LETTER

Hippokratia 2016, 20(4): 318

Radovanovic Z1, Stankovic M2
1Institute for Radiology
2Clinic for Otolaryngology, Clinical Center Nis, Serbia

 

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Key words: Hypopharynx, fibrovascular polyp, surgery

Corresponding author: Prof. Milan Stankovic, Clinic for Otolaryngology, Clinical Center Nis, Bul Zorana Djindjica 48, Serbia, tel: +381638263831, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Dear Editor,

Hypopharyngeal fibrovascular polyps are rare and usually indolent benign tumors until reaching a large size with possible aspiration and asphyxia in extreme cases. Only four such tumors larger than 15 cm originating in the hypopharynx and just one regurgitated in the oral cavity without any previous specific symptoms are reported1-3.

The diagnosis is made by clinical examination, endoscopy, and computed tomography or magnetic resonance imaging scans for determining the origin, content of the mass, and feeding vessels. Surgical removal can be achieved using a transoral, transcervical, or endoscopic approach, depending on the size, location, and structure of the tumor. Endoscopic removal of giant polyps is now feasible1-3.

We present a case of oligosymptomatic hypopharyngeal fibrovascular polyp protruding from the mouth, which is the largest reported such tumor. A 66-year-old man was admitted to the Otolaryngology department with a pendulous mass protruding four cm from his mouth that appeared during a forced cough episode. The patient did not report any previous significant respiratory distress, except for slight swallowing difficulty. Computed tomography showed a well-circumscribed mass, with fat density in the center, which started from the posterolateral left hypopharyngeal wall, filling hypopharynx, oropharynx and oral cavity. Under general anesthesia, the tumor was removed completely endoscopically. The mass measured 17 x 3 x 3 cm, and the stalk was 1.5 cm in length (Figure 1). The histopathological diagnosis was a fibrovascular polyp. The postoperative course was uneventful.



Figure 1: Composite figure showing the tumor protruding from the mouth (left image), computed tomography coronal image showing a large, edunculated tumor originating in the hypopharynx (right image; *: fat density in the center of the tumor, arrows: stalk of the tumor) and the surgically removed specimen (bottom image).

Giant fibrovascular polyps are extremely rare, with only a few cases described. It is crucial to estimate the size of the airway and to perform adequate preoperative investigations to identify the pedicle’s origin before planning the surgical approach and treatment.

Conflict of interest

Authors declare no conflict of interest.

References

1. Arenaz Búa J, Luáces R, Lorenzo Franco F, García-Rozado A, Crespo Escudero JL, Fonseca Capdevila E, et al. Angiolipoma in head and neck: report of two cases and review of the literature. Int J Oral Maxillofac. Surg. 2010; 39: 610-615.
2. Ozdemir S, Gorgulu O, Selcuk T, Akbas Y, Sayar C, Sayar H. Giant fibrovascular polyp of the hypopharynx: per-oral endoscopic removal. J Laryngol Otol. 2011; 125: 1087-1090.
3. Park JS, Bang BW, Shin J, Kwon KS, Kim HG, Shin YW, et al. A Case of Esophageal Fibrovascular Polyp That Induced Asphyxia during Sleep. Clin Endosc. 2014; 47: 101-103.