Hamartomatous Polyp of the Hypopharynx

Millás-Gómez, Teresa; Benito-Orejas, José Ignacio; Morais-Pérez, Darío; Fernández-Salazar, Luis; Álvarez-Quiñones Sanz, María

doi:10.1016/j.otoeng.2010.10.002

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Hamartoma. Haematoxylin–eosin (100×)." ] ] ] "textoCompleto" => "IntroductionMost hypopharyngeal tumours are squamous cell carcinomas. Benign polypoid neoplasms represent less than 1% of tumours in this location,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> with the diagnosis of hamartoma being extremely rare.<a class="elsevierStyleCrossRefs" href="#bib0005">1–3</a>In general, benign pharyngo-oesophageal polyps are predominant in middle-aged males, with dysphagia being the most common symptom. One peculiarity of these polypoid formations is their ability to reach large sizes, starting with “astonishing” symptoms that can be manifested by a prolapse of the mass within the mouth or asphyxiation caused by an aspiration mechanism.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Faced with the possibility of these serious complications and malignant transformation, which is infrequent but has been described occasionally, surgical resection is recommended.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Clinical CaseWe report the case of a 58-year-old female patient with a history of chronic inflammatory disease of the middle ear. She was referred to our department upon accidental discovery during an upper endoscopy in the context of gastritis, of a polypoid lesion emerging from the hypopharynx (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>During the anamnesis, the patient reported suffering intermittent hoarseness and rough throat, of 8 years evolution. The fibroendoscopic examination found a pedunculated growth occupying the right pyriform sinus.Through a direct hypopharyngoscopy we identified the origin of the mass in the outer wall of the right pyriform sinus, so we proceeded to perform complete microsurgical resection, cauterizing its thick implantation base. Two episodes of haematic vomiting took place in the immediate postoperative period, so a new endoscopic review was carried out, with haemostasis of the bleeding layer through compression and electrocoagulation of a pulsating vessel.Pathological AnatomyAt the histological level, we observed a lesion of hamartomatous aspect with polypoid architecture (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). It presented a flat, stratified, squamous epithelial lining and loose stroma with pseudomucinous glands, prominent vascularity and clefts lined by cylindrical epithelium of respiratory type. We also noted adipose and cartilaginous tissue.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>We established the diagnosis of hypopharyngeal hamartoma.DiscussionIn the case presented, the peculiar composition of the polyp (with a mixture of normal stromal tissue, typical of the organ where it was established but which did not reproduce the architecture of the surrounding tissue) led us to establish the diagnosis of hamartomatous polyp.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> From the pathological point of view, this entity is different from a “fibrovascular polyp”,<a class="elsevierStyleCrossRef" href="#bib0020">4</a> although both terms are often confused in medical literature.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>Hamartoma is a benign neoplasm present from birth. It is very rarely described in the head and neck, with counted cases in the pharynx.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Pharyngo-oesophageal polyps are often located in areas where the musculature is weaker (lower portion of the pharynx - Killian's triangle - and upper oesophagus - Laimer's triangle). Perhaps, the tension generated on the mucosa in these areas through deglutitive movements could be a causal factor.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> Peristaltic activity would facilitate a further growth of the polyp, which might reach up to 30cm in length.<a class="elsevierStyleCrossRefs" href="#bib0005">1,3</a>Diagnosis depends on the location and clinical presentation. When large polypoid formations regurgitate to the mouth, the diagnosis is simpler.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> However, these are often non-specific discomforts, occasionally mislabelled as functional, which require complementary studies. The initial test is usually an oesophageal transit test, which generally shows the intraluminal defect and which is complemented by endoscopic examination and radiological imaging tests. Although CT and MRI may confirm the diagnosis, 22% of contrast studies and 33% of endoscopies resulted negative in the early stages because the polyps became adhered to the oesophageal wall and offered a normal appearance.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>In the case presented, it was a digestive endoscopy guided visually from the mouth that warned of the presence of a growth with pedunculated appearance in the pharynx.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>Given the possibility of serious complications and even malignization,<a class="elsevierStyleCrossRef" href="#bib0015">3</a> we recommend surgical resection of all pharyngeal polyps. The approach may be oral (the most commonly used), transcervical or transthoracic, depending on the location and size of the polyp.Conflict of InterestsThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres94895" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec82047" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres94894" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec82046" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical Case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Pathological Anatomy" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of Interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec82047" "palabras" => array:3 [ 0 => "Hamartoma" 1 => "Hypopharynx" 2 => "Polyp" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec82046" "palabras" => array:3 [ 0 => "Hamartoma" 1 => "Hipofaringe" 2 => "Pólipo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "We present the clinical case of a polyp in the hypopharynx discovered incidentally while performing an upper digestive endoscopy in a middle aged woman. Endoscopic resection was performed, and the histological result was a hamartomatous polyp. We review the diagnosis and treatment of this rare entity." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "Presentamos el caso clínico de una mujer de mediana edad a la que se le descubre de forma casual, practicándole una endoscopia digestiva, una formación polipoide en hipofaringe. La extirpación tumoral por vía endoscópica reveló el diagnóstico histológico de hamartoma. Revisamos los procedimientos diagnósticos y terapéuticos utilizados en esta rara entidad." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Millás-Gómez T, et al. Pólipo hamartomatoso de la hipofaringe. Acta Otorrinolaringol Esp. 2011;62:472–4." ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 729 "Ancho" => 1000 "Tamanyo" => 112841 ] ] "descripcion" => array:1 [ "en" => "Finger-like polypoid growth, 3×0.9cm in size, with a rough surface, pinkish colour and medium consistency." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 752 "Ancho" => 1000 "Tamanyo" => 140496 ] ] "descripcion" => array:1 [ "en" => "Smooth, stratified epithelial lining together with vascularized and loose stroma, with glands and adipose and destructured cartilaginous tissue. Hamartoma. Haematoxylin–eosin (100×)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fibromatous polyp of the hypopharynx" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Nishimura" 1 => "C. Horiuchi" 2 => "T. Yoshida" 3 => "M. Kawakami" 4 => "K. Yabuki" 5 => "H. 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ISSN: 2173-5735

Acta Otorrinolaringológica Española, the official publication of the Spanish Society of Otolaryngology and Head and Neck Surgery and the Ibero-American Society of Otorhinolaryngology, is the most important journal in Spanish dedicated to Otorhinolaryngology, which reflects the continuous scientific and technical progress of the specialty. It has become an important tool to be kept up to date. The Journal publishes Original Articles (articles on basic research and clinical investigation), reviews, brief communications, case studies and images, which are subjected to a rigorous peer review process.

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Acta Otorrinolaringológica Española has received its first journal Impact Factor (JCR) in 2023. Instructions for authors - Submit an article

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Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

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Impact factor 2023

0.9

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

1.4

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.326

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.54

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Vol. 62. Issue 6.