Ernest G Chan, MD, MPH, Patrick G Chan, MD, MPH, Omar Awais, DO, Rajeev Dhupar, MD, James D Luketich, MD, Matthew J Schuchert, MD. UPMC
INTRODUCTION: Polyps can develop at any portion of the gastrointestinal tract and are most common in the colon. In the esophagus, an overwhelming majority of these polyps are benign lesions originating from the cervical esophagus. While polyps more commonly become neoplastic in the colon, a rare percentage have the ability to develop into a malignancy in the esophagus. We present the diagnostic work-up, operative management, and postoperative course of an unusual case of an esophageal polyp.
CASE DESCRIPTION: A 68-year-old male presented to the gastroenterology department with significant signs of anemia including a sudden drop in hemoglobin. Upon upper endoscopy, he was noted to have a 4 cm X 7 cm mass in the proximal thoracic esophagus with a well demarcated stalk which began at 20 cm from the incisors. The mass extended to 27 cm from the incisors. A barium swallow was obtained for additional work-up which showed a filling defect in the proximal esophagus outlining a lengthy stalk arising from the esophagus at the level of the cricopharyngeus. The patient was brought to the operating room for endoscopic evaluation and attempt at endoluminal excision. However, upon inspection of the mass, there were several areas of nodularity suspicious for malignancy. Multiple attempts at snaring the lesion was unsuccessful give the sheer girth of the polyp. Next, attempts were directed to cauterize the stalk to detach the lesion from the mucosa. However, due to the fear of thermal injury to the esophagus and the close vicinity to the cricopharengeous, the operation was again aborted. Therefore, a final attempt via a left neck exploration with creation of an esophagotomy was planned to achieve the complete removal of the esophageal polyp. The esophagus was circumferentially dissected and a 4 cm longitudinal esophagotomy was created along the lines of the longitudinal fibers. The stalk of the pedunculated mass was divided, over-sewn with an absorbable suture, and cauterized. Final pathology was positive for squamous cell carcinoma with an associated malignant spindle cell stromal component.
DISCUSSION: Esophageal polyps are defined in the literature as macroscopic, well-demarcated projections of epithelial tissue above the mucosa with a fibrovascular core. While majority of these polyps are indeed benign, there is potential for malignancy. Extensive work up including computed tomography and barium esophagram can provide prudent information regarding structural characteristics of the lesion. We recommend further observation and follow up to ensure there is no residual disease.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94809
Program Number: P521
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster