Pedunculated lipoma of the esophagus
18 April 2018 (online)
Large pedunculated polyps are very rare. Leading symptoms are usually dysphagia and regurgitation of the polyp. Though malignant transformation is unlikely a prompt resection should be performed in order to avoid fatal asphyxiation caused by aspiration. The resection can be performed using a transoral, transcervical, or transthoracic approach.
A 75-year old male patient presented himself in the department of maxillofacial surgery of our interdisciplinary head centre with a recently regurgitated enoral mass and no preceding symptoms. The mass was secured with a clamp and the patient presented to our ENT-department. Endoscopic examination revealed a pedunculated smooth polyp coming out of the deep hypopharynx without definitive origin. To prevent aspiration and asphyxia the polyp was secured with retention stitches followed by immediate hypopharyngoscopy and esophagoscopy in general anaesthesia without any prior imaging. The polyp of approximately 9 cm length was found to have its root on the anterior wall between the hyphopharynx and the upper esophageal sphincter. Transoral laser resection was performed after exposition using the diverticuloscope. No nasogastric tube needed to be inserted, soft food as restorative diet was used for several days.
The histopathological result showed a submucosal lipoma with metaplastic bone formation (5 mm) without malignant transformation.
Large pedunculated polyps of pharynx and esophagus should be laser resected using an endoscopic transoral approach without any delay in order to avoid fatal complications.