Endoscopic resection of colorectal granular cell tumors

Granular cell tumor of the appendix: a case report and literature review

A granular cell tumor (GCT) is an unusual benign soft tissue tumor that can occur at any age and in any part of the body. GCTs are mostly found in the skin and subcutaneous tissues, bronchi, esophagus, breast tissue, and tongue. A GCT originating in the digestive tract, particularly in the appendix, is relatively rare and usually diagnosed as an incidental finding. We herein describe the first case of abdominal distension and occasional pain secondary to a GCT of the appendix in our hospital. The findings from this case suggest that a GCT of the appendix is a rare entity for which surgical resection is an efficient therapy.

Ligation-assisted endoscopic mucosal resection for esophageal granular cell tumors is safe and effective

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.

A Rare Granular Cell Tumor with a Center Ulcer of the Rectum

We report a very rare case of granular cell tumor with a center ulcer of the rectum, which was detected in a 47-year-old man during screening colonoscopy. It is difficult to distinguish granular cell tumor from other subepithelial tumors. However, our case had a center ulcer unlike previous cases. We confirmed the diagnosis using histological and immunohistochemical examinations. In addition to our case report, we discuss the morphology, size, layer of invasion, and treatment of rectal granular cell tumors based on a literature review.

Benign Granular Cell Tumor of the Cecum

Granular cell tumors (GCT) are usually benign, soft tissue tumors that are mostly found in the oral cavity, skin, and subcutaneous tissue. GCTs in the gastrointestinal (GI) tract are mainly located in the esophagus. A 63-year-old male was referred to the gastroenterology clinic for a major complaint of six months of painless rectal bleeding. Laboratory results showed mild macrocytic anemia. He denied any prior colonoscopies and hence, a lower endoscopic procedure was done. The colonoscopy showed multiple polyps, one of them located at the cecum. The cecal polyp showed polygonal cells with abundant eosinophilic infiltration and S100 stain positive. This confirmed a diagnosis of GCT. GCTs are thought to be derived from the neural tissue (Schwann cells). This entity is usually asymptomatic; however, tumors located at the lower GI tract can present with hematochezia. Only 2% of GCTs follow a malignant course, with associated poor prognosis.  This case is being presented because of its asymptomatic nature. It is important to monitor these lesions in order to recognize early signs/symptoms concerning for malignancy.

Granular Cell Tumor: Report of 13 Cases in a Veterans Administration Hospital

INTRODUCTION

Granular cell tumors (GCTs) are of neuroectodermal origin and account for 0.5% of soft tissue tumors. They are most prevalent in African-Americans in the fourth to sixth decades, with a predilection for the head and neck regions. GCTs usually resemble more common lesions and hence are difficult to diagnose preoperatively. The tumor is readily identified on needle biopsy. Although usually benign with a malignancy rate of only 2-3%, the malignant form has a reported 3-yr mortality of 60%.

MATERIALS AND METHODS

Clinical records of the Gulf Coast Veterans Healthcare System were surveyed for the period 1996-2016. Thirteen cases of GCT were found and reviewed for demographics, clinical course, method of diagnosis, management, and outcome.

RESULTS

All patients had a solitary GCT. Eleven lesions were benign and two were atypical. Sites involved were skin (8), colon (2), larynx (1), bronchus (1), and esophagus (1) (see Table I). The two atypical lesions occurred in the skin and larynx. Skin tumors were slow-growing, painful nodules, and, except for the two with preoperative needle biopsies, were misdiagnosed as epidermal inclusion cysts, lipoma, and papillary condyloma. Two colon lesions resembling a sessile polyp and submucosal lipoma, respectively, were found on colonoscopy performed for occult blood in the stool. The bleeding was attributed to adenomatous polyps also present. An atypical laryngeal GCT, found on laryngoscopy for hoarseness, was removed by submucosal resection. A bronchial GCT, excised during bronchoscopy for atelectasis, required re-excision 3 mo later. The esophageal GCT was an incidental finding on EGD for a dilated esophagus and gastric outlet obstruction. The patient declined surgical excision and elected MRI follow-up.

CONCLUSION

Granular cell tumors are infrequent and usually resemble more common lesions. Although almost always benign, the malignant form has a very poor prognosis. It is important to identify GCT preoperatively by fine-needle aspiration or core needle biopsy to improve outcome.

Colonic granular cell tumor: Report of 11 cases and management with review of the literature

Colonic granular cell tumors (GCTs) are rare and benign, but have malignant potential. The recent progress in endoscopic procedures and technology facilitate the diagnosis and treatment of GCTs. The present study described 11 cases of colonic GCTs diagnosed between March 2010 and April 2015, including patient clinical and histopathological features. Patients were generally asymptomatic. The most common symptoms were hematoquezia and abdominal pain. The male/female ratio was 7:4; age range was 40–67 years. Colonoscopy revealed a yellowish or white, solid and well-circumscribed tumor covered by normal mucosa. Endoscopic ultrasonography (EUS) showed a homogenous, or granular-type heterogeneous, hypoechoic solid tumor originating from the submucosal layer (8 cases) or muscularis mucosae (3 cases), with maximum diameters 0.3–3.0 cm. All patients underwent endoscopic submucosal dissection or endoscopic submucosal excavation without complication. All tumors were block removed. The mean operative time was 38 min (range, 31–50 min). Immunohistochemical analysis of all specimens confirmed the diagnosis of GCT by positive staining of S-100 protein. No recurrence or metastasis was observed during follow-up periods of 11 months to 5 years. In conclusion, colonoscopy, EUS and immunohistological examination increase the accuracy of diagnosis of GCTs. Endoscopic management is feasible and safe for GCT treatment.

Efficacy and safety of endoscopic submucosal dissection for submucosal tumors of the colon and rectum

BACKGROUND AND AIMS

Endoscopic submucosal dissection (ESD) of colorectal submucosal tumors (SMTs) is becoming increasingly common; however, there have been few large consecutive studies analyzing its therapeutic efficacy and safety. The aim of this study was to evaluate the efficacy, safety, and long-term outcomes of ESD for colorectal SMTs.

METHODS

This retrospective study included 412 consecutive patients with colorectal SMTs who underwent ESD at the Zhongshan Hospital of Fudan University from January 2008 to July 2014. Tumor histopathology, completeness of resection, adverse events, tumor recurrence, and distant metastasis were analyzed.

RESULTS

Complete resection was achieved for 358 lesions (86.9%). Thirteen patients had serious adverse events (3.2%) including bleeding and perforation, and 28 patients (6.8%) had post-ESD electrocoagulation syndrome (PEECS). Because more ESDs for colorectal SMTs were performed by endoscopists, the rate of complete resection increased (78.5% vs 88.5%), and the rate of serious adverse events decreased (9.2% vs 2.0%). SMTs in the colon increased the risk of incomplete resection (19.6% vs 11.3%), serious adverse events (8.7% vs 1.6%), and PEECS (16.3% vs 4.1%). SMTs originating from the muscularis propria and sized ≥20 mm increased the rate of PEECS (22.7% vs 5.9% and 31.3% vs 5.8%, respectively).

CONCLUSION

ESD is effective for resection of colorectal SMTs and rarely causes serious adverse events. Tumor location and the experience of endoscopists influence the complete resection rate and the development of serious adverse events. ESD is feasible for large tumors and tumors in the muscularis propria, but this is associated with relatively high risks of adverse events.

Simultaneous endoscopic full-thickness resection of two synchronous colonic granular cell tumours

Granular cell tumours (GCTs) are rare soft tissue tumours originating from Schwann cells. Due to potential malignant transformation, complete endoscopic resection should be aimed for. We report on a 49-year-old patient with two synchronous GCTs found in the caecum and the ascending colon, respectively. Synchronous endoscopic full-thickness resection (EFTR) using an all-in-one full-thickness resection device (FTRD) was performed under propofol sedation. Completeness of resection was proven histologically. No adverse events occurred. We report safe and complete simultaneous EFTR of two synchronous colonic GCTs.

Comparative evaluation of colonoscopy-assisted transanal minimally invasive surgery via glove port and endoscopic submucosal dissection for early rectal tumor

BACKGROUND

Early rectal tumor is usually managed by local excision. A novel method-colonoscopy-assisted transanal minimally invasive surgery via glove port (CA-TAMIS-GP)-for resecting early rectal tumor was developed and compared with endoscopic submucosal dissection (ESD).

MATERIALS AND METHODS

We performed CA-TAMIS-GP surgery on 26 patients from January 2014 to February 2016. For better analysis, we retrospectively collected data from 31 patients who underwent ESD between October 2012 and December 2013; overall, 57 patients diagnosed with early rectal tumor were included in this study. Perioperative conditions and long-term outcomes of both groups were compared.

RESULTS

All lesions were dissected completely and successfully without conversion to open surgery or major complications. On histopathologic examination, all specimens in this study had negative margins. All patients had uneventful postoperative recoveries, except 3 patients of CA-TAMIS-GP with minor hematochezia, which resolved spontaneously; 7 ESD patients had late-onset bleeding and 3 needed colonoscopic hemostasis; 2 patients in each group had mild fever. The CA-TAMIS-GP group had a shorter operation time, less hemorrhage, and a lower average consumable cost than the ESD group (P < 0.05); moreover, the CA-TAMIS-GP group had no recurrence or long-term complications during a follow-up of 10-32 months, whereas3 patients in the ESD group developed local recurrence during a follow-up of 24-36 months.

CONCLUSIONS

The CA-TAMIS-GP is a new method that is safe and effective in patients with early rectal tumor and appears to have a shorter operation time and less blood loss as compared with ESD.