Fibrovascular Polyp of the Cervical Esophagus: A Rare Neoplasm
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CLINICAL REPORT
Fibrovascular Polyp of the Cervical Esophagus: A Rare Neoplasm Kushal Bairoliya1 • Ramesh Rajan1 Sarath Kumar1 • D. S. Rajeev1
•
Harigovind Sasidhara Panicker1 • Sreejith Sreekumar1 • Jaya Chrisanthus1 •
Received: 24 June 2020 / Accepted: 2 September 2020 Ó Association of Otolaryngologists of India 2020
Abstract Fibrovascular polyps are rare benign epithelial neoplasia of the cervical esophagus. Usually they are large and frequently require a thoracotomy/thoracoscopy. This is a case report of an elderly lady with a large Fibrovascular polyp who had anemia and weight loss due to dysphagia, managed by rendezvous technique. Keywords Benign esophageal neoplasm Fibrovascular polyp Rendezvous procedure
Introduction A 67 year old lady was referred to our center with foreign body sensation, grade 2 dysphagia and weight loss of 6 months duration. Four months earlier, she was referred for a thyroidectomy elsewhere, with a clinical diagnosis of iodine deficiency goiter. On presentation to us, she had stridor and orthopnea. She gave history of coughing out a fleshy mass which she could push back, almost an year back. Examination showed an anteriorly placed neck swelling that moved on deglutition. X-ray chest showed widening of the upper mediastinum with a soft tissue density in the tracheoesophageal region. Endoscopy revealed a large polypoidal mass, 20 cm from the incisors with the base not visualized, the overlying mucosa showing ulceration. Barium swallow showed filling defects in the upper esophagus with a smooth mucosa (Fig. 1). Clinical diagnosis of FVP was made and a CECT done for anatomic delineation. & Ramesh Rajan [email protected] 1
Trivandrum Medical College, Trivandrum, Kerala, India
In view of the large size, she was planned for an operative polypectomy rather than an endoscopic approach. Intraoperatively, initially a rigid esophagoscopy was performed by an ENT surgeon under General anesthesia to identify the base of the polyp, which revealed a wide base just below the UES. Under the guidance of intraoperative esophagoscopy, an esophagotomy was done via a left cervical approach. The esophagotomy was extended up to the suprasternal notch as the polyp was large. The large polyp, which was filling the lumen and partly dipping into the thoracic esophagus was delivered out (Fig. 2) and excised at the base. The mucosal defect at the base was approximated with 4–0 polyglactin 910 sutures. Esophagotomy was closed with interrupted absorbable sutures and a drain left in the cervical region. A feeding jejunostomy was also done in the same setting. A watersoluble contrast study on POD 5 showed no extravasation or gross aspiration. Postoperatively initially there was swallowing difficulty, with frequent episodes of microaspirations which gradually settled with small frequent meals. Meanwhile, the feeding jejunostomy (FJ) came to the rescue. Histopathology confirmed the diagnosis of fibrovascular polyp (FVP). At follow up two and a half years later, the patient remains asymptomatic.
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