Fibroepithelial polyp of the hypopharynx
Our patient underwent an upper endoscopy to evaluate symptoms of refractory gastroesophageal reflux disease and was found to have a large hiatal hernia. Upon careful endoscopic withdrawal, the polyp was briefly visualized as it was pulled back into the oropharynx. The patient was referred for flexible laryngoscopy that confirmed a polypoid mass involving the right lateral piriform wall. She subsequently underwent direct laryngoscopy with harmonic scalpel-assisted excision of the lesion leading to resolution of her symptom of oropharyngeal dysphagia. The surgical specimen measured 3 × 1.4 × 0.4 cm. Pathology demonstrated benign overlying squamous mucosa with submucosa composed of bland spindle cells and fat, consistent with a benign fibroepithelial polyp (Figure C, original magnification × 100; stain: hematoxylin and eosin).
Fibroepithelial polyps are rare benign lesions of the hypopharynx and proximal esophagus that can lead to oropharyngeal dysphagia.1 Larger hypopharyngeal polyps have been associated with aspiration and airway compromise.1 Owing to their proximal location, these lesions are more readily identified under flexible laryngoscopy, but can also be observed with esophagogastroduodenoscopy. Cross-sectional imaging of the neck can be considered for patients with oropharyngeal dysphagia and a normal video-swallow study. Although the underlying pathogenesis remains unclear, inflammation or infection may play a role, especially in smokers.2 The rate of recurrence after resection is low.1
Further evaluation for her symptomatic hiatal hernia was performed and the patient ultimately underwent a laparoscopic Nissen fundoplication with wedge gastroplasty, leading to improvement in her symptoms of gastroesophageal reflux disease. This case illustrates that, although esophagogastroduodenoscopy is not considered the first step in the evaluation of patients with oropharyngeal dysphagia, a careful examination can sometimes reveal the diagnosis.
1. Caceres M, et al. Large pedunculated polyps originating in the esophagus and hypopharynx. Ann Thorac Surg. 2006;81:393-6.
2. Maskey AP, et al. Endobronchial fibroepithelial polyp. J Bronchology Interv Pulmonol. 2012;19:313-4.