A) mass regurgitation; (B) endoscopic view of the polyps (red arrows); (C) resected specimen (see the common bases); (D) the surface of the polyp is covered by benign squamous epithelium (haematoxylin and eosin). View Large Image Figure Viewer Download Hi-res image

A Case of Esophageal Fibrovascular Polyp That Induced Asphyxia during Sleep

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.

Recurrent giant fibrovascular polyp of the esophagus

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.

Sudden Death Due to Asphyxia by Esophageal Polyp

Asphyxia, not an uncommon cause of sudden death, may result from numerous etiologies. Foreign-body aspiration and strangulation are 2 extrinsic causes. Airway obstruction may also be caused by laryngeal edema, asthma, infection, or anaphylaxis. Chronic causes of asphyxia include musculoskeletal diseases (eg, muscular dystrophy, amyotrophic lateral sclerosis), neurologic disorders (eg, myasthenia gravis, multiple sclerosis), respiratory disease (eg, emphysema, chronic bronchitis), or tumors. The manner of death in cases of asphyxiation may be natural, accidental, homicide, or suicide. For the death investigator, determining the cause and manner of death can often be quite challenging. We report here 2 cases of an esophageal fibrovascular polyp causing sudden asphyxial death, review of the literature, and discussion of other differential diagnoses in the case of asphyxial death.

Esophageal Plexiform Schwannoma.

We report a patient with a plexiform schwannoma located in the cervical part of the esophagus. A large pedunculated intraluminal polyp, originating in the postcricoid region and protruding into the oropharynx, was found in association with multiple submucosal nodules. Both the intraluminal polyp and submucosal nodules consisted of cellular schwannomatous tissue. The patient showed no signs of neurofibromatosis or schwannomatosis. Plexiform schwannomas are uncommon tumors, mainly confined to the dermis and subcutis of trunk, head, and neck region and upper extremities. Visceral examples are vanishingly rare, and a location in the esophagus has not yet been described. The intruiging mode of presentation in the present case, mimicking that of so-called giant esophageal fibrovascular polyp, probably relates to mechanical factors inherent to the unique esophageal location, Int J Surg Pathol 8(4):353-357, 2000