Recurrent giant fibrovascular polyp of the esophagus

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 preoperative 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.

A Case of Fibrovascular Polyp of the Esophagus

“…Fibrovasküler poliplerin %85-90'ı proksimal özofagustan, %10-15'i ise hipofarinksten kaynaklanır (4,5).…”

Pólipo fibrovascular gigante do esôfago: desafio diagnóstico

“…It consists of a network of lipomas in conjunction with loose or dense connective tissue, interspersed by a network of vessels and covered by squamous epithelium 2,9 . Usually these polyps arise from the cervical esophagus, inferiorly to the cricopharyngeal muscle, the triangle of Laimer 3,8,12,13 . Redundant mucous folds of the region result in a polypoid formation.…”

“…Polyps are fibrovascular indolent behavior, so that, with their slow growth rate, these lesions may reach masses of large volume, but without developing symptoms for many years. When they appear, they tend to be nonspecific 2,4,6,7,8,11,13,14 . However, the most characteristic symptom is tumoral regurgitation to the oral cavity 9,10,11 .…”

An Usual Cause of Intermittent Dysphagia

“…Generally, small polyps ＜2 cm in diameter with a thin pedicle can be removed endoscopically without many complications but this is not recommended in larger tumors (length ＞8 cm). 2 However, after accurate evaluation of the origin of the polyp and the realm of its pedicle under endoscopic ultrasonography, endoscopic resection can be another treatment option for a giant esophageal fibrovascular polyp.…”