Esophageal polyp

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Classification according to ICD-10
D13 Benign new formation of other and imprecisely designated parts of the digestive system
D13.0 Esophagus
ICD-10 online (WHO version 2019)
Fibrovascular polyp in swallowing examination: (a) The intraluminal tumor extends almost the entire length of the esophagus. (b) Circular or spiral contractions can be observed as a reaction to the chronic foreign body stimulus.
Axial and sagittal fibrovascular polyp on computed tomography .

Esophageal polyps (fibrovascular polyps or giant polyps of the esophagus ) are usually benign tumors that hang from a stalk from the wall into the lumen of the esophagus . They can get very big. The frequency figures vary from "extremely rare" to "second most common benign esophageal tumor " after leiomyoma .

histology

The polyps show in varying proportions the histology of a lipoma , fibroma , myxoma , vascular tissue and rarely a well-differentiated liposarcoma . Usually they are grouped together as fibrovascular polyps regardless of the individual histology.

Appearance

The polyps have their origin or stalk almost always in the upper part of the esophagus and hang far in the caudal direction, sometimes up to the transition to the stomach, into the lumen. So they are often more than 10 cm long. As a rule, they are covered by intact mucous membrane, which, despite the size , can lead to the polyp being overlooked in endoscopy .

Clinically, patients have difficulty swallowing . The esophagus can react to the constant, apparent stimulus of a foreign body with spasmodic, segmental contractions similar to those in diffuse esophageal spasm .

A potentially dangerous complication is regurgitation of the stalked polyp up into the throat with the possibility of obstruction of the airway. Cases have been described in which the long, regurgitated polyp hung from the mouth.

Diagnosis

The X-ray swallowing examination shows a long, club-shaped, lavaged, intraluminal tumor with a smooth, somewhat lobed contour. In the case of a very bulky tumor, the enlarged esophagus can form the contour of the mediastinum on the chest x-ray .

If the tumor clearly contains fat, this can be detected in computed tomography or magnetic resonance imaging and can thus be helpful for differentiating it from other tumors.

swell

  • AZ Giani et al .: Giant esophageal polyp: a clinical and radiological entity with variable histology. In: European Radiology. 1998; 8 (2), pp. 264-269. PMID 9477279
  • F. Palacios et al .: Giant esophageal fibrovascular polyp. In: Rev Gastroenterol Peru. 2003 Jul-Sep; 23 (3), pp. 213-216. PMID 14532922
  • C. Ridge et al .: Giant oesophageal fibrovascular polyp. In: European Radiology. (2006); 16, pp. 764-766.