Esophageal Polyp Research Articles

Follicular Thyroid Carcinoma Metastasis to the Esophagus Detected by 18FDG PET/CT

We report an unusual case of an esophageal metastasis demonstrated on integrated 18F-fluorodeoxyglucose (18FDG) positron emission tomography/computed tomography (PET/CT) scanning. A 55-year-old male with treated well-differentiated follicular thyroid carcinoma (FTC) had persistently raised thyroglobulin levels despite both negative whole-body CT scan and 131I scans. An initial 18FDG PET/CT scan showed moderate focal uptake in the esophagus, which was initially thought to be physiological. A subsequent comparative 18FDG PET/CT scan showed more intense uptake. A diagnostic endoscopy revealed a pedunculated esophageal polyp, which histological examination confirmed to be metastatic FTC. Such a case has not previously been reported.

Angiolipoma of hypopharynx: A diagnostic dilemma.

Fibro vascular polyps of esophagus are rare tumours. They usually arise close to cricopharyngeus muscle. The commonest symptom is dysphagia but regurgitation of fleshy mass into mouth, regurgitation of recently digested food and sensation of lump in throat are also reported. Several reports of polyp regurgitation and subsequent airway obstruction are mentioned. We present a 48-year-old male with fibrovascular polyp of hypopharynx. Diagnosis was established by barium swallow and oesophagoscopy.Transoral route was used to remove the polyp and histopathology reported as angiolipoma.

Endoscopic resection of a giant esophageal polyp: case report and review of the literature

Fibrovascular esophageal polyp, also referred to as giant esophageal polyp, is a very rare benign neoplasm and represents the most common intraluminal tumor of the esophagus. It usually manifests with dysphagia and weight loss, but could be as dramatic as regurgitation of the polyp through the mouth or asphyxiation. The difficulty involved in the interpretation of radiological and endoscopic findings is responsible for frequent mistakes in its diagnosis. Here, we present the case of a patient with a 20-cm-long esophageal polyp located below the upper esophageal sphincter that was removed using an endoscopic approach. We review the recent literature and describe the various diagnostic and therapeutic methods to diagnose and manage this benign but potentially life-threatening entity.

The Characteristic and Diagnosis of Chronic Pancreatitis in Endoscopic Ultrasound

Purpose: The purpose of our study was to character the feature of CP and to diagnosis of CP by EUS (endoscopic ultrasound) with good resolution and whole pancreas scanning potential. Material and methods: 30 cases of CP patients were examined by EUS from 9 2003 to 9 2004 with the Olympus EU-M30 and GF-UM200. The size of pancreas, the boundary, echo, pancreatic ducts, the diameter of common bile duct, side ducts, pancreas stone, pancreas albumen thrombosis, cysts were recorded. The control group was 30 cases with small polyps of stomach and esophagus.

Asphyxiation Caused by Giant Fibrovascular Polyp of the Esophagus

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.

Asphyxiation Caused by Giant Fibrovascular Polyp of the Esophagus

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.

Giant Fibrovascular Polyp of Esophagus: One Case Report

Esophageal polyps are very rare. One case of giant fibrovascular polyp of the esophagus was described. The patient had symptoms of dysphagia and hematemesis. After examinations, the diagnosis of esophageal leiomyoma was made. In the process of thoracic exploration, esophageal polyp was removed. The pathological diagnosis postoperation was giant fibrovascular polyp of the esophagus associated with mucoid degeneration.

A CASE OF SIALADENOMA PAPILLIFERUM OF THE ESOPHAGUS

Sialadenoma papilliferum of the esophagus is an extremely rare benign tumor that derives from the submucosal gland duct of the minor salivary gland. A 45‐year‐old man underwent upper gastrointestinal series. A 13 mm diameter esophageal polyp was suspected in the mid esophagus. Endoscopy examination revealed a pedunculated polyp arising from the posterior wall of the esophagus. The head of the polyp was covered with exudate and was slightly nodular but the pedicle had normal mucosa. We performed endoscopic mucosal resection (EMR) and the histological examination of the polyp showed that it was compatible with sialadenoma papilliferum of the esophagus.

Esophageal Polyps in a HIV Infected Patient with Upper GI Bleeding

To highlight esophageal polyps in the setting of upper GI bleeding in a HIV infected patient. Case Report: 40 y/o male was referred for follow up EGD two months after an episode of massive upper gastrointestinal bleed. Initial upper endoscopy (EGD) had revealed multiple esophageal polyps with ulcerations and the patient was subsequently placed on proton pump inhibitors. Follow up EGD revealed multiple small and large polyps in the esophagus with severe candidal esophagitis. A single large pedunculated polyp (7 cm in length) was seen in the upper esophagus that extended from 15 cm to 22 cm from the gums. Barium esophagogram also revealed the multiple esophageal polyps and the large pedunculated polyp was clearly seen in the proximal esophagus, measuring 2 cm in transverse diameter. Biopsies from the polyp showed candida esophagitis with granulation tissue and ulceration. No dysplasia or malignancy were noted. Viral cultures were negative. The patient was treated with a two week course of oral fluconazole. He was noncompliant with subsequent follow up. Two months later, HIV testing was found to be positive and his CD4 count was 6. He developed respiratory failure and died shortly afterwards at an outside instituition. Discussion: Esophageal polyps in the setting of HIV infection is seen rarely. Primary esophageal lymphomas and inflammatory fibroid polyps of the esophagus have been reported in HIV infected patients and they usually present with dysphagia. Esophageal polyps as a possible cause of upper GI bleeding, as illustrated in our case, is extremely rare. Conclusion: In patients with HIV infection, esophageal polyps should be considered in the setting of upper GI bleeding. [figure 1][figure 2]FigureFigure

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.

Pyloric gland adenoma arising in Barrett’s esophagus with mucin immunohistochemical and molecular cytogenetic evaluation

Pyloric gland adenoma is a recently described and very rare entity. The occurrence of adenoma is very unusual in Barrett's epithelium of the esophagus. We report a case of esophageal polyp showing the features of pyloric gland adenoma, which was surrounded by so-called specialized columnar epithelium. Immunohistochemically, most tumor glands were strongly positive for MUC6, except in the superficial layer. MUC5AC was positive in almost all tumor cells, but MUC2 and CD10 were negative in the tumor. MIB-1-positive proliferating cells were distributed throughout the tumor. Microdissection and comparative genomic hybridization analyses revealed losses on 2p24-25.2, 2q14.1-ter, 5q31.3-32, 6q23-24, 8q23-24.2, 11q22.3-24 and 18q21.1-22. This is the first case of pyloric gland adenoma found to arise in Barrett's epithelium of the esophagus, showing its unstable and precancerous nature.

Fibrovascular polyp of the esophagus: diagnostic dilemma

A 51-year-old female patient was admitted to our department. She had symptoms of dysphagia, regurgitation of a fleshy mass into the mouth, and attacks of dyspnea. Every effort was made for diagnosis. At cervical exploration, upper esophageal polyp was discovered incidentally, and removed. We present this case because of rarity and emphasize the clinical presentation. The physician should be aware of the presence of this rare esophageal tumor.

Submucosal adenoma of the esophagus: case report and review of the literature

A 60-year-old woman complaining of abdominal discomfort was found at endoscopy to have a dome-shaped esophageal polyp, located 22 cm from the incisor teeth and covered by normal epithelium. Histologic examination after endoscopic removal showed a submucosal esophageal gland adenoma. This is the ninth reported case of this entity. Eleven years later, the patient remains well with no evidence of esophageal disease. We review all nine reported cases of submucosal adenoma of the esophagus.

Regression of esophageal papillomatous polyposis caused by high-risk type human papilloma virus

Esophageal squamous papilloma is an uncommon benign squamous epithelial polypoid tumor and is usually identified as a solitary lesion in the lower esophagus. Chronic mucosal irritation and infection with human papilloma virus (HPV) are two proposed etiologies. However, the natural history of esophageal squamous papilloma is unknown, and whether it can develop to esophageal cancer is also controversial. The authors report a case of esophageal papillomatous polyposis in which the presence of high-risk HPV DNA was proven by type-specific polymerase chain reaction (PCR). The patient was an 83-year-old man referred to our hospital with complaints of nausea and dysphagia. Esophago-gastroduodenoscopy (EGD) was carried out, and diffuse polyposis of the entire length of the esophagus and stenosis in the antrum of the stomach were revealed. Histological examination of the tissue confirmed the diagnosis of squamous papilloma of the esophagus and poorly differentiated adenocarcinoma of the stomach. Furthermore, HPV type-specific PCR was carried out in the biopsied specimens, and HPV type-16 and type-33 were detected. One month after total gastrectomy performed for the treatment of gastric cancer, follow-up EGD was carried out, and complete regression of the esophageal polyps was noted. This case is rare and supports the evidence that esophageal squamous papilloma is caused by infection with HPV. Furthermore, this case also reflects a unique aspect of the natural history of esophageal papillomatous polyposis.

Polypoid esophageal adenocarcinoma—a clinicopathological variant of esophageal cancer?

Purpose: Neoplastic polyps are common in the colon, but not elsewhere in the gastrointestinal tract. They are rare at the gastroesophageal junction, especially associated with Barrett’s dysplasia or adenocarcinoma. We identify a subset of early esophageal adenocarcinomas that present as symptomatic polyps with gastrointestinal bleeding, reflux, and even dysphagia. Because little is known about polypoid esophageal adenocarcinomas, we examine the clinical presentation, pathological features, and postoperative outcomes of these lesions. Methods: We defined esophageal polyps as macroscopic, well-demarcated projections above the mucosa that project the greater percentage of their mass into the lumen without central ulceration. From a consecutive series of 400 patients who underwent esophagectomies for adenocarcinoma (1988 to 2000), 14 (4%) had polyps on presentation. Clinical records, pathology reports, photographs, and original slides of these resected specimens were reviewed. Results: All patients with polyps had early staged esophageal adenocarcinomas. Lymph node involvement was found in only 4 patients, and no patients with distant metastases were found. All but 1 patient (13 of 14; 93%) were symptomatic at diagnosis. Most presented either with gastrointestinal bleeding or gastroesophageal reflux (11 of 14; 79%). Only 2 patients complained of mild dysphagia, and mean weight loss of the series was minimal at 1.3 ± 4.0 kg (range, 0 to 15 kg). Barrett’s was present in 10 patients (71%), and in 80% of these cases, high-grade dysplasia was found. The polyps were small 3.4 ± 1.1 cm, and most contained poorly differentiated adenocarcinomas. No postoperative mortalities occurred, and follow-up was complete at 100%. Actuarial 2-year survival was 88%, with a mean survival of 61.3 months. Recurrent disease was identified in 4 patients. Conclusions: Polypoid adenocarcinomas of the distal esophagus are a subset of esophageal cancer that produce clear symptoms at an early tumor stage, which allows prompt detection and favorable prognosis. Their pathological features and demographics suggest an origin via the Barrett’s esophagus-dysplasia-carcinoma sequence.

Polypectomy of Esophageal Polyp Due to Esophagitis

Esophageal polyp can be found by chance during endoscopic examination. Polyps can be formed by changes in the esophageal mucosa due to reflux esophagitis. We report a case of multiple esophageal polyp in a patient with complaints of recurrent regurgitation without heartburn. Endoscopy demonstrated multiple polyps at the distal esophagus. Anatomic pathology evaluation of the polyp demonstrated mucosa lined with squamous epithels demonstrating elongation of the papilla and deposition of acute and chronic inflammatory cells, indicating chronic esophagitis with hyperplastic epithels. In this case, we conducted recurrent ligation of the multiple polyps. Evaluation at 2 weeks after the final ligation demonstrated no polyp remains, and the post-ligation ulcer was found. Evaluation at 1 month following treatment found diminished complaints. From this case, we can conclude that endoscopy is an important investigation modality to establish the diagnosis in cases of chronic gastrointestinal complaints. Ligation is a choice for the management of esophageal polyps. Key words : Esophageal polyp, polipectomy, ligation

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

Juvenile polyp in esophageal colon interposition

Esophageal polyps are rare in children, whereas colorectal juvenile polyps are common. An 11-year-old boy with an esophageal colonic interposition for an esophageal stricture secondary to caustic injury was found to have a polypoid mass in the interposed colon. Fiberoptic endoscopic removal with diathermy was performed. Histological examination confirmed it was a juvenile polyp. The occurrence of a polyp in a colon removed from its natural location and serving a different function suggests the possibility that an unknown factor produced by colonic cells play a pivotal role in its development.

The Diagnostic Value of Transendoscopic Miniature Ultrasonic Probe for Esophageal Diseases

To investigate the value of a transendoscopic miniature ultrasonic probe (USP) in the diagnosis of esophageal diseases. Endoscopic ultrasonography was performed by means of USP in 53 patients with esophageal diseases, including 16 with esophageal leiomyoma, 14 with esophageal carcinoma, seven with achalasia, seven with reflux esophagitis, six with esophageal polyps and three with esophageal varices. USP clearly showed all 16 esophageal leiomyomas, whereas, conventional EUS could not show five small leiomyomas less than 1.0 x 1.0 cm in size. The appearance of esophageal leiomyoma was that of a hypoechoic mass with a homogeneous inner echogram arising from the fourth hypoechoic layer. All 14 patients with esophageal carcinoma underwent full endosonographic T and N staging with USP. In two cases passage of the malignant stenosis proved to be impossible using conventional EUS. The accuracy of USP on T staging and N staging was 80% and 30%, respectively. In the seven achalasia patients USP demonstrated a seven-layer structure of the esophageal wall, with thickening of the third and fifth layers. In the seven patients with reflux esophagitis no difference was found for the ultrasonic image between that with and that without Barrett's epithelium. All of the esophageal polyps were showed by USP as hypoechoic homogeneous lesion with indistinct margins. After endoscopic sclerotherapy the ultrasonographic feature of esophageal varices changed from submucosal multiple anechoic areas to high echoic areas. With refinement, the transendoscopic miniature ultrasonic probe will play an increasing role in the diagnosis of esophageal disease.

Crohn's esophagitis: a unique cause of esophageal polyposis

Esophageal involvement in adults with Crohn's disease is uncommon.1-5 The previously described endoscopic and radiologic abnormalities associated with Crohn's esophagitis include erythematous or friable mucosa, “cobblestone” mucosa, superficial aphthoid or “punched out” ulcers, deep ulcers, nodular masses, strictures, intramural sinus tracts, and fistulae. Cockey et al.6 reported a case of esophageal filiform polyposis in the setting of active esophageal Crohn's disease. We present a patient with multiple small esophageal polyps in the setting of active gastric, duodenal, and jejunal Crohn's disease.