Esophagus
Other tumors
Giant fibrovascular polyp / well differentiated liposarcoma


Topic Completed: 28 February 2020

Minor changes: 28 February 2020

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PubMed Search: Fibrovascular polyp esophagus [Title]

Yukihiro Nakanishi M.D., Ph.D.
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Cite this page: Nakanishi Y. Giant fibrovascular polyp / well differentiated liposarcoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/esophagusfibrovascularpolyp.html. Accessed July 13th, 2020.
Definition / general
  • Giant fibrovascular polyp used to be considered a nonneoplastic polypoid lesion of the esophagus
  • The majority of giant fibrovascular polyps of the esophagus now appear to represent well differentiated and dedifferentiated liposarcoma based on the result of MDM2 FISH (fluorescence in situ hybridization) testing (Mod Pathol 2018;31:337)
Essential features
Terminology
  • Giant fibrovascular polyp, fibrovascular polyp, well differentiated liposarcoma, atypical lipomatous tumor
Epidemiology
Sites
Clinical features
  • Middle aged to elderly patients with male predominance (Int J Surg Case Rep 2019;64:113)
  • Slowly worsening dysphagia, weight loss, odynophagia and oral regurgitation of polyp
Radiology images

Images hosted on other servers:
Missing Image

Sagittal CT image of intraluminal polypoid mass

Prognostic factors
Case reports
Treatment
  • Endoscopic or surgical resection
Gross description
Gross images

Images hosted on other servers:

Sausage shaped mass

Microscopic (histologic) description
Microscopic (histologic) images

Contributed by Jason L. Hornick, M.D., Ph.D.

Giant fibrovascular polyp / well differentiated liposarcoma

Positive stains
Molecular / cytogenetics description
Sample pathology report
  • Esophagus, mass, endoscopic resection:
    • Well differentiated liposarcoma / giant fibrovascular polyp (see comment)
    • Resection margin negative for liposarcoma
    • Comment: The slightly atypical stromal cells are positive for MDM2 and CDK4 by immunohistochemistry with appropriate controls. The results support the above diagnosis.
Differential diagnosis
  • Lipoma:
    • Pedunculated tumor
    • Composed of mature adipose tissue with no atypical stromal cells
    • MDM2 and CDK4 testing would be negative
  • Carcinosarcoma:
    • Pedunculated tumor
    • Biphasic tumor with carcinomatous and sarcomatous components
Board review style question #1
    Which of the following is true about this mass shown in the picture?

  1. Despite large size of the tumor, patients never present with dysphagia
  2. Gross features suggest an aggressive tumor
  3. Patients need an aggressive treatment including chemotherapy and radiation
  4. This polypoid tumor is usually seen in the proximal / cervical esophagus
Board review answer #1
D. Giant fibrovascular polyp / well differentiated liposarcoma is usually seen in the proximal / cervical esophagus

Reference: Giant fibrovascular polyp / well differentiated liposarcoma

Comment Here
Board review style question #2
    Which of the following is true about giant fibrovascular polyp of the esophagus?

  1. Most giant fibrovascular polyps show MDM2 amplification
  2. They represent a reactive / nonneoplastic mass of the esophagus
  3. They usually are composed of markedly pleomorphic, hyperchromatic stromal cells
  4. They usually are seen in young female patients
Board review answer #2
A. Most giant fibrovascular polyps show MDM2 amplification and CDK4 amplification supporting the diagnosis of well differentiated liposarcoma

Reference: Giant fibrovascular polyp / well differentiated liposarcoma

Comment Here
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