Ascension St. John Hospital and Medical Center Grosse Pointe Woods, MI
Zeyad Sako, MD1, Fadi Hawa, MD2; 1Ascension St. John Hospital and Medical Center, Grosse Pointe Woods, MI; 2St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI
Introduction: Fibrovascular polyps are rare, benign intraluminal esophageal tumors. Endoscopic appearance of the polyp is smooth with firm to rubbery consistency. Giant fibrovascular polyps present with a spectrum of clinical presentations. Different approaches for resection of these rare malformations have been reported in the literature
Methods: An 83-year-old male presented with a 3-years history of regurgitation and dysphagia, mainly to solids. He also complains of occasional cough with oral intake, especially upon initiating meals. His past medical history is significant for atrial fibrillation, and hypertension. Physical examination and routine bloods were unremarkable. Endoscopy showed a long intraluminal polypoidal mass originating from just below the left aryepiglottic fold, covered with normal squamous epithelium and no stigmata of recent bleeding. It was not obstructing the airway and it measured 18 cm in length. He was referred for EUS to evaluate the vascularity of the polyp. Based on his history, clinical examination and imaging findings a diagnosis of fibrovascular polyp was made. A decision was made for endoscopic resection. During endoscopic removal, the base of the polyp was exposed and it was injected with epinephrine. Bipolar cautery with a snare was used to excise the polyp about 2 cm from the base of the polyp to avoid bleeding. The mass was retrieved with a forceps. Final pathology was consistent with fibrovascular polyp. Upon 4 weeks follow-up, the patient was doing well and was asymptomatic Discussion: Fibrovascular polyps are rare benign esophageal tumors. They represent about 1% of all benign esophageal tumors; however, they are the most common intraluminal benign tumors of the esophagus. They commonly originate from areas of lower resistance in the pharyngeal musculature. The pathophysiology of the fibrovascular polyps is unknown. Imaging has an important 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. There are different approaches and modalities to treat fibrovascular polyps, based on the characteristics of each polyp as well as the general condition of the patient and the presence of other comorbidities. Removal of the polyp is usually recommended because of the progressive nature of the lesion.The two commonest approaches are cervical esophagostomy with complete excision of the polyp, and endoscopic resection.
Disclosures: Zeyad Sako indicated no relevant financial relationships. Fadi Hawa indicated no relevant financial relationships.