| Fibrovascular
polyps are rare submucosal tumours of the esophagus almost always
originating from the cervical esophagus. These are benign
but potentially life-threatening lesions.
In the past
these lesions have been variably classified as “lipomas,” “fibromas,”
and “fibrolipomatous” polyps.
Site:
Usually arise in the proximal esophagus behind the cricoid cartilage,
frequently from the upper esophageal sphincter.
Age & sex:
Most
patients are middle-aged or elderly men. Some cases occur in
children or infants and in women.
Clinical presentation:
Presents as a large,
pedunculated lesion. Patient usually complains of dysphagia, substernal discomfort, and sensation of
a mass.
Many fibrovascular
polyps have presented as regurgitated masses in the mouth, others have
led to airway obstruction as the mass impacted on the larynx.
Gross:
Soft, long, polypoid lesion usually covered by normal mucosa. The lesion is attached
by a pedicle to the wall in the cervical esophagus. The cut surface has
a loose, edematous or myxoid look, with white fibrous tissue areas mixed
with yellow adipose tissue lobules.
Microscopic features:
Histologically, the
lesion is composed of variable admixtures of mature adipose tissue lobules, collagenous and sometimes myxoid tissue, and prominent vasculature (mixture
of muscular arteries, thin-walled veins, and capillaries), all
surrounded by mature squamous epithelium. Numerous plasma cells
and mast cells are often present.
Mixture of normal
or near-normal stromal tissues suggests that the fibrovascular polyp is
not a neoplasm. It may be an acquired malformation, hamartoma or an
unusual form of inflammatory polyp or a lesion related to injury.
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