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Thread: Fibroepithelial Polyp Pictures - Atlas of Colon and Ileum

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    Default Fibroepithelial Polyp Pictures - Atlas of Colon and Ileum

    Case Report
    A 39-year-old woman with a history of irregular menstrual bleeding was referred for pelvic sonogram for evaluation of possible uterine polyps. The patient reported occasional colicky right flank pain.

    Pelvic sonogram showed an incidental vermiform solid mass in the urinary bladder near the right ureterovesical orifice (Figure 1). The mass was mobile, and appeared to arise from the right distal ureter, with portion of the mass protruding into the urinary bladder. A small amount of color flow was detected in the mass with color Doppler imaging. While the predominant mass was detected within the bladder, its exophytic and vermiform shape were felt to be atypical for a primary bladder tumor. No focal bladder wall thickening or hydroureteronephrosis was seen on sonography. The uterus and adnexa were normal.

    Discussion
    Ureteral fibroepithelial polyps are rare benign tumors that most frequently occur in adults but may also arise in children.1 There is a slight male predominance. The most common presenting symptoms are hematuria and / or nonspecific flank pain which may be attributable to either torsion or intussusception of the polyp or intermittent obstruction. Although the exact etiology of fibroepithelial polyps is uncertain, some have suggested both congenital factors in children and chronic inflammation in adults.

    Ureteral fibroepithelial polyps vary in size, and can measure up to 12 cm in greatest dimension. Histologically, fibroepithelial polyps are of mesodermal origins, and are characterized by a loose vascular fibrous stroma with overlying benign transitional epithelium. Despite the benign nature, the majority of fibroepithelial polyps reported in the literature were discovered at the time of nephroureterectomy for a presumed ureteral malignancy. Although fibroepithelial polyps are themselves benign lesions, cases of coexistent transitional cell carcinoma have been reported. Bellin et al has also reported a case of an ureteral fibroepithelial polyp with progressive growth documented on serial CT examination.

    In general, differential considerations for ureteral lesions include malignant lesions such as transitional cell carcinoma, rare benign mesenchymal tumors, and non-neoplastic etiologies including blood clots, sloughed papillae, fungus ball, or rare parasitic infection. There have been few reports of ureteral fibroepithelial polyps detected on ultrasound. Liddell et al described a case of fibroepithelial polyp of the proximal ureter in a child presenting as a mildly echogenic structure with polypoid projections extended into the right renal pelvis. In our case, the real-time cine mode imaging and the excellent resolution on ultrasound allowed for the correct preoperative diagnosis of a distal ureteral fibroepithelial polyp in an adult. On ultrasound, the lesion was elongated and smoothly marginated with a vermiform appearance. Cine mode imaging showed that the lesion was mobile and protruded from the right distal ureter into the urinary bladder in real time, a feature not expected for malignancy which is usually fixed in place. The availability of Doppler imaging confirmed a solid mass in this case, therefore excluding entities such as blood clots, sloughed papillae or fungus ball, which may occasional present as a mobile ureteral lesion. CT urogram also showed similar findings of an elongated ureteral lesion with a corkscrew appearance suggestive of a benign fibroepithelial polyp. CT may have an advantage over ultrasound in the diagnosis when the ureteral polyp is entirely located within a non-dilated ureter. In summary, either the sonographic features of a vermiform and mobile solid ureteral mass or the CT features of an elongated ureteral lesion with a corkscrew appearance should strongly suggest the diagnosis of a fibroepithelial polyp.

    The treatment of choice for a fibroepithelial polyp is complete excision. Accurate preoperative diagnosis of this entity is important as it will direct the treatment towards less invasive endoscopic resection rather than more radical surgery such as nephroureterectomy.
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    What Is Fibroepithelial Polyp Or Skin Tags?
    Fibroepithelial Polyp or Skin Tags is a benign condition which normally causes no symptoms but affects an individual cosmetically, although it is important to understand what they actually are. The exact cause of Fibroepithelial Polyp or Skin Tags is not well known but it can be easily treated by simply removing it. Fibroepithelial Polyp or Skin Tags are benign skin growths that surface on the skin and hangs off the body. They are also known by the name of Cutaneous Tags, Soft Fibromas, and Acrochordons. Fibroepithelial Polyp or Skin Tags are usually small and dark in color, although they can grow as big as about an inch in length. Fibroepithelial Polyp or Skin Tags may develop without the individual even observing them develop. Fibroepithelial Polyp or Skin Tags can develop anywhere in the body but usually occur in the eyelids, neck and groin areas or in the armpits. An individual may have a solitary skin tag or there may be multiple skin tags around the body.

    What Are The Causes Of Fibroepithelial Polyp Or Skin Tags?
    Fibroepithelial Polyp or Skin Tags are quite common and are found in many individuals but they usually are found in people above the age of 50. They tend to be found more in diabetics as well as people who are overweight. Fibroepithelial Polyp or Skin Tags are usually caused due to the friction that is caused when two parts of skin rub against each other like in the armpits. Along with constant friction, wearing tight clothing also contributes to development of skin tags, especially in people who are obese.

    Where Do Fibroepithelial Polyp Or Skin Tags Usually Occur?
    As stated, Fibroepithelial Polyp or Skin Tags usually occur around the eyelids, armpits, neck, or groin areas but they can develop anywhere in the body. Some of the other areas which can develop Fibroepithelial Polyp or Skin Tags are upper chest, especially in females, and buttock folds. Tags are typically thought to occur where skin rubs against itself or clothing. Fibroepithelial Polyp or Skin Tags may also be seen in babies who are born plump due to friction of the skin rubbing against skin. Infants may develop Fibroepithelial Polyp or Skin Tags in the areas of the eyelid due to frequent rubbing of the eyes. Teenagers may develop Fibroepithelial Polyp or Skin Tags due to skin rubbing against clothing when involved in sporting activities.

    Some Facts About Fibroepithelial Polyp Or Skin Tags
    Below mentioned are some common facts about Fibroepithelial Polyp or Skin Tags:
    • This is a very common condition and is absolutely harmless.
    • They usually occur in the eyelids, neck, armpits, and groin folds.
    • An individual may have one or more Skin Tags.
    • Fibroepithelial Polyp or Skin Tags tends to occur in almost every individual at some point or the other.
    • This condition is more common in obese people and diabetics.
    • Once a skin tag is removed the chance of it re-growing is minimal
    • There is no specific risk factor for development of Skin Tags
    • The basic treatments include freezing, tying the tag with a thread or a suture, or excising the Skin Tag.

    Attachment 2086

    What Are Treatments For Fibroepithelial Polyp Or Skin Tags?
    Usually, there is no treatment required for Fibroepithelial Polyp or Skin Tags as it is a benign condition and does not cause any damage to any structures in the body. If the growths are not particularly bothersome and cosmetically not degrading then leaving the tags as it is may be the best option. In case if an individual finds them to be bothersome there are many treatment options available to remove the Fibroepithelial Polyp or Skin Tags. Some of the treatment options are:
    • Tying off the tag at its base with a piece of string
    • Freezing the tag with liquid nitrogen
    • Burning the tag using electrocautery
    • Removing the tag using scissors.


    Generally, the small tags are easily removed by scissors and do not cause any pain or discomfort but tags which are relatively big may need to be removed utilizing local anesthesia so that individual does not experience any pain during the procedure. It is advisable to use topical anesthesia when removing multiple tags from one area. Fibroepithelial Polyp or Skin Tags are usually treated by dermatologist but at times an individual may have to go to an ophthalmologist for treatment of skin tags present on the eyelids.
    Apart from pharmacological treatments, there are certain home remedies which can be used for treatment of Fibroepithelial Polyp or Skin Tags which include tying off the tag with a piece of thread and leaving it like that for the tag to fall off on its own after some days. The smaller tags can be removed with scissors and an individual does not have to wait for the tags to fall off on its own, although this form of treatment may cause mild amount of bleeding.
    There are also some risks associated with freezing of the Skin Tags and that is temporary discoloration of the skin or the need for repetitive treatments.
    Thus far there is no evidence to suggest that Fibroepithelial Polyp or Skin Tags tends to recur. It is just that an individual may be prone to developing Fibroepithelial Polyp or Skin Tags and for those individuals Skin Tags may grow from time to time.
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    What Problems Can An Individual Face Due To Fibroepithelial Polyp Or Skin Tags?
    With the exception of cosmetic abnormalities, there is potentially no damage done to any part of the body due to Fibroepithelial Polyp or Skin Tags. These growths do not cause any pain or discomfort. The only reason for removal of Skin Tags is due to its cosmetic appearance which may be unpleasant. In some instances, a Skin Tag may become red due to bleeding or necrotic. In some instances, they can get irritated and may cause some pain due to tight clothing, or being rubbed frequently by seat belts or jewelry.

    References:
    Fibroepithelial Polyp or Skin Tags|Causes|Treatment|Facts
    Ureteral Fibroepithelial Polyp











    Last edited by Medical Photos; 09-14-2015 at 05:03 PM.

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