Giant fibroepithelial vulvar polyp in a pregnant woman.

Fibroepithelial polyps are benign lesions that may appear in the vulvovaginal region. They usually occur in women of reproductive age and tend to grow up to 5 cm, but there are some rare cases in which they grow up to 20 cm. We report a case of a 22-year-old woman in the third trimester of her first pregnancy with spontaneous bleeding from a pedunculated mass measuring 15 cm in the widest diameter on the right side of the vulva. Features of this case are discussed as well as its implications, especially regarding the decision of labour. Due to the big size of the mass and its propensity to bleed, we decided to perform an elective caesarean section as well as its excision.

Common causes of 'swelling' in the oral cavity.

BACKGROUND: Conditions that present as a 'swelling' in the oral cavity are relatively common, and patients may seek initial assessment from their general practitioners. OBJECTIVE: The aim of this article is to provide an overview of common causes of a 'swelling' in the oral cavity to help with formulating a differential diagnosis and stratifying the urgency of referral. DISCUSSION: Pathological conditions in the oral cavity (excluding mucosal presentations) may present as a swelling in the submucosa or jaws, symptoms related to teeth and/or gums or an incidental finding on imaging. In this review, the authors outline the most common submucosal or jaw swellings, organised according to their clinical presentations, and describe their typical appearance and management.

Benign fibroepithelial bladder polyp: a rare cause of childhood haematuria.

Haematuria in paediatric population is common yet alarming. It warrants a thorough physical examination and other investigations. Of late, a number of extremely rare aetiology of childhood haematuria have come to forefront. One such uncommon cause is benign fibroepithelial urinary bladder polyp. The presentation is of a child with intermittent haematuria exacerbated by physical/sports activity associated with or without suprapubic pain. Diagnosis is usually made by ultrasonography and cystoscopy and confirmed by histopathological examination. Treatment is surgical and involves cystoscopic transurethral resection of the mass. The exact aetiology of benign fibroepithelial polyp is uncertain with no clear guidelines on long-term surveillance. However, these cases should be subjected to cystourethroscopy if haematuria recurs. Treatment is surgical with good long-term prognosis. Not much is written in literature about benign fibroepithelial bladder polyp.

Robot-Assisted Laparoscopic Excision of Ureteral and Ureteropelvic Junction Fibroepithelial Polyps in Children.

INTRODUCTION: Fibroepithelial polyps of the ureter are a rare cause of asymptomatic and symptomatic upper urinary tract obstruction in children. While these lesions can often be managed endoscopically, large or multifocal polyps may preclude such an approach. OBJECTIVE: We aim to describe our institutional experience with robot-assisted laparoscopic treatment of ureteral polyps and show that a robotic approach is an effective alternative for large or multifocal polyps. MATERIALS AND METHODS: Four children were identified with ureteral polyps over a 5-year period and underwent transperitoneal robot-assisted laparoscopic excision. Patients presented with flank pain and/or worsening hydronephrosis. All patients were evaluated preoperatively with ultrasound and Tc99m-mercaptoacetyltriglycine (MAG3) diuretic renogram or MR urogram. Retrograde pyelography corroborated the diagnosis of ureteral polyps. We reviewed the charts of these patients and compared the specific robotic approach for each patient, length of hospitalization, surgical complications, need for additional procedures, and resolution of symptoms and hydronephrosis. RESULTS: In one patient, more than 20 polyps were identified over a long ureteral segment and all were excised; for the remaining three patients, 1 to 2 polyps were found. Mean postoperative length of stay was 1.5 days. One patient developed a ureteral stricture requiring repeat ureteroureterostomy, and another patient required repeat retrograde pyelography for gross hematuria that occurred several months after surgery. No polyps or obstruction was observed on retrograde pyelography in these patients. Mean duration of follow-up was 29 months (9-62 months). Symptoms and degree of hydronephrosis have improved in the three patients who have been followed for at least 12 months. CONCLUSIONS: Robot-assisted laparoscopy is a safe and feasible alternative to endoscopic treatment of fibroepithelial ureteral polyps. The robotic platform may be preferred in cases of multifocal or large ureteral polyps, or in cases in which a concomitant ureteropelvic junction narrowing may be present.

Retroperitoneal laparoscopy management for ureteral fibroepithelial polyps causing hydronephrosis in children: a report of five cases.

INTRODUCTION: Hydronephrosis is a common disease in children and may be caused by ureteral fibroepithelial polyps (UFP). Ureteral fibroepithelial polyps are rare in children and are difficult to precisely diagnose before surgery. Surgical treatment for symptomatic UFP is recommended. At the present institution, retroperitoneal laparoscopy has been used to treat five boys with UFP since 2006. OBJECTIVE: To highlight the significance of UFP as an etiological factor of hydronephrosis in children and evaluate the applicative value of retroperitoneal laparoscopy in the treatment of children with UFP. METHODS: Between 2006 and 2013 five boys underwent retroperitoneal laparoscopy at the present institution. They were identified with UFP by review of the clinical database. Detailed data were collected, including: radiographic studies, gross anatomical pathology, and pathology and radiology reports. All boys had been followed up at least every 6 months. RESULTS: All of the boys were aged between 7 and 16 years (mean 9.8 years). The main symptoms were flank pain (all five) and hematuria (three). Radiographic examination showed that all of the boys presented with incomplete ureteral obstruction and hydronephrosis. The ureteral fibroepithelial polyps were located near the left UPJ or the left proximal ureter. All of the boys had the UFP removed: three underwent retroperitoneal laparoscopic dismembered Anderson-Hynes pyeloplasty and polypectomy, and two had retroperitoneal laparoscopic ureteral anastomosis. These polyps were all on the left side and between 15 and 35 mm in length (mean 22 mm) (Figure). All of the boys recovered well and were discharged from hospital. The postoperative histological report confirmed that the specimens were UFP. Hydronephrosis was periodically assessed by ultrasonography (using the same method as pre-surgical ultrasonography) after surgery. Mean follow-up was 33 months (range 6-58 months) and no complications were found afterwards. CONCLUSIONS: Ureteral fibroepithelial polyps are rare but rather important as they can cause UPJ obstruction, which often manifests as hydronephrosis. It is most important to confirm the site of ureteral obstruction before surgery as this may have an effect on the surgical management. It is recommended that UFP be successfully managed in children with retroperitoneal laparoscopy.

Recurrent urethral fibroepithelial polyps in a golden retriever.

A 2 yr old castrated male golden retriever was referred multiple times over a period of 7.5 yr for stranguria, pollakiuria, urinary incontinence and urinary outflow obstructions due to urethral polyps. Diagnostic imaging modalities used to identify polyps included abdominal ultrasound, excretory urography, double-contrast retrograde urethrocystograms, and urethrocystoscopy, which revealed multiple filling defects within the proximal and prostatic urethra. Multiple cystotomies and endourologic procedures were performed to remove the multiple fibroepithelial polyps within the proximal and prostatic urethra. Urinary incontinence resulted from treatments, but did respond to phenylpropanolamine. Medical treatment consisted of a nonsteroidal anti-inflammatory drug, which appeared to decrease the recurrence of the polyps over time. Urethral polyps are an uncommon cause of urinary outflow obstruction and do not usually recur after removal. This case illustrates an uncommon clinical presentation and the difficulties encountered in treatment over an expanded time frame.

An unusual bilateral fibroepithelial pharyngeal polyps: report of a case.

Fibroepithelial polyps are benign polypoid lesions arising from the mesodermal tissue and composed of varying amounts of stroma covered by squamous epithelium. We report the unusual case of a 57 years old man who visited our Hospital with complains of airway obstruction and uneasy feeling like a foreign body deep in his throat. After medical examination we find a large mass on the right side of his hypopharinx and we resected tumour as an emergency procedure. Postoperative recovery was good. After two years patient came again in our Hospital with the same feeling and we found another lesion on the left side of his hypopharynx. We repeated the same surgical procedure like the first time. In medical review that is a rare lesion with small number of references. In this case, fibroepithelial polyps arose from the hypopharynx and these potentially fatal lesions may have resulted in complete airway obstruction.

Utilizing ultrasonography in the diagnosis of pediatric fibroepithelial polyps causing ureteropelvic junction obstruction.

BACKGROUND: Fibroepithelial polyps are a rare cause of ureteropelvic junction (UPJ) obstruction in children. Preoperative US diagnosis of fibroepithelial polyps is infrequently reported, with intravenous pylogram and retrograde pyelography being most commonly used for diagnosis. OBJECTIVE: To recommend the most accurate process for diagnosing this disease in children by assessing a modified ultrasonographic procedure for the diagnosis of fibroepithelial polyps. MATERIALS AND METHODS: A retrospective review of US and IVP imaging studies performed in surgically and histologically confirmed cases of fibroepithelial polyps in children. Each child was asked to drink as much water as possible 30 min before the US testing. For US, the renal pelvis, UPJ and the proximal ureter were inspected for an echogenic mass resulting in hydronephrosis. For IVP studies, abdominal plain films were performed at 7, 15 and 30 min following contrast injection. RESULTS: Thirty-five children, 34 boys and 1 girl, had confirmed fibroepithelial polyps. The children ranged in age from 3 to 14 years (mean age 9 years). Clinical presentation included intermittent vague abdominal pain (100%) and/or hematuria (9.7%) for a period ranging from 1 month to 5 years. Of the 35 children (37 polyps), 21 (23 polyps) were correctly diagnosed preoperatively with US, establishing a 62.2% (23/37) US accuracy rate. Twenty polyps were seen on the left, three on the right and two children had bilateral polyps. The masses were all mildly echogenic with defined edges. Eight children (9 polyps) had an IVP consistent with fibroepithelial polyps giving IVP an accuracy rate of 24.3% (9/37). CONCLUSION: US is an effective screening tool for identifying fibroepithelial polyps causing UPJ obstruction in children.

Bladder outlet obstruction in a 5 years boy.

We report a 5 years old boy with bladder outlet obstruction secondary to a fibroepithelial polyp of prostatic urethra. The micturating cystourethrogram showed a filling defect in the posterior urethra. Cystourethroscopy revealed a polyp in the prostatic urethra proximal to the verumontanum. Transurethral resection was done and histopathology confirmed fibroepithelial polyp of the urethra.

Fibroepithelial polyp of the tonsil: case report of a rare, benign tonsillar lesion.

OBJECTIVE: We report the case of a man presenting with a tonsillar mass causing difficult breathing, snoring and disturbed sleep. METHOD: Case report. RESULTS: The patient was found to have a fibroepithelial polyp of the left tonsil. CONCLUSION: To our knowledge, this is the first case of its type to be presented in the English-language literature. The case is presented and the tumour and its management are discussed.

Obstructive ileus due to a giant fibroepithelial polyp of the anus.

Fibroepithelial polyps or hypertrophied anal papillae are essentially skin tags that project up from the dentate line and the junction between the skin and the epithelial lining of the anus. They are usually small in size, but sometimes they become enlarged, causing unexpected medical conditions. An extremely rare case of a giant hypertrophied anal papilla complicated by obstructive ileus is reported. Fibroepithelial anal polyp, despite its size, should be included in the differential diagnosis of a smooth mass located near the anal verge, especially in a patient with a history of chronic anal irritation or infection.

Association of psoriasis and vulval fibroepithelial polyp: first reported case.

Fibroepithelial stromal polyps of the vulvovaginal region display a wide range of morphologic appearances. This morphologic spectrum allows the correct diagnosis to be made in some cases but when histology reveals unusual features, the lesion may be misinterpreted as malignant. We present a case of a 35-year-old woman with psoriasis who developed a 15-cm polypoid lesion localized in the left labium. The labial lesion was resected and no recurrence was detected 12 months after the initial treatment. Histologically, the lesion exhibited the characteristics of a fibroepithelial stromal polyp with focal myxoid areas and underlying vulval psoriasis disease. The clinical, microscopic, and immunohistochemical findings of this case suggest a fibroepithelial polyp of the vulva. This vulval lesion represents a unique example of giant fibroepithelial stromal polyp developed in association with psoriasis.

Screening of glucose/insulin metabolic alterations in men with multiple skin tags on the neck.

SUMMARY: Multiple skin tags appear associated with abnormalities in glucose/insulin metabolism. Clinical and metabolic glucose/insulin characteristics of men with multiple (8 or more) skin tags on the neck were compared with a control group with few or none. Both groups were divided in two subgroups according to normal or abnormal laboratory findings. In the study subgroup with normal laboratory findings the number of skin tags varied from 8-33, whereas in those with abnormal laboratory findings the range was 9-65. Eight or more skin tags were related with statistically significant laboratory glucose/insulin abnormalities: basal hyperinsulinemia (p<0.002), postprandial hyperinsulinemia (p<0.003), and postprandial hyperglycemia (p<0.01). In the multiple skin tag group 77 % had diverse laboratory abnormalities, including insulin resistance, basal hyperinsulinemia, postprandial hyperinsulinemia, glucose intolerance or type 2 diabetes, in contrast with the control group, where only 33 % showed laboratory abnormalities. One-third of the study group had acanthosis nigricans. Only 15 % of patients with metabolic abnormalities did not show any cutaneous expression of glucose/insulin alterations (9 or more skin tags on the neck, acanthosis nigricans, or waist circumference greater than 95 cm). Multiple skin tags were more sensitive than acanthosis nigricans in identifying those with alterations in the glucose/insulin metabolism (77 vs. 32 % respectively), although less specific (68 vs.100%). Multiple skin tags should raise suspicion of insulin resistance or hyperinsulinemia.

Fibroepithelial polyp of the prostatic urethra in an adolescent.

Benign fibroepithelial polyp of the prostatic urethra is a rare congenital lesion most commonly diagnosed in the pediatric population because of diverse urinary symptoms. We report a case of a 16-year-old adolescent boy who presented with urinary retention. Imaging and endoscopic studies confirmed the presence of a polypoid lesion at the bladder base/posterior prostatic urethra. Following transurethral resection of this polypoid mass, the diagnosis of a congenital fibroepithelial polyp of the prostatic urethra was rendered by pathologic evaluation. Although this is considered a benign lesion with no previous reports of recurrence or malignant behavior, it produces dramatic urinary symptoms in the pediatric population with a wide differential diagnosis. Imaging and endoscopic findings may suggest a malignancy and are not sufficient to render a precise diagnosis, which can only be made by pathologic examination.

Recurrent giant fibroepithelial stromal polyp of the vulva associated with congenital lymphedema.

BACKGROUND: The relatively site-specific mesenchymal lesions of the vulvovaginal region can exhibit superficially overlapping histological features and can be diagnostically challenging. Fibroepithelial stromal polyp is generally an easily recognizable entity, but certain cases cause differential diagnostic problems. CASE: We present a case of a 16-year-old girl with a 10-cm polypoid lesion localized to the left labium. The patient has therapy resistant congenital lymphedema localized to the left arm and leg. The labial lesion was resected and recurred after 12 months and 6 years following the initial treatment. Histologically, it exhibited characteristics of a fibroepithelial stromal polyp with scattered bizarre multinucleated giant cells and ectatic tortuous lymphatic spaces. CONCLUSION: This vulvar lesion represents a unique example of giant fibroepithelial stromal polyp developed in association with Nonne-Milroy-Meiges syndrome.

An unusual cause of complete distal ureteral obstruction: giant fibroepithelial polyp.

Fibroepithelial polyp of the ureter is a rare benign neoplasm of mesodermal origin. It is an extremely rare cause of hydronephrosis in children. It usually causes partial ureteral obstruction without loss of renal function. The preferred treatment is endoscopic or surgical resection of the polyp with preservation of the renal unit. The authors present an adolescent patient with a nonfunctioning left hydronephrotic kidney caused by complete ureteral obstruction caused by a giant fibroepithelial polyp of the distal ureter. This is an extremely rare presentation and outcome of this benign ureteral neoplasm with resultant loss of renal unit.