Giant fibrovascular polyp of the esophagus - imaging techniques can localize, preoperatively, the origin of the stalk and designate the way of surgical approach: a case report

Abstract

Fibrovascular polyps of the esophagus are rare benign lesions that arise from the cervical esophagus and can reach very big size before they become symptomatic. Surgical excision is the treatment of choice, since endoscopic removal is not always feasible.We present this case in order to emphasize the significance of localizing, preoperatively, the exact origin of the pedicle in planning the way of surgical approach. We consider the accurate pre-operative assessment of the origin of the pedicle essential for the proper surgical treatment of such a polyp. In respect to this, imaging provides important information concerning the exact location of the pedicle, the vascularity of the polyp and even tissue elements of the mass.

Pólipo fibrovascular gigante do esôfago: desafio diagnóstico

“…It is infrequent and feared, because can obstruct the larynx and suffocate the patient 11 . For purposes of diagnostic investigation, barium studies are commonly used 2,4,5,11,15 . However, it should be noted that they have low sensitivity to demonstrate the pedicle of the lesion 5 .…”

“…In this case, the x-ray showed no tumor, however, suggested a foreign body obstruction in the distal esophagus. Endoscopy visualizes polypoid mass, elongated, emerging from the upper esophagus 1,7,8,13,15 , however due to the squamous epithelium covering the lesion it can be false negative or inconclusive 6,12,14 The endoscopic ultrasound may be useful as adjunct imaging examination, since it provides information about the size and origin of the lesion on the vascularization of polyps 13 . It was not performed in this case due it is not available on the service.…”

“…Tomography and resonance are more accurate in evaluating these lesions 2,4,5,7,12 . This is considered adjunct tool which may be useful both for diagnosis and for surgical planning 3,15 . Despite benign polyps resection is usually recommended 11 .…”

“…1 . Thoracotomy is considered to more caudal lesion or larger lesions, thus obtaining the best possible management of intraoperative bleeding 4,8,15 . Esophagectomy can be used in bulky tumor 6 or in doubt about benign behavior 12 .…”

Hypopharynx giant fibrovascular polyps

“…FVP of the esophagus are benign lesions that arise from the cervical esophagus and upper gastrointestinal esophageal sphincter [1]. The hypopharyngeal FVP usually originated from Killian dehiscence (the area between the superior and inferior cricopharyngeal muscles) or Laimer-Haeckermann area triangle (area between the inferior cricopharyngeal muscle and the proximal end of the esophagus) [2].…”