Fibrovascular esophageal polyp as a diagnostic challenge

Fibrovascular polyps are rare benign esophageal tumors that usually arise f rom the proximal third of the esophagus. We present the case of a 48-year-o ld man with a history of dysphagia and 7-kg weight loss over a period of 2 months. A barium swallow showed a distended esophagus with a tumor extendin g from the upper esophageal sphincter to the cardia. On a thoracic computed tomographic scan, a homogeneous intramural mass with a density of 22 Houns field units was seen, which extended throughout the entire esophagus. Fiber optic endoscopy confirmed the presence an intramural tumor beginning at the upper esophageal sphincter and reaching to the cardia. The tumor was compl etely covered with mucosa, except for an ulcerated area at its distal end, which herniated into the stomach. On endoscopic ultrasound, the tumor appea red to grow submucosally and to respect the muscularis propria. Endoscopic biopsies from the ulcerated distal aspect of the tumor suggested a leiomyom a. None of the imaging modalities used revealed evidence of a polyp or intr aluminal esophageal tumor. Rather, a potentially malignant extensive intram ural tumor was suspected, and an esophagectomy was performed. Only at the t ime of removal of the specimen did it become evident that the tumor mass wa s located intraluminally with a pedicle in the region of the upper esophage al sphincter. The final pathological diagnosis was a giant fibrovascular po lyp of the esophagus.