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Kim IK, Ju YT, Kim HG, Lee JK, Kim DC, Kim JM, Cho JK, Park JH, Kim JY, Jeong CY, Hong SC, Kwag SJ. Experience of surgical treatment in a granular cell tumor in the ascending colon: a case report. Ann Coloproctol 2023; 39:275-279. [PMID: 34228911 PMCID: PMC10338165 DOI: 10.3393/ac.2020.00836.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 10/20/2022] Open
Abstract
We report a case about successful surgical treatment of a granular cell tumor in the ascending colon. A 36-year-old man underwent screening colonoscopy. An endoscopic examination revealed a 10-mm yellowish and hemispheric mass in the ascending colon, and lower endoscopic ultrasonography revealed a hypoechoic-to-isoechoic mass invaded the submucosal layer. The mass was suspected to be a colonic carcinoid tumor. Based on the preoperative evaluation, endoscopic complete resection was considered difficult. Therefore, the lesion was removed via laparoscopic right hemicolectomy. Histological examination revealed that the tumor consisted of nests of polygonal cells with abundant granular eosinophilic cytoplasm. Immunohistochemical staining revealed diffuse positivity for S100 and CD68. Therefore, the tumor was diagnosed as a granular cell tumor. We suggest that surgical resection should be considered if it is located in the thin-walled ascending colon prone to perforation, difficult to rule out malignant tumor due to submucosal invasion, or to remove endoscopically.
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Affiliation(s)
- In-Kyeong Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Young-Tae Ju
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Han-Gil Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jin-Kwon Lee
- Department of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Dong-Chul Kim
- Department of Pathology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jae-Myung Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jin Kyu Cho
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Ji-Ho Park
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Ju-Yeon Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Chi-Young Jeong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Soon-Chan Hong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Seung-Jin Kwag
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
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Kawai M, Goda N, Nikaido M, Fukuda A. A case of gastric granular cell tumor. JGH OPEN 2021; 5:966-967. [PMID: 34386607 PMCID: PMC8341187 DOI: 10.1002/jgh3.12610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/22/2021] [Accepted: 06/27/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Munenori Kawai
- Department of Gastroenterology and Hepatology Graduate School of Medicine, Kyoto University Kyoto Japan
| | - Naoki Goda
- Department of Diagnostic Pathology Graduate School of Medicine, Kyoto University Kyoto Japan
| | - Mitsuhiro Nikaido
- Department of Gastroenterology and Hepatology Graduate School of Medicine, Kyoto University Kyoto Japan
| | - Akihisa Fukuda
- Department of Gastroenterology and Hepatology Graduate School of Medicine, Kyoto University Kyoto Japan
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3
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Kumar S, Chandrasekhara V, Kochman ML, Ahmad N, Attalla S, Ho IK, Jaffe DL, Lee PJ, Panganamamula KV, Saumoy M, Fortuna D, Ginsberg GG. Ligation-assisted endoscopic mucosal resection for esophageal granular cell tumors is safe and effective. Dis Esophagus 2020; 33:5843550. [PMID: 32448896 PMCID: PMC7397483 DOI: 10.1093/dote/doaa027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/16/2020] [Accepted: 04/01/2020] [Indexed: 12/11/2022]
Abstract
Given their malignant potential, resection of esophageal granular cell tumors (GCTs) is often undertaken, yet the optimal technique is unknown. We present a large series of dedicated endoscopic resection using band ligation (EMR-B) of esophageal GCTs. Patients diagnosed with esophageal GCTs between 2002 and 2019 were identified using a prospectively collected pathology database. Endoscopic reports were reviewed, and patients who underwent dedicated EMR-B of esophageal GCTs were included. Medical records were queried for demographics, findings, adverse events, and follow-up. We identified 21 patients who underwent dedicated EMR-B for previously identified esophageal GCT. Median age was 39 years; 16 (76%) were female. Eight (38%) had preceding signs or symptoms, potentially attributable to the GCT. Upon endoscopic evaluation, 12 (57%) were found in the distal esophagus. Endoscopic ultrasound was used in 15 cases (71%). Median lesion size was 7 mm, interquartile range 4 mm-8 mm. The largest lesion was 12 mm. A total of 20 (95%) had en bloc resection confirmed with pathologic examination. The only patient with tumor extending to the resection margin underwent surveillance endoscopy that showed no residual tumor. No patients experienced bleeding, perforation, or stricturing in our series. No patients have had known recurrence of their esophageal GCT. EMR-B of esophageal GCT achieves complete histopathologic resection with minimal adverse events. EMR-B is safe and effective and seems prudent compared with observation for what could be an aggressive and malignant tumor. EMR-B should be considered first-line therapy when resecting esophageal GCT up to 12 mm in diameter.
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Affiliation(s)
- Shria Kumar
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Address correspondence to: Dr Shria Kumar, MD, Division of Gastroenterology, Perelman Center for Advanced Medicine, South Pavilion, 7th Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | | | - Michael L Kochman
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nuzhat Ahmad
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sara Attalla
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Immanuel K Ho
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David L Jaffe
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Peter J Lee
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kashyap V Panganamamula
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Monica Saumoy
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Danielle Fortuna
- Division of Pathology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory G Ginsberg
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Sharma NR, Linke CS, Zelt C. Endoscopic Mucosal Resection of Granular Cell Tumors in the Esophagus: a Study of Four Cases and Brief Literature Review. J Gastrointest Cancer 2019; 49:532-537. [PMID: 28477072 DOI: 10.1007/s12029-017-9947-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Neil R Sharma
- Parkview Cancer Institute, Advanced Interventional Endoscopy & Endoscopic Oncology, GI Oncology Program, 11104 Parkview Circle, Suite 310, Fort Wayne, IN, 46845, USA
| | - Colin S Linke
- Loyola University Medical Center, 2160 S 1st Ste 3312, Maywood, IL, 60153, USA
| | - Christina Zelt
- Parkview Research Center, 3602 New Vision Drive, Fort Wayne, IN, 46845, USA.
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Barakat M, Kar AA, Pourshahid S, Ainechi S, Lee HJ, Othman M, Tadros M. Gastrointestinal and biliary granular cell tumor: diagnosis and management. Ann Gastroenterol 2018; 31:439-447. [PMID: 29991888 PMCID: PMC6033765 DOI: 10.20524/aog.2018.0275] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 03/26/2018] [Indexed: 12/14/2022] Open
Abstract
Granular cell tumors (GCTs) are generally thought to be of Schwann cell origin and are typically S-100 positive. Up to 11% of these tumors affect the gastrointestinal tract, most commonly the esophagus, colon, and stomach. While GCTs are mostly benign, malignant and metastatic GCTs have been reported. GCTs are usually found incidentally during esophagogastroduodenoscopy, colonoscopy, imaging studies or during the evaluation of non-specific symptoms. Endoscopically, they are typically yellow in appearance with intact mucosa. On endoscopic ultrasound, they usually are hypoechoic, homogenous, smooth-edged lesions that appear to originate from the submucosal layer, although other endoscopic and ultrasound appearances have been described. There is no consensus on how to treat GCT. Surgical and conservative approaches have been described in the literature. GCTs can also affect the biliary tract, where patients may be misdiagnosed with cholangiocarcinoma. We explore the epidemiology, histology, clinical presentation, diagnosis and treatment of these tumors in the gastrointestinal tract, including the pharynx, esophagus, stomach, small intestine, large intestine and the perianal region. In addition, GCTs in the biliary tract are reviewed.
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Affiliation(s)
- Mohamed Barakat
- Department of Internal Medicine, Icahn School of Medicine - Queens Hospital Center, NY (Mohamed Barakat)
| | - Abdullah Abu Kar
- Department of Internal Medicine, Albany Medical Center, Albany, NY (Abdullah Abu Kar)
| | - Seyedmohammad Pourshahid
- Department of Internal Medicine, Icahn School of Medicine - Queens Hospital Center, NY (Seyedmohammad Pourshahid)
| | - Sanaz Ainechi
- Department of Pathology, Albany Medical Center, Albany, NY (Sanaz Ainechi, Hwa Jeong Lee)
| | - Hwa Jeong Lee
- Department of Pathology, Albany Medical Center, Albany, NY (Sanaz Ainechi, Hwa Jeong Lee)
| | - Mohamed Othman
- Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine, Houston, TX (Mohamed Othman)
| | - Micheal Tadros
- Department of Internal Medicine, Division of Gastroenterology, Albany Medical Center, Albany, NY (Micheal Tadros), USA
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Yang SY, Min BS, Kim WR. A Granular Cell Tumor of the Rectum: A Case Report and Review of the Literature. Ann Coloproctol 2017; 33:245-248. [PMID: 29354608 PMCID: PMC5768480 DOI: 10.3393/ac.2017.33.6.245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 10/02/2017] [Indexed: 01/20/2023] Open
Abstract
A granular cell tumor (GCT) is an uncommon mesenchymal lesion that rarely occurs in the colon and the rectum. We describe the case of 51-year-old man with a 2-cm-sized rectal GCT 10 cm above the anal verge that was incidentally detected after a screening colonoscopy. Preoperative radiologic studies demonstrated a suspicious submucosal rectal mass with mesorectal fat infiltration, but without circumferential resection margin threatening, extramural vessel invasion, and regional lymph-node enlargement. The tumor was resected by using a transanal endoscopic operation (TEO) without immediate postoperative complications. The final pathology revealed that the tumor consisted of a GCT that had invaded the subserosa with clear margins. It had no other risk factors for malignancy according to Fanburg-Smith criteria. We systematically reviewed the English literature by using PubMed and Google Scholar. This report may be the first documented case in the literature to describe a TEO for a GCT that had invaded the subserosa in the rectum.
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Affiliation(s)
- Seung Yoon Yang
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Soh Min
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Ram Kim
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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7
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Diagnosis and Treatment of Esophageal Granular Cell Tumor: A Case Report and Review of the Literature. Case Rep Gastrointest Med 2017; 2017:1071623. [PMID: 29359053 PMCID: PMC5735579 DOI: 10.1155/2017/1071623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/07/2017] [Indexed: 01/28/2023] Open
Abstract
Gastrointestinal granular cell tumors are uncommon. The most common site of gastrointestinal granular cell tumor (GCT) is esophagus. We report a case of esophageal GCT incidentally diagnosed by endoscopy. The lesion was evaluated by endoscopic ultrasonography and resected using the endoscopic technique without complication.
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8
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Rajagopal MD, Gochhait D, Shanmugan D, Barwad AW. Granular Cell Tumor of Cecum: A Common Tumor in a Rare Site with Diagnostic Challenge. Rare Tumors 2017; 9:6420. [PMID: 28975016 PMCID: PMC5617916 DOI: 10.4081/rt.2017.6420] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/27/2016] [Accepted: 06/27/2016] [Indexed: 12/26/2022] Open
Abstract
Granular cell tumor (GCT) also known as Abrikossoff's tumor is a benign neoplasm that is usually seen in the fourth to sixth decades of life with slight female preponderance. It is most frequently seen in the oral cavity, skin, and subcutaneous tissue. Gastrointestinal tract involvement is uncommon, in which esophagus is the most commonly affected site. There are case reports of GCT in stomach, appendix, colon and rectum. In this article, we report a case of GCT involving cecum. The cell of origin in GCT is controversial. There are various pools of thoughts regarding its histogenesis, the details of which are reviewed in this article with emphasis on the diagnostic difficulties encountered in this tumor.
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Affiliation(s)
- Meyyappa Devan Rajagopal
- Departments of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, India
| | - Debasis Gochhait
- Departments of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, India
| | - Dasarathan Shanmugan
- Departments of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, India
| | - Adarsh Wamanrao Barwad
- Departments of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, India
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9
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Abstract
Esophageal granular cell tumor is a rare benign soft tissue tumor with malignant potential, and its histogenesis remains unclear. Since clinical manifestations lack specificity, the diagnosis depends on endoscopy, endoscopic ultrasonography, pathology and immunohistochemistry. Esophageal granular cell tumors have the potential of malignant transformation and are easily confused with leiomyoma and interstitialoma. At present, the treatment of this disease has not yet reached a consensus. This review aims to elucidate the histogenesis, clinical manifestations, diagnosis, treatment and prognosis of esophageal granular cell tumors.
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Ooms H, Pelckmans PA, Van Outryve S, Driessen A, Moreels TG. Endoscopic resection of two rare esophageal tumors. J Gastrointest Cancer 2015; 46:170-4. [PMID: 25675949 DOI: 10.1007/s12029-015-9687-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Hanne Ooms
- Division of Gastroenterology and Hepatology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium,
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11
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Krishnan A, Ramakrishnan R, Menon M. Endoscopic Removal of Granular Cell Tumors of Stomach: Case Report and Review of Literature. Gastroenterology Res 2013; 6:240-243. [PMID: 27785260 PMCID: PMC5051133 DOI: 10.4021/gr588w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2013] [Indexed: 01/23/2023] Open
Abstract
Gastrointestinal granular cell tumors (GCTs), usually benign, soft-tissue tumors, are thought to arise from Schwann cells that may occur at many sites. Only 5-7% of these lesions are detected in the gastrointestinal tract. Histologically, it is composed of sheets or nests of plump round or polygonal cells having abundant slightly amphophilic granular cytoplasm with centrally located uniform pyknotic nuclei and immunohistochemical staining for S-100 protein supports the proposed derivation from Schwann cells. In this study, we reported a case of a solitary GCT of the stomach that was completely removed after endoscopic submuscosal resection.
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Affiliation(s)
| | | | - Maya Menon
- Department of Pathology, Apollo Hospitals, Chennai, India
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Kahng DH, Kim GH, Park DY, Jeon MS, Yi JW, Choi YY, Song GA. Endoscopic resection of granular cell tumors in the gastrointestinal tract: a single center experience. Surg Endosc 2013; 27:3228-36. [PMID: 23479255 DOI: 10.1007/s00464-013-2899-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 02/15/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND The frequency of granular cell tumors (GCTs) identified in the gastrointestinal tract has recently increased with the increased use of routine endoscopy. Endoscopic treatment is increasingly used as an alternative to traditional surgical resection, but there are few reports on the efficacy, safety, and long-term prognosis of endoscopic treatment for GCTs. The aim of this study was to assess the efficacy, safety, and long-term prognosis of endoscopic resection for the gastrointestinal GCTs. METHODS We examined a total of 27 GCTs in 25 patients who were treated by endoscopic resection from January 2007 to February 2011. For endoscopic resection, endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) was used. RESULTS Twenty GCTs were located in the esophagus, 5 in the stomach, and 2 in the colon. The median size of the GCTs was 10 mm; the largest size, located in the ascending colon, measured 18 mm. EMR with a ligation device was performed in 20 cases, conventional EMR in 5 cases, and ESD in 2 cases. En bloc resection was performed in 25 cases (92.6%), and endoscopic complete resection piecemeal resection was achieved in 25 cases (92.6%). Pathologic complete resection was achieved in 22 lesions (81.5%). Intraprocedural bleeding was noted in three patients, with no occurrence of perforation or postprocedure stricture. No recurrence was observed during the mean follow-up period of 15 months (range 9-31 months). CONCLUSIONS Endoscopic resection appears to be a safe and effective treatment for GCTs in the gastrointestinal tract.
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Affiliation(s)
- Dong Hwahn Kahng
- Department of Internal Medicine, Pusan National University School of Medicine, 1-10 Ami-dong, Seo-Gu, Pusan 602-739, Korea
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Granular cell tumour in a patient with Crohn's disease treated with infliximab: coincidence or causal relationship? Eur J Gastroenterol Hepatol 2012; 24:857-9. [PMID: 22475791 DOI: 10.1097/meg.0b013e3283530999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Granular cell tumour (or Abrikossoff's tumour) was first described by Abrikossoff in 1926. This is a rare benign neoplasm of unclear histogenesis that is generally believed to be of nerve sheath origin. Usually, it presents as a solitary lesion, located mainly in the subcutaneous tissue of the head, or the neck, or in the oral cavity, such as a tongue lesion, although it may develop anywhere in the body. Approximately 1-2% of granular cell tumours are malignant. Granular cell tumours are extremely rare in patients with inflammatory bowel disease. To the best of our knowledge, granular cell tumours have never been reported in association either with Crohn's disease or scheduled infliximab treatment. Herein, we report a case of a granular cell tumour that presented as a subcutaneous skin nodule of the right lumbar area without any associated local or systemic symptoms in a 41-year-old woman with Crohn's disease who was receiving scheduled treatment with infliximab (5 mg/kg every 8 weeks) for 7 years.
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Komori K, Akahoshi K, Tanaka Y, Motomura Y, Kubokawa M, Itaba S, Hisano T, Osoegawa T, Nakama N, Iwao R, Oya M, Nakamura K. Endoscopic submucosal dissection for esophageal granular cell tumor using the clutch cutter. World J Gastrointest Endosc 2012; 4:17-21. [PMID: 22267979 PMCID: PMC3262174 DOI: 10.4253/wjge.v4.i1.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 09/01/2011] [Accepted: 01/12/2012] [Indexed: 02/05/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) with a knife is a technically demanding procedure associated with a high complication rate. The shortcomings of this method are the deficiencies of fixing the knife to the target lesion, and of compressing it. These shortcomings can lead to major complications such as perforation and bleeding. To reduce the risk of complications related to ESD, we developed a new grasping type scissors forceps (Clutch Cutter®, Fujifilm, Japan) which can grasp and incise the targeted tissue using an electrosurgical current. Esophagogastroduodenoscopy on a 59-year-old Japanese man revealed a 16mm esophageal submucosal nodule with central depression. Endoscopic ultrasonography demonstrated a hypoechoic solid tumor limited to the submucosa without lymph node involvement. The histologic diagnosis of the specimen obtained by biopsy was granular cell tumor. It was safely and accurately resected without unexpected incision by ESD using the CC. No delayed hemorrhage or perforation occurred. Histological examination confirmed that the granular cell tumor was completely excised with negative resection margin.We report herein a case of esophageal granular cell tumor successfully treated by an ESD technique using the CC.
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Affiliation(s)
- Keishi Komori
- Keishi Komori, Kazuya Akahoshi, Yoshimasa Tanaka, Yasuaki Motomura, Masaru Kubokawa, Soichi Itaba, Terumasa Hisano, Takashi Osoegawa, Naotaka Nakama, Risa Iwao, Department of Gastroenterology, Aso Iizuka Hospital, 3-83, Yoshio-machi, Iizuka, Fukuoka 820-8505, Japan
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Znati K, Harmouch T, Benlemlih A, Elfatemi H, Chbani L, Amarti A. Solitary granular cell tumor of cecum: a case report. ISRN GASTROENTEROLOGY 2011; 2011:943804. [PMID: 21991536 PMCID: PMC3168574 DOI: 10.5402/2011/943804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 10/19/2010] [Indexed: 01/20/2023]
Abstract
Granular cell tumor (GCT) was first described by Abrikossof in 1926. This tumor is a benign neoplasm of unclear histogenesis that is generally believed to be of nerve sheath origin. GCT is not common and most often affects the tongue, skin, and soft tissue, although it may occur anywhere in the body. Gastrointestinal tract involvement, and especially that of the colon, is very rare. This usually benign tumor appears as a submucosal nodule, measuring less than 2 cm in diameter and is often found incidentally during colorectal examinations. We describe the case of a 27-year-old man with a GCT in the cecum that was detected after a screening colonoscopy. Endoscopic examination revealed a yellowish submucosal tumor, 0.7 cm in diameter. An endoscopic mucosal polypectomy was done for histological confirmation and treatment.
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Affiliation(s)
- Kaoutar Znati
- Department of Pathology, Hassan II University Hospital, Fez, Morocco
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Zoccali M, Cipriani N, Fichera A, Turner JR, Krane M. Acute appendicitis secondary to a granular cell tumor of the appendix in a 19-year-old male. J Gastrointest Surg 2011; 15:1482-5. [PMID: 21533589 DOI: 10.1007/s11605-011-1536-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 04/04/2011] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Granular cell tumors are rare, usually benign, neoplasms presenting as solitary small nodules in the skin or subcutaneous tissue. Involvement of the gastrointestinal tract is unusual, particularly of the appendix, and it is characterized by indolent, submucosal lesions usually diagnosed as an incidental finding. CASE REPORT We describe the rare case of acute appendicitis secondary to a granular cell tumor of the appendix in a 19-year-old male.
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Affiliation(s)
- Marco Zoccali
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, 60637, USA.
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Díaz-Sánchez A, Soto S, Ponferrada A, Campos R, García MO, Benito DM, Troya J, Merino B, Aldeguer M. [Granular cell tumor of the esophagus: description of an infrequent benign tumor]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:454-9. [PMID: 21636174 DOI: 10.1016/j.gastrohep.2011.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 03/01/2011] [Accepted: 03/02/2011] [Indexed: 02/08/2023]
Abstract
Granular cell tumors (GCT) are infrequent tumors first described by Abrikossoff in 1926. Gastrointestinal involvement occurs in about 6% of GCT, the esophagus being the most frequent location. These tumors are usually benign and asymptomatic and are usually found incidentally when an upper gastrointestinal endoscopy is carried out for another reason, showing an isolated polyp or sessile submucosal nodule, covered by intact yellowish mucosa and with firm consistency. Endoscopic ultrasonography has significantly improved the diagnosis of these lesions. Nowadays endoscopic mucosectomy is the treatment of choice of esophageal GCT with a low frequency of complications. Histologic analysis of the surgical specimen shows specific characteristics such as positivity for S-100 protein. We present two new cases of esophageal GCT that were diagnosed recently and discuss the most relevant features of this infrequent disease.
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Affiliation(s)
- Antonio Díaz-Sánchez
- Sección de Aparato Digestivo, Hospital Universitario Infanta Leonor, Madrid, España.
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Kim DU, Kim GH, Ryu DY, Lee DG, Cheong JH, Lee BE, Song GA, Park DY, Shin NR, I H, Kida M. Endosonographic features of esophageal granular cell tumors using a high-frequency catheter probe. Scand J Gastroenterol 2011; 46:142-7. [PMID: 20950209 DOI: 10.3109/00365521.2010.525661] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Submucosal tumors (SMTs) are occasionally found in the esophagus during upper endoscopy. Granular cell tumors (GCTs) are reported to be the second most common esophageal mesenchymal tumors, after leiomyomas. Endoscopic ultrasonography (EUS) is an effective tool for predicting the histologic characteristics of SMTs by providing an accurate image of the layering structure of the esophagus, but it is hard to differentiate GCTs from submucosal leiomyomas accurately with conventional EUS. The aim of the present study was to characterize the EUS features of GCTs compared with those of submucosal leiomyomas using a high-frequency catheter probe EUS. MATERIAL AND METHODS A total of 41 patients with GCTs or submucosal leiomyomas were included. All of the patients underwent EUS before histologic confirmation by endoscopic resection or biopsy. RESULTS There were 14 GCTs in 12 patients and 30 leiomyomas in 29 patients. GCTs had a white-to-yellow surface color more frequently than leiomyomas. In comparison with the surrounding normal proper muscle layer, the echogenicity of the leiomyomas was similar to that of the surrounding muscle layer, but more than half of the GCTs were hyperechoic compared to the surrounding muscle layer. Unclear borders were observed more frequently in GCTs than in leiomyomas. The presence of at least two of these three features in a given tumor had a sensitivity of 85.7%, a specificity of 96.7%, and an accuracy of 93.2% for predicting GCTs. CONCLUSIONS High-frequency probe EUS is helpful for differentiating esophageal GCTs from submucosal leiomyomas.
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Affiliation(s)
- Dong Uk Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea
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20
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Esophageal granular cell tumor successfully resected by endoscopic submucosal dissection. Esophagus 2011; 8:203-207. [PMID: 22593727 PMCID: PMC3339600 DOI: 10.1007/s10388-011-0283-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 06/28/2011] [Indexed: 02/03/2023]
Abstract
Granular cell tumors of the esophagus are rare neoplasms and their diagnosis is mainly based on histopathologic examination of endoscopic biopsies. With the development of endoscopic techniques, there has been a marked increase in local treatment modalities for early esophageal neoplasms. In this case report, we describe the removal of a granular cell tumor by the endoscopic submucosal dissection technique, and briefly discuss the literature on clinicopathologic aspects and management of granular cell tumors.
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21
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John BK, Dang NC, Hussain SA, Yang GCH, Cham MD, Yantiss R, Joseph AS, Giashuddin SM, Lee PC, Fleming R, Somnay K. Multifocal granular cell tumor presenting as an esophageal stricture. J Gastrointest Cancer 2009; 39:107-13. [PMID: 19340612 DOI: 10.1007/s12029-009-9056-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 03/18/2009] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Granular cell tumors are uncommonly found in the gastrointestinal tract with slow progression and are usually benign though they may have propensity for malignant transformation. Initially attributed to neuronal origin through immunohistochemistry, there has been controversy with increasing reports of granular cell tumors of non-neural origin. CASE REPORT We report a case of multifocal granular cell tumor involving the esophagus and stomach in a young female with history of dysphagia for 9 years with worsening symptoms. She had been managed at another facility with repeated dilations for presumed benign peptic stricture. Radial endosonography (EUS) of the proximal end of stricture showed a posterior submucosal esophageal mass that was heterogeneous and invaded into the muscularis propria. Fine-needle aspiration (FNA) showed large cells with granular cytoplasm along with spindle nuclei. Cells were initially checked for CD117 stain alone and found to be negative. A follow-up CT-guided core needle biopsy revealed similar granular cells that were positive for S-100. She underwent a two-stage transhiatal esophagogastrectomy as the tumor circumferentially involved the cervical esophagus and was adherent to the trachea and recurrent laryngeal nerve bilaterally. At surgery, there were two additional foci palpable in the proximal stomach. DISCUSSION AND CONCLUSION As these tumors may have potential for malignant transformation and locoregional invasion, they should be considered while evaluating submucosal lesions of the esophagus even in young patients. A large number of granular cell tumors may be missed in the absence of S-100 staining, which should be requested when granular cells are seen on cytology obtained by EUS FNA as this can be a minimally invasive diagnostic modality for these tumors. Other foci should be sought at surgery as they have a propensity for locoregional spread.
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Affiliation(s)
- Bijo K John
- Department of Medicine, New York Hospital Queens and Weill Cornell Medical College, New York, NY, USA.
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22
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Cha JM, Lee JI, Joo KR, Choe JW, Jung SW, Shin HP, Lim SJ. Granular cell tumor of the descending colon treated by endoscopic mucosal resection: a case report and review of the literature. J Korean Med Sci 2009; 24:337-41. [PMID: 19399282 PMCID: PMC2672140 DOI: 10.3346/jkms.2009.24.2.337] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2007] [Accepted: 01/29/2008] [Indexed: 01/02/2023] Open
Abstract
Although colorectal granular cell tumors (GCTs) are rare, their incidental finding has increased as the use of diagnostic colonoscopy has become more common. Here we describe the case of a 41-yr-old man with a GCT in the descending colon that was detected after a screening colonoscopy. Endoscopic examination revealed a yellowish submucosal tumor, 13x12 mm in diameter, in the descending colon. Endoscopic mucosal resection (EMR) followed by histological examination revealed that the tumor was composed of plump histiocyte-like cells with an abundant granular eosinophilic cytoplasm and small round nuclei. The tumor cells expressed S-100 protein and stained with periodic acid-Schiff, but were negative for desmin and cytokeratin. The resected tumor was diagnosed as a GCT. Colonoscopists should consider the possibility of GCT in the differential diagnosis of yellowish submucosal tumors of the colon. In such patients, EMR seems to be a feasible and safe approach for diagnosis and treatment.
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Affiliation(s)
- Jae Myung Cha
- Department of Internal Medicine, Kyunghee University College of Medicine, Seoul, Korea
| | - Joung Il Lee
- Department of Internal Medicine, Kyunghee University College of Medicine, Seoul, Korea
| | - Kwang Ro Joo
- Department of Internal Medicine, Kyunghee University College of Medicine, Seoul, Korea
| | - Jae Won Choe
- Department of Internal Medicine, Kyunghee University College of Medicine, Seoul, Korea
| | - Sung Won Jung
- Department of Internal Medicine, Kyunghee University College of Medicine, Seoul, Korea
| | - Hyun Phil Shin
- Department of Internal Medicine, Kyunghee University College of Medicine, Seoul, Korea
| | - Sung Jik Lim
- Department of Pathology, Kyunghee University College of Medicine, Seoul, Korea
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23
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Garrido E, Marín E, González C, Juzgado D, Boixeda D, Vázquez-Sequeiros E. [Endoscopic mucosal resection of Abrikosoff's tumor of the esophagus]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 31:572-5. [PMID: 19091245 DOI: 10.1157/13128296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abrikosoff's tumor (AT), or granular cell tumor (GCT), is relatively rare in the gastrointestinal tract, where the most common site is the esophagus. This tumor is usually found incidentally when an upper gastrointestinal endoscopy is carried out for another reason. Endoscopically, GCT appears as a small, yellow and submucosal lesion covered by normal mucosa. Endoscopic ultrasonography shows a homogeneous hypoechoic lesion with well defined margins. The definitive diagnosis is histological. The origin of GCT is neurogenic and the tumor is composed of eosinophilic granular cytoplasm and PAS-positive cells, which show the S-100 protein on immunohistochemistry. Although GCT is usually clinically and histologically benign, some malignant cases have been reported. Consensus is lacking on the treatment and follow-up of this tumor. Currently, endoscopic mucosal resection is a safe and effective technique to treat submucosal esophageal lesions, allowing subsequent histologic analysis. We present three patients with esophageal CGT, who were definitively treated with endoscopic mucosal resection.
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Affiliation(s)
- Elena Garrido
- Servicio de Gastroenterología, Hospital Universitario Ramón y Cajal, Madrid, España
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24
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Granular cell tumor of the esophagus: report of five cases and review of the literature. Am J Med Sci 2008; 335:338-41. [PMID: 18480648 DOI: 10.1097/maj.0b013e3181568197] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Granular cell tumor (GCT) is an uncommon esophageal neoplasm. It commonly presents as a nonspecific painless mass. The purpose of this study is to describe our experience with 5 patients newly diagnosed with GCT at VA Medical Center in Memphis, Tennessee from February 2001 to June 2005. Clinical manifestation, endoscopic appearance, histology, different modalities of treatment and prognosis are discussed. Based on this experience, we conclude that GCTs are relatively rare in occurrence. They usually present as a firm to hard submucosal nodule on esophagogastroduodenoscopy. Diagnosis can be made by endoscopic biopsy in most cases. Treatment options include endoscopic surveillance, endoscopic resection, or surgery. The usual course of GCTs is benign.
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25
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Aoufi S, Leo E, García-Agudo R, Crivell C. [Multifocal granular cell esophageal tumour as an incidental endoscopic finding]. Med Clin (Barc) 2008; 130:597. [PMID: 18462641 DOI: 10.1157/13119962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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26
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Abstract
The finding of a mass lesion in the upper gastrointestinal tract at endoscopy with apparent normal overlying mucosa is common. The differential diagnosis of such lesions is broad and includes those of intramural or extramural origin. Endoscopic ultrasound provides accurate imaging of subepithelial mass lesions and characterizes them according to size, echogenicity, and origin including the histologic layer if the lesion is intramural which narrows the differential diagnosis. Endoscopic ultrasound allows a guided tissue sample to be obtained for histologic confirmation which is especially important for hypoechoic lesions arising from the 3rd or 4th echogenic layers. The purpose of this article is to review the diagnosis of the more common subepithelial mass lesions with an emphasis on endoscopic ultrasound and the subsequent management or monitoring.
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Affiliation(s)
- Jeremy L Humphris
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, and University of Sydney, Sydney, New South Wales, Australia
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27
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De Rezende L, Lucendo AJ, Alvarez-Argüelles H. Granular cell tumors of the esophagus: report of five cases and review of diagnostic and therapeutic techniques. Dis Esophagus 2007; 20:436-43. [PMID: 17760659 DOI: 10.1111/j.1442-2050.2007.00692.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Granular cell tumors (GCT) of the esophagus are stromal lesions originating from the Schwann cells of the submucosal neuronal plexus. Although they are very infrequent, they constitute the second largest cause of non-epithelial tumors in the esophagus after leiomyomas. These tumors are generally benign, although a certain number of malignant, aggressive cases have been reported. Diagnosis requires that this possibility be ruled out before deciding on which course of therapeutic action to take as well as familiarization with the relevant indicators. GCT linked synchronically or metachronically to other malignant neoplasias of the esophagus have also been described, but the actual extent of this association is uncertain. This report describes five cases of GCT recently diagnosed as incidental findings following endoscopic exploration. All of these were benign and were treated conservatively. The article discusses new aspects relating to the diagnosis of these lesions and the role carried out by endoscopic ultrasonography in their characterization, both at preliminary diagnosis and monitoring levels. No standard therapeutic guidelines exist for the management of GCT, but endoscopic treatment without invading the muscularis propria layer would be used for symptomatic patients, creating histopathological doubts requiring research on the entire organ. Endoscopic therapeutic techniques are analyzed (resection with forceps or diathermy handles, yttrium-aluminum-garnet laser ablation, alcohol injection) in esophageal GCT, which have overtaken surgery in most cases due to their efficiency, greater safety and fewer complications.
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Affiliation(s)
- L De Rezende
- Department of Gastroenterology, University Hospital of the Canary Islands, Tenerife, Spain
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28
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Núñez Hospital D, Sánchez Muñoz D, Schmidt Baumler A, Pinto Morales W, Ramírez Martín del Campo M, García Romero D, Pérez Pastor A, Guerrero Jiménez P, Grande Santamaría L, Miralles Sanchis EJ, Romero Gómez M. Tumor de células granulares cecal y enfermedad de crohn. GASTROENTEROLOGIA Y HEPATOLOGIA 2007; 30:315-6. [PMID: 17493442 DOI: 10.1157/13101983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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29
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Lowe DL, Chaudhary AJ, Lee JR, Chamberlain SM, Schade RR, Cuartas-Hoyos U. Four cases of patients with gastrointestinal granular cell tumors. South Med J 2007; 100:298-300. [PMID: 17396735 DOI: 10.1097/smj.0b013e318030eeff] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present four cases of gastrointestinal granular cell tumors (GCT) with a literature review. Gastrointestinal granular cell tumors, a benign neural tumor thought to arise from Schwann cells, can occur in several areas, including the gastrointestinal tract. Studies suggest that endoscopic ultrasound and endoscopic removal is the treatment of choice for esophageal GCTs if they are small in size (< 2 cm) and do not involve the muscularis propria. GCTs are malignant less than 2% of the time. Although most GCTs are benign and can be followed endoscopically without resection, the malignant potential warrants evaluation with endoscopic ultrasound for possible endoscopic or surgical resection.
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Affiliation(s)
- Douglas L Lowe
- Department of Internal Medicine, Section of Gastroenterology/Hepatology, Medical College of Georgia 1120 15th Street, BBR2538, Augusta, GA 30912-3120, USA
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30
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Abstract
Granular cell tumor (GCT) was described for the first time by Abrikosoff in 1926. It is a relatively rare neoplasm that may occur at many sites, but most commonly in the skin or soft tissues. The occurrence of GCT in the gastrointestinal tract is rare, accounting approximately for 8% of all tumors, among which the most common site is the esophagus, whereas gastric localization is very rare. Gastric GCTs can be solitary or, more frequently, associated with other gastrointestinal localization. Although GCTs are usually clinically and histologically benign, some malignant cases have been reported. Histologically, these tumors consist of polygonal and fusiform cells disposed in compact “nests” and immunohistochemical staining for S-100 protein supports the proposed derivation from Schwann cells. A correct preoperative diagnosis of this tumor can only be made in 50% of all patients and it is always based on endoscopic biopsy. Laparoscopic or conventional wedge resection represents the treatment of choice. In this study, the authors reported a case of a 49-year-old woman with a solitary granular cell tumor of the stomach with infiltrative pattern, successfully treated with surgical resection. A review of literature is also presented with emphasis on diagnostic criteria concerning the malignant form.
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Affiliation(s)
- Rosalia Patti
- Department of Surgical and Oncological Science, Division of General Surgery, University of Palermo, Italy
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31
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De Ceglie A, Gatteschi B, Blanchi S, Scotto F, Pellecchia A, Conio M. Esophageal granular cell tumor treated by endoscopic mucosal resection. A case report and review of the literature. Dig Dis Sci 2005; 50:1875-9. [PMID: 16187190 DOI: 10.1007/s10620-005-2954-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Accepted: 01/28/2005] [Indexed: 12/17/2022]
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32
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Sohn DK, Choi HS, Chang YS, Huh JM, Kim DH, Kim DY, Kim YH, Chang HJ, Jung KH, Jeong SY. Granular cell tumor of colon: Report of a case and review of literature. World J Gastroenterol 2004; 10:2452-4. [PMID: 15285042 PMCID: PMC4576310 DOI: 10.3748/wjg.v10.i16.2452] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Granular cell tumor (GCT) is uncommon in the colon and rectum. Here we report a case of GCT in the transverse colon. A 48-year-old male patient underwent a screening colonoscopy. A yellowish sessile lesion, about 4 mm in diameter, was found in the transverse colon. An endoscopic snare resection was performed without complication. Histological examination revealed the tumor consisted of plump neoplastic cells with abundant granular eosinophilic cytoplasm containing acidophilic periodic acid Schiff-positive, diastase-resistant granules. Immunohistochemical analysis showed the tumor cells expressed S-100 protein and neuron-specific enolase. Thus, the resected tumor was diagnosed as a GCT. Since GCTs are usually benign, endoscopic resection constitutes an easy and safe treatment. Colonoscopists should consider the possibility of GCT in the differential diagnosis of submucosal tumors of the colon.
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Affiliation(s)
- Dae-Kyung Sohn
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, 809 Madu-dong, Ilsan-gu, Goyang, Gyeonggi 411-769, Korea
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33
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Abstract
Gastrointestinal endoscopy has changed in recent years from a largely diagnostic to a highly therapeutic procedure. Technical advances in endoscopic ultrasound as well as new devices designed for endoscopic mucosal resection (EMR) have opened the field to many therapeutic possibilities. Endoscopic resection is technically challenging, and while our colleagues in the Far East have been using such techniques for over a decade, EMR in the West is still in its infancy. The decision to resect a benign esophageal tumor must take several factors into account including whether the patient is symptomatic; characteristics of the particular tumor (including the potential for malignant transformation, risk of bleeding, and obstruction); and the available therapeutic options. Endoscopic resection of benign esophageal tumors is an attractive option as it is a safe and minimally invasive procedure. Its use is limited, however, to smaller tumors arising from the mucosal or submucosal layers. In this article we examine the techniques used in endoscopic mucosal resection and review the literature on this subject.
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Affiliation(s)
- Timothy Kinney
- Section of Endoscopy and Therapeutics, University of Chicago, Chicago, IL 60637, USA
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34
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Vinco A, Vettoretto N, Cervi E, Villanacci V, Baronchelli C, Giulini SM, Cervi GC. Association of multiple granular cell tumors and squamous carcinoma of the esophagus: case report and review of the literature. Dis Esophagus 2002; 14:262-4. [PMID: 11869335 DOI: 10.1046/j.1442-2050.2001.00198.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This report describes the case of a man who underwent subtotal esophagectomy for the concomitant presence of a multifocal esophageal squamous carcinoma and a granular cell tumor (GCT); he had been previously affected by another metachronous esophageal GCT excised endoscopically. This is the sixth case described in the literature detailing other cases of a combination of malignancies involving additional organs. We emphasize the need for a prolonged surveillance of patients with multiple GCTs in order to promptly recognize the possibility of associated neoplasms.
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Affiliation(s)
- A Vinco
- Hospital of Gardone Val Trompia, Division of General Surgery, Brescia, Italy
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35
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Brandimarte G, Tursi A, Vittori I, Monardo E. Granular cell tumour of the oesophagus: a rare cause of dysphagia with differential diagnosis of oesophageal neoplastic lesions. Dig Liver Dis 2000; 32:803-6. [PMID: 11215563 DOI: 10.1016/s1590-8658(00)80360-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Granular cell tumour is a relatively uncommon, typically benign neoplasm of soft tissue. The macroscopic appearance of oesophageal granular cell tumour is a polypoid lesion, which is often asymptomatic and can be found incidentally, but, in some cases, is symptomatic and requires a correct differential diagnosis with malignant neoplasms of the oesophagus. We describe the case of a 28-year-old female who came to our attention due to a six-month history of heartburn and dysphagia. Oesophagogastroduodenoscopy showed the presence of a polypoid lesion 2 cm above the gastro-oesophageal junction. The overlying mucosa was normal and the lesion seemed to be an isolated submucosal nodule with a "submucosal pill" appearance. It was excised completely using a standard diathermic snare, and diagnosis of oesophageal granular cell tumour was made by histological and immunohistochemical staining. The patient's symptoms disappeared immediately after removal of the nodule by endoscopic polypectomy, and no macroscopic or microscopic recurrence of granular cell tumour was noted during follow-up. Likewise, the patient was symptom-free during follow-up. This case shows that endoscopy is very effective, not only in the diagnosis, but also in the treatment of oesophageal lesions which require careful differential diagnosis.
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Affiliation(s)
- G Brandimarte
- Department of Internal Medicine, Cristo Re Hospital, Rome, Italy
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36
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Fotiadis C, Manolis EN, Troupis TG, Gorgoulis VG, Sechas MN. Endoscopic resection of a large granular cell tumor of the esophagus. J Surg Oncol 2000; 75:277-9. [PMID: 11135273 DOI: 10.1002/1096-9098(200012)75:4<277::aid-jso12>3.0.co;2-p] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- C Fotiadis
- Third Department of Surgery, Medical School, University of Athens, Goudi, Greece
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37
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Rossi GB, de Bellis M, Marone P, De Chiara A, Losito S, Tempesta A. Granular cell tumors of the colon: report of a case and review of the literature. J Clin Gastroenterol 2000; 30:197-9. [PMID: 10730927 DOI: 10.1097/00004836-200003000-00014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Granular cell tumors are uncommon, usually benign tumors that can be located anywhere in the body. They commonly occur in the oral cavity and in subcutaneous tissue. In the gastrointestinal tract, granular cell tumors are uncommon and are quite rare in the colon. To date, 55 patients diagnosed with granular cell tumors of the colon have been reported in the literature, only 15 had multiple tumors. We describe the case of a 38-year-old man with a family history of colon cancer who was diagnosed with multiple colonic granular cell tumors after a screening colonoscopy. This seems to be the first report of this type. However, in our patient, the diagnosis of colonic granular cell tumors was incidental and there is no data that correlates adenomas or colorectal cancer with granular cell tumors of the colon. Finally, since granular cell tumors are usually benign, we suggest a conservative approach to patients with multiple granular cell tumors of the colon by means of endoscopic resection and a strict endoscopic follow-up.
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Affiliation(s)
- G B Rossi
- Endoscopy Unit, National Cancer Institute and G. Pascale Foundation, Naples, Italy
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38
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Córdoba A, Manrique M, Zozaya E, Martinez Peñuela J, Gomez-Dorronsoro M, Querol I. Granular-cell tumor of the esophagus: report of a case with a cytologic diagnosis based on esophageal brushing. Diagn Cytopathol 1998; 19:455-7. [PMID: 9839137 DOI: 10.1002/(sici)1097-0339(199812)19:6<455::aid-dc10>3.0.co;2-s] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report a case of granular-cell tumor (GCT) in the esophagus. This is a rare location for this tumor and only 80 cases have been described. The tumor was diagnosed in a 24-yr-old woman with epigastralgia. Endoscopic examination revealed a submucosal ulcerated lesion. The smears derived from esophageal brushings contained clusters of granular cells. Histologic examination of the endoscopic biopsy provided diagnostic confirmation of GCT. To our knowledge, this is the first reported case of esophageal GCT in which the characteristic tumor cells were seen in the endoscopic brushing material. This case demonstrates that a cytologic diagnosis of GCT is possible if the lesion is ulcerated and/or brushing is subsequent to taking the biopsy. Although rare in the esophagus, GCT should be considered in the differential diagnosis of esophageal neoplasms.
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Affiliation(s)
- A Córdoba
- Service of Pathology, Hospital de Navarra, Pamplona, Spain
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39
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Esaki M, Aoyagi K, Hizawa K, Nakamura S, Hirakawa K, Koga H, Yao T, Fujishima M. Multiple granular cell tumors of the esophagus removed endoscopically: a case report. Gastrointest Endosc 1998; 48:536-9. [PMID: 9831849 DOI: 10.1016/s0016-5107(98)70102-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- M Esaki
- Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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40
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Shikuwa S, Matsunaga K, Osabe M, Ofukuji M, Omagari K, Mizuta Y, Takeshima F, Murase K, Otani H, Ito M, Shimokawa I, Fujii M, Kohno S. Esophageal granular cell tumor treated by endoscopic mucosal resection using a ligating device. Gastrointest Endosc 1998; 47:529-32. [PMID: 9647381 DOI: 10.1016/s0016-5107(98)70257-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- S Shikuwa
- Department of Internal Medicine, Omura Municipal Hospital, Nagasaki, Japan
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41
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Goldblum JR, Rice TW, Zuccaro G, Richter JE. Granular cell tumors of the esophagus: a clinical and pathologic study of 13 cases. Ann Thorac Surg 1996; 62:860-5. [PMID: 8784020 DOI: 10.1016/s0003-4975(96)00443-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Fewer than 200 cases of esophageal granular cell tumors (GCT) have been reported. However, determination of malignant potential and appropriate management are as yet unresolved issues. METHODS We evaluated the clinical and pathologic features of 13 esophageal GCTs. RESULTS This group included 11 women and 2 men. Six patients were black. Patient ages ranged from 27 to 69 years (median, 47 years). Tumors were found incidentally in 10 patients. Only 2 patients were symptomatic. Most tumors were in the distal esophagus and were less than 8 mm. In 5 patients, multiple GCTs were found, including 3 patients with multiple esophageal GCTs. In 11 cases, the tumor was diagnosed by endoscopic biopsy. Ten patients were treated with biopsy alone, without further attempt at tumor excision. No recurrent or metastatic disease developed within the follow-up period. In all but 1 case, tumors were characterized by nests of cells with pyknotic nuclei, abundant granular cytoplasm, an absence of mitotic figures, and strong S-100 protein positivity. One patient who presented with dysphagia had a 2.5-cm distal esophageal GCT that showed atypical histologic features, including cellular spindling, nuclear pleomorphism, and mitoses. Because of this patient's symptoms, the large tumor size, and atypical endoscopic ultrasonographic and histologic features, the lesion was surgically excised. CONCLUSIONS Esophageal GCTs are usually asymptomatic, small, and found incidentally on upper endoscopy done for other reasons. Flexible esophagoscopy and biopsy are the mainstay in diagnosis, and endoscopic ultrasound can provide additional information on the layer of origin and tumor extension. Observation of these tumors is indicated unless the patient is symptomatic or the tumor is greater than 1 cm or has atypical endoscopic ultrasonographic or histologic features.
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Affiliation(s)
- J R Goldblum
- Department of Anatomic Pathology, Cleveland Clinic Foundation, OH 44105, USA
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