Abstract
Aim
Giant esophageal polyps are a relative rare and benign entity, which can lead to major complications. Our knowledge about their pathology and management originates from scattered case reports. Our aim is to report the clinical presentation and management of this rare case in order to enrich the current literature.
Background & Methods
Large pedunculated esophageal polyps are a rare entity encountered in clinical practice. The majority of these polyps are located near the upper esophageal sphincter or upper esophagus. They are slowly growing and asymptomatic. Most common clinical symptoms, associated with polyp size, include dysphagia, chest pain, regurgitation and, rarely, acute respiratory distress. Histology reveals benign submucosal tumors with fibrous and vascular components, covered by normal squamous cells, in most cases. Malignant transformation of these polyps has been infrequently described. Surgical approach, either with endoscopic resection or with open surgery, is the treatment of choice and recurrence is extremely uncommon. A review of current literature was conducted, followed by presentation of our rare case.
Results
A 50 year-old woman with clear medical history presented with a 3-month history of dysphagia and endoscopy revealed a large esophageal polyp extending from the upper esophageal sphincter to the lower esophageal sphincter. The initial attempt of endoscopic resection of the polyp led to regurgitation and intraoral prolapse of the polyp, causing respiratory distress. The patient was transferred to the ENT operation room and an orotracheal intubation was performed. The tumor was successfully removed transorally after ligation of its stem. Histopathology showed an inflammatory fibroid polyp (IFP) and postsurgical follow-up revealed no recurrence of the mass.
Conclusion
Giant IFPs are an extremely rare entity among upper esophageal polyps and the pathogenesis of these tumors remains poorly understood. Life threatening regurgitation of the polyp causing respiratory distress is an uncommon complication demanding urgent surgical approach. Once diagnosed, these benign tumors can be removed either with open surgery or endoscopic resection depending on the location and the size of the tumor. The impressive size of these polyps renders them a challenge for surgeons and endoscopists, whose cooperation is often in need.
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