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Have a felling like something stuck in my throat. Chest X-ray showed bronchitis. Chances of having tumor?

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ENT Specialist
Practicing since : 2001
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I already asked Dr. Bhatti this question. I am reposting for a second opinion from another ENT doctor please. I would just like to have a couple different opinions.
For approximately 3 months I've felt like there was literally something "stuck" in my throat. I've tried to cough it up but only phlegm would come out. I am typically not a person who coughs up phlegm, this is very unusual for me unless I have an active cold (which I do not).
Today I coughed up what I think this "thing" is that gave me the stuck in throat feeling. It literally looks like a raw piece of meat or raw piece of chicken. It is approximately half the size of my finger nail on my pinky finger. Have I just coughed up a tumor or polyp of some sort? When I coughed it up, there was some bright red blood on the object and then I gargled with water and the water I spit out had a very slight tinge of red in it. So the bleeding was very minimal and I did not cough any actual blood or anything else after the object came out.
I took the specimen to one of those Physician's Immediate Med places (I have been there before and was happy with their care). The doctor looked at the tissue and immediately concluded it was mucus. I asked him several times how could he be sure just by looking at it for a few seconds. He said sometimes mucus can take on odd appearances. He examined me, did a chest xray which he said was normal except with some mild bronchitis (I have never smoked and do not drink). I received a call later in the evening after the radiologist also saw the chest xray and said it was normal. While I was in the doctor's office, I asked him to send the specimen for pathology and he said if it would make me feel better, he would send it off but he highly suspected it would come back as mucus.
I have posted a photo of the item I coughed up. Oddly, since the two days has passed since I coughed up the object, my 3 months of coughing up phlegm is 90% gone. I have not really coughed any phlegm up since then or very little.
Please take a look at the picture I included of what I coughed up. Could mucus really look like a pure piece of raw meat? I've never seen anything like this in my life. Could this be a tumor or throat cancer?
Thank you.
Posted Mon, 1 Apr 2013 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Naveen Kumar 11 hours later
Hi

Thanks for posting the query

According to the history provided and image of the specimen posted by you, I do feel, it could be either a papillomatous growth or pedunculated hypertrophied lingual tonsils over the base of the tongue which had got dislodged after repeated coughing or clearing of the throat.

1. Going by the history of foreign body sensation in the throat since 3 months - there should be something which should be protruding from the normal mucosal layer into the pharyngeal outlet. Hence, repeated clearing of the same would have brought out the secretions accumulated to reduce the irritation.

2. Secondly, coughing out of blood along with the fleshy mass implies that it has got dislodged recently from a mucosal surface.

3. Spitting of the blood tinged gargled water substantiates it further that the mass is from somewhere above the epiglottis and not lower down. And, the relief in the symptoms following the extrusion of the mass confirms the same.

4. The image posted shows a fleshy mass of tissue resembling a growth rather a mucosal layer.

To conclude, after considering all the above factors I am of the opinion that it could be:
(i). A papillomatous tissue arising from either base of the tongue or epiglottis OR
(ii). A pedunculated hypertrophied lingual tonsil from the base of the tongue.

Finally, we need to wait for the histopathological report to confirm the above diagnosis. I doubt any malignancy at this stage. You need to consult a good ENT specialist and get an endoscopy done to detect the site (if possible) and to look for any other pathological lesions.

Hope I have answered your query; I will be available for the follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
Follow-up: Have a felling like something stuck in my throat. Chest X-ray showed bronchitis. Chances of having tumor? 47 minutes later
Thank you for your reply.

Of course I understand you can not answer for another doctor, but I am pretty shocked that the doctor seeing this object so easily concluded it was mucus. I would think if there were any doubt, he would have suggested on sending it for pathology rather than me insisting he send it "to make me feel better" as he stated.

Have you ever seen anything like the object I provided in the photo? Is it at all possible for accumulated mucus to resemble something like what I posted? I have been reading a lot on the Internet and have read where other people have coughed up meat looking substances even with vessels in the coughed up object.

I'm not sure what a lingual tonsil is but I still do have my tonsils, they have never been removed.

Lastly, is it common to cough up things such as what you have stated in your opinion and if you have seen something like this in your practice, did it turn out to be a malignancy. My biggest fear is malignancy.
Thank you.
 
 
Answered by Dr. Naveen Kumar 1 hour later
Hi

Thanks for writing back

I am sure this cannot be a piece of mucous plug. This is a fleshy piece of extra growth of tissue which is probably containing a small chunk of sub-mucous and muscular tissue in it. Such as big piece of mucosa cannot get stripped-off so easily without significant bleeding.

Lingual tonsils are the hypertrophied lymphoid follicles present over the base of the tongue which can enlarge during during chronic infections, acid reflux, etc. seldom it can become pedunculated with a small stalk. Similarly, a papilloma over the epiglottis or valeculla can be a pedunculated tissue.

But, this is definitely not a cancerous tissue. If there were to be any malignancy, then you would have other symptoms such as difficulty in swallowing, sensation of lump in the throat, etc.

Only a histopathological examination can confirm it. Also, as suggested in my previous response please get an endoscopy done, it is an office procedure and not traumatic.

I have never seen such a thing in my career as an ENT specialist.

I do not understand why the doctor hesitated to send the specimen for histopathological examination.

I wish you good luck and good health.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
Follow-up: Have a felling like something stuck in my throat. Chest X-ray showed bronchitis. Chances of having tumor? 1 hour later
When you say of this were to be a malignancy, I would have other symptoms such as difficulty in swallowing and sensation of lump in throat.

I did have sensation of something stuck in my throat but now that this tissue is out, I no longer have the sensation of something in my throat. Do you mean I would still likely have a sensation of lump in throat even after I coughed up the tissue?

Thank you.
 
 
Answered by Dr. Naveen Kumar 9 hours later
Hi

Welcome back

In case of malignancy, the sensation of lump in the throat will still remain even after extrusion of the soft tissue. Apart from this, there would be difficulty in swallowing solid food. Occasionally, there would be swelling(s)outside the neck also, which are termed as enlarged lymph nodes. Hence in your case except for the foreign body sensation there was no other symptoms are signs of malignancy.

Hope this clarifies your doubt.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
Follow-up: Have a felling like something stuck in my throat. Chest X-ray showed bronchitis. Chances of having tumor? 14 days later
Hi,
I would like to post what I did after our conversation.

During the time I was waiting for the pathology report to come back on the tissue, I decided to go ahead and see an ENT doctor. I saw the ENT doctor approximately 5 days after I coughed out the tissue. The ENT did a flexible laryngoscopy in his office where he sprayed my throat with a numbing spray and inserted a flexible type tube to take a look at my throat. He said he did not see any growths, he only saw a small area that looked a little red/irritated, "like it was freshly healed".

About a week later I received the pathology report where I'd taken the tissue. The report said "benign squamous epithelium", "consistent with papilloma".

I have researched quite a bit on the internet and could not find where anyone has actually coughed up a papilloma but my ENT said it's possible because the tissue/papilloma is actually attached inside the throat on a delicate stalk-like tissue and it's possible repeated coughing dislodged the stalk (you can actually see the stalk-like tissue in the photo I'd previously posted, towards the bottom of the photo).

I do have a couple of questions please. Can the pathologist definitely see the difference between a papilloma and for example a granuloma?
I've read a lot about papilloma's, that they are caused by HPV and they often repeatedly will come back. I'm curious, have you had patients with papillomas in their throat and if yes, do the papillomas almost always come back or is it possible to have just one and never get another? I've read they can even become life threatening if they get out of control with too many in the throat and consistently having to laser them off. And then the possibility of getting a cancerous papilloma is also concerning.

Can you please answer above questions and if I were your patient, what would you recommend? The ENT told me I should just come back in 6 months or sooner if I felt that sensation again like something was stuck in my throat. I wonder if I should take a more proactive approach, maybe I need a full upper endocoscopy?

Thanks for your help.
 
 
Answered by Dr. Naveen Kumar 1 hour later
Hi

Thanks for writing back

So, my initial diagnosis is consistent with the histopathological report posted by you. Do not worry! It was a harmless piece of tissue which got dislodged from the mucosal surface.
1.     Can the pathologist definitely see the difference between a papilloma and for example a granuloma?

There is a huge difference between papilloma and granuloma (presuming, you are discussing about pyogenic granuloma), similar to rice grain and a wheat grain. It can be easily differentiated under the electron microscope.

2.     I've read a lot about papilloma's, that they are caused by HPV and they often repeatedly will come back. I'm curious, have you had patients with papillomas in their throat and if yes, do the papillomas almost always come back or is it possible to have just one and never get another?
Do not worry! In your case it is a benign solitary papilloma (caused by human papilloma virus). Recurrence is seen infrequently in these types of lesions. An oral papilloma differs from other types of papilloma in a few important ways. While most of these growths are noncancerous in nature, a growth within the mouth does have a slightly higher likelihood of developing into a malignant mass. Oral papillomas are multiple lesions and are more likely to recur. But, your lesion was solitary, from the throat and hence it is very unlikely to recur. Please go through this link, it will give you an insight about your problem. http://jos.dent.nihon-u.ac.jp/journal/51/3/367.pdf
Till now I have not come across any such lesions in my clinical practice.
3.     I've read they can even become life threatening if they get out of control with too many in the throat and consistently having to laser them off. And then the possibility of getting a cancerous papilloma is also concerning.

This happens in the case of multiple oral papillomas, but not in a solitary lesion. Do not worry! The chances of the lesion in your case turning into malignancy are almost nil.

4.     Can you please answer above questions and if I were your patient, what would you recommend? The ENT told me I should just come back in 6 months or sooner if I felt that sensation again like something was stuck in my throat. I wonder if I should take a more proactive approach, maybe I need a full upper endocoscopy?
I do understand your concern behind this problem; I agree with the decision of your doctor to wait and watch. If you still insist, you can go for a complete upper GIT endoscopy, but I do not recommend the same. Also, collect the images and the report of the endoscopy performed by your doctor. This is important to compare the images in the future.

Hope this answers your queries. I wish you good luck and good health.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
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