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Iwamuro M, Tanaka T, Kanzaki H, Kawano S, Kawahara Y, Okada H. Esophageal Granular Cell Tumors Can Be Differentiated from Leiomyomas Using Endoscopic Ultrasonography. Intern Med 2018; 57:1509-1515. [PMID: 29321437 PMCID: PMC6028673 DOI: 10.2169/internalmedicine.9816-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Although esophageal granular cell tumors have been reported to present as hypoechoic tumors, we noticed that their echogenicity is similar to that of the submucosal layer. We investigated the sonographic features of esophageal granular cell tumors and the diagnostic accuracy of the features. Methods Seven patients with esophageal granular cell tumors who underwent endoscopic ultrasonography were retrospectively reviewed. Thirteen patients with esophageal leiomyoma were selected as historical control subjects. The brightness of the tumor on ultrasonography images was measured and the echogenicity was standardized according to the echogenicity of the proper muscle and submucosal layers. Ten board-certified endoscopists then independently evaluated the endoscopic pictures of the 20 patients (Test 1), as well as the endoscopic ultrasonography images together with endoscopic pictures of the same patient set (Test 2). Results The standardized echogenicity in granular cell tumors was significantly higher than that in leiomyomas. The diagnostic accuracy of the 10 evaluators using endoscopic pictures alone (Test 1) was 72.0%. The addition of endoscopic ultrasonography images (Test 2) significantly improved the accuracy to 93.0%. Conclusion The echogenicity of granular cell tumors was similar to that of the submucosal layer, and it was significantly higher than that of leiomyomas. Endoscopic ultrasonography images facilitate the accurate identification of esophageal granular cell tumors.
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Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | | | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Seiji Kawano
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | | | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
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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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Lu W, Xu MD, Zhou PH, Zhang YQ, Chen WF, Zhong YS, Yao LQ. Endoscopic submucosal dissection of esophageal granular cell tumor. World J Surg Oncol 2014; 12:221. [PMID: 25030028 PMCID: PMC4126351 DOI: 10.1186/1477-7819-12-221] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 07/04/2014] [Indexed: 12/12/2022] Open
Abstract
Background Esophageal granular cell tumor (GCT) is a rare benign tumor with malignant potential. With wide application of endoscopic techniques, the esophageal GCT discovery rate and treatment strategy has changed. This study was to preliminarily evaluate outcomes of endoscopic diagnosis and treatment for esophageal GCT. Methods Fourteen patients (eight men, six women; median age, 48.5 years) with esophageal GCT diagnosed and treated by esophageal endoscopy. Esophagoscopy, endoscopic ultrasound (EUS), and endoscopic submucosal dissection (ESD) techniques were employed in diagnosis and resection. Results Esophageal GCTs are tumors which arise from the submucosal layer, and vary in color but with a yellowish color on endoscopy being most common. On EUS, features were homogenous (ten cases) or mildly heterogeneous (four cases) hypoechoic solid pattern originating from the muscularis mucosa (six cases) or submucosal layer (eight cases) of the esophageal wall. Tumors ranged from 4 to 26 mm (mean 12.1 mm). ESD was performed in all patients without complication. Clinical diagnosis was confirmed by pathology and immunohistochemical examination (positive for S-100 and vimentin). The en bloc resection rate was 92.9% (13/14) pathologically. Operation time was 25 to 60 minutes, mean 38.2 ± 10.1 minutes. No recurrence was observed during a mean follow-up of 16.6 ± 12.7 (range, 4 to 40) months. Conclusions Esophagoscopy and EUS increased the esophageal GCT discovery rate, and its features were summarized. Minimally invasive ESD is feasible and safe for excisional biopsy, providing pathological diagnosis and treatment.
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Affiliation(s)
| | - Mei-Dong Xu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai 200032, PR China.
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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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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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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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Marolleau F, Baert F, Mertens V, Ghillebert G. Abrikossoff cell tumor of the oesophagus: a case report and review of the literature. Acta Clin Belg 2008; 63:273-6. [PMID: 19048707 DOI: 10.1179/acb.2008.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abrikossoff tumours or granular cell tumours are rare and usually benign tumours. The oesophagus is a rare location (0.001% of all tumours). The macroscopic appearance is typical (yellow, firm, well circumscribed submucosal neoplasm-like with reduced vascular patterns) but due to the rarity of this lesion, it can be mistaken with other similar lesions. This is the report of a case of a 47-year-old female with a granular cell tumour of the distal oesophagus. In this case, the Abrikossoff tumour is clinically, radiologically en histologically benign. According to the fact that there is low evidence in the literature for removing such Lesions in patient without symptoms, it was decided to be conservative. In this paper we discuss the case with review of the Literature with emphasis on the diagnosis, evaluation and management.
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Affiliation(s)
- F Marolleau
- Departement of Gastroenterology, Heilig Hart Ziekenhuis, Roeselare, Belgium.
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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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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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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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Hamada H, Shikuwa S, Wen CY, Isomoto H, Nakao K, Miyashita K, Daikoku M, Yano K, Ito M, Mizuta Y, Chen LD, Xu ZM, Murata I, Kohno S. Pedunculated rectal carcinoid removed by endoscopic mucosal resection: a case report. World J Gastroenterol 2003; 9:2870-2. [PMID: 14669356 PMCID: PMC4612075 DOI: 10.3748/wjg.v9.i12.2870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2003] [Revised: 09/10/2003] [Accepted: 10/23/2003] [Indexed: 02/06/2023] Open
Abstract
Carcinoid tumors generally appear as yellow/gray or tan submucosal nodules. We experienced a case of pedunculated rectal carcinoid showing a mushroom-like appearance. The case was a forty years old woman who was admitted to our hospital due to rectal bleeding. Colonoscopy revealed a pedunculated polyp presenting a mushroom-shaped appearance measuring 13 mm in diameter in the rectum. The histological diagnosis of specimens obtained by biopsy was adenocarcinoma and transanal ultrasonography revealed the tumor localization within the submucosal layer in the rectum. Endoscopic mucosal resection (EMR) was performed. Histopathological examination established the diagnosis of carcinoid tumor in the rectum. Frequencies of the pedunculated type in rectal carcinoids were reported to be 2.4% to 7.1% in the literature. Because of its rarity, pedunculated configuration may confuse the endoscopic diagnosis of carcinoids. Treatment for carcinoids of 1 to 1.5 cm in size remains controversial. Although such tumors are technically respectable by EMR, careful attention must be paid in dealing with these tumors because there may be unexpected behaviors of the tumors.
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Affiliation(s)
- Hisayuki Hamada
- Institute for Clinical Research Center, WHO Collaborating Center for Reference and Research on Viral Hepatitis, National Nagasaki Medical Center, Japan
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Affiliation(s)
- Roy M Soetikno
- Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, California, USA
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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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Abstract
Recent advances in endoscopic mucosal resection of superficial early digestive tract cancers are truly remarkable. The extraordinary long-term outcomes of patients who have been treated with endoscopic mucosal resection have encouraged the widespread practice of endoscopic mucosal resection in Japan. These minimally invasive techniques allow safe and effective treatment of diseases that would otherwise require major surgery. This article provides an overview of endoscopic mucosal resection techniques, their associated outcomes, and other potential applications of endoscopic mucosal resection.
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Affiliation(s)
- R M Soetikno
- Gastroenterology Section, Veterans Affairs Palo Alto Health Care System, California, USA.
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