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Li H, Zhang M, Zheng Y, Zhang H. Gastric granular cell tumor: A case report and literature review. Oncol Lett 2024; 28:403. [PMID: 38983126 PMCID: PMC11228929 DOI: 10.3892/ol.2024.14536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 06/11/2024] [Indexed: 07/11/2024] Open
Abstract
Granular cell tumors (GCTs) are neoplasms of uncertain histopathological etiology and therefore there are no universally accepted treatment strategies. GCTs are characterized by abundant eosinophilic granules. Since they are predominantly located in the skin and subcutaneous tissues, gastric GCTs are exceedingly rare. The present study documents the case of a 52-year-old man who visited the Gastroenterology Clinic of the People's Hospital of Putuo District (Zhoushan, China) due to upper abdominal fullness. Endoscopic ultrasonography revealed a well-defined hypoechoic nodule in the submucosal layer of the stomach body. The lesion was completely excised using endoscopic submucosal dissection and the patient made a full postoperative recovery. Immunohistochemistry showed positivity for S100 and CD68, with CD34 expression surrounding the tumor cells. At telephone follow-up until May 2024, the patient's fullness and discomfort were noted to be relieved. The characteristics of the CD34 expression pattern may serve as a novel basis for the pathological diagnosis of gastric GCTs. Endoscopic resection is a feasible option for gastric GCTs smaller than 2 cm.
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Affiliation(s)
- Huixi Li
- Department of Pathology, People's Hospital of Putuo District, Zhoushan, Zhejiang 316000, P.R. China
| | - Miao Zhang
- Department of Pathology, People's Hospital of Putuo District, Zhoushan, Zhejiang 316000, P.R. China
| | - Youyou Zheng
- Department of Gastroenterology, People's Hospital of Putuo District, Zhoushan, Zhejiang 316000, P.R. China
| | - Hong Zhang
- Department of Obstetrics and Gynecology, People's Hospital of Putuo District, Zhoushan, Zhejiang 316000, P.R. China
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Templeton E, Eliachevsky C, Nanda AK. Granular cell tumor presenting with perforation of fourth part of the duodenum: A case report. Int J Surg Case Rep 2021; 86:106336. [PMID: 34454210 PMCID: PMC8397910 DOI: 10.1016/j.ijscr.2021.106336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/13/2021] [Accepted: 08/21/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Granular cell tumors (GCT) are relatively rare neoplasms most commonly occurring in skin or soft tissues. GCT are thought to be of Schwann cell origin and strongly positive for s100 protein. GCT of the intestinal tract are usually asymptomatic and found incidentally in the esophagus on endoscopy. CASE PRESENTATION Here, we present a case of GCT jejunum and the fourth part of the duodenum. The patient is a 41-year-old female who presented with abdominal pain and was subsequently found to have pneumoperitoneum with a perforation of the fourth part of the duodenum. Intraoperatively, there were multiple enlarged and hard mesenteric lymph nodes, which were found to be due to GCT involving the fourth duodenum and proximal jejunum. CLINICAL DISCUSSION The occurrence of GCT in the gastrointestinal (GI) tract are even less common accounting for 5-9% of all GCT with very few cases reported in the duodenum. GCT of the GI tract are often asymptomatic, consequently leading to misdiagnosed delays in treatment. CONCLUSION In the setting of GCT in the fourth part of the duodenum with evidence of locally advanced disease, local resection is the preferred treatment.
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Affiliation(s)
- Erin Templeton
- St. George's University School of Medicine, Humboldt Park Health, 1044 N Francisco Avenue, Chicago, IL 60622, USA.
| | - Christina Eliachevsky
- St. George's University School of Medicine, Humboldt Park Health, 1044 N Francisco Avenue, Chicago, IL 60622, USA.
| | - Atul K Nanda
- Humboldt Park Health, 1044 N Francisco Avenue, Chicago, IL 60622, USA.
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3
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Tiwary AK, Shah H, Madke B, Kumar P. A Compendium of Specific Histopathological Bodies in Dermatology. Indian J Dermatol 2021; 66:179-186. [PMID: 34188275 PMCID: PMC8208273 DOI: 10.4103/ijd.ijd_629_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The spectrum of histopathological variations of most of the Dermatological conditions is so wide and overlapping that even with our current vast knowledge of this discipline, it seems to be a tough task for clinicians as well as Dermatopathologists to arrive at a conclusive diagnosis in many cases. However, with the aid of special stains and advanced diagnostic techniques, some characteristic histopathologic features have been defined over the time, among which histopathological bodies or inclusion bodies serve as specific clues. With this perspective in view, an attempt has been made to collate and describe the well-known as well as the lesser-known histopathological bodies seen in various dermatological diseases. The underlying pathogenesis and ultramicroscopic features of these structures have also been outlined in brief.
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Affiliation(s)
- Anup Kumar Tiwary
- Consultant Dermatologist, Globax Healthcare Polyclinic, Noida, Uttar Pradesh, India
| | - Hiral Shah
- Department of Skin and Venereal Diseases, Baroda Medical College, Vadodara, Gujarat, India
| | - Bhushan Madke
- Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College and AVBR Hospital, Wardha, Maharashtra, India
| | - Piyush Kumar
- Department of Dermatology, Katihar Medical College, Katihar, Bihar, India
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Abstract
A 56-year-old man presented to the emergency department with painless jaundice and weight loss. Abdominal ultrasound detected dilation of the common bile duct and the intrahepatic bile ducts. Follow-up with endoscopic retrograde cholangiography exposed a stricture of the common hepatic duct, with cholangioscopy identifying an infiltrating tumor. Biopsy revealed a granular cell tumor, which was confirmed by positive S-100 immunohistochemical staining. Surgical excision confirmed granular cell tumor of the bile duct with morphological features suggestive of malignancy.
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5
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Evaluation and Management of Premalignant Conditions of the Esophagus: A Systematic Survey of International Guidelines. J Clin Gastroenterol 2019; 53:627-634. [PMID: 31403982 DOI: 10.1097/mcg.0000000000001247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Esophageal cancer represents one of the most lethal forms of malignancy. The growing incidence of esophageal adenocarcinoma represents an emerging public health concern. This review article summarizes current diagnostic, management, and therapeutic practices of premalignant conditions of the esophagus including Barrett's esophagus, tylosis, granular cell tumors, achalasia, and the ingestion of caustic substances. Our report provides clinicians and academics with a global clinical perspective regarding presentation, surveillance guidelines, and therapeutic management of these esophageal conditions.
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6
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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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7
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Ofori E, Ramai D, Lui YX, Reddy M. Esophageal Granular Cell Tumor: A Case and Review of the Literature. Gastroenterology Res 2018; 10:372-375. [PMID: 29317947 PMCID: PMC5755641 DOI: 10.14740/gr898w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 09/28/2017] [Indexed: 01/15/2023] Open
Abstract
Granular cell tumors (GCTs) are rare and benign tumors that can occur at any anatomical site. GCTs are thought to originate from nerve cells, particularly Schwann cells. Their name derives from the fact that an accumulation of cytoplasmic lysosomes imparts the tumor with a granular appearance. They are most commonly observed in the oral cavity, skin and subcutaneous tissue, breast, and respiratory tract. GCTs rarely affect the gastrointestinal tract. We report a 56-year-old female with a medical history of human immunodeficiency virus, hepatitis C, and cholelithiasis, who presented with abdominal pain. Upper endoscopy revealed a 1 - 2 cm solitary yellowish appearing nodule just distal to the GE junction. Biopsy of the nodule followed by histopathology was positive for S100, but negative for pancytokeratin immunostains. PAS staining highlighted cytoplasmic granules, further supporting the diagnosis of gastrointestinal GCT.
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Affiliation(s)
- Emmanuel Ofori
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, 121 DeKalb Avenue, Brooklyn, NY 11201, USA
| | - Daryl Ramai
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, 121 DeKalb Avenue, Brooklyn, NY 11201, USA.,Department of Anatomical Sciences, St. George's University School of Medicine, True Blue, Grenada, WI
| | - Ying X Lui
- Department of Pathology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, 121 DeKalb Avenue, Brooklyn, NY 11201, USA
| | - Madhavi Reddy
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, 121 DeKalb Avenue, Brooklyn, NY 11201, USA
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8
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Tumor de células granulares del esófago: reporte de un caso. REPERTORIO DE MEDICINA Y CIRUGÍA 2017. [DOI: 10.1016/j.reper.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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9
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Granular cell tumor of the esophagus with elevated preoperative serum carbohydrate antigen 19-9: a case report. Int Surg 2016; 100:365-9. [PMID: 25692443 DOI: 10.9738/intsurg-d-13-00195.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 59-year-old Japanese man was admitted to our hospital for treatment of a submucosal tumor of the esophagus detected by upper gastrointestinal endoscopy and computed tomography (CT). Endoscopic examination revealed a submucosal tumor in the esophagus 35 cm from the incisor teeth. Biopsy of the lesions identified granular cell tumor. CT indicated a projecting and slightly enhanced homogenous mass measuring 2.0 × 1.5 cm in the esophagus below the tracheal bifurcation. Serum tumor marker studies revealed elevated carbohydrate antigen (CA) 19-9. Therefore, the tumor was considered to have malignant potential, and surgical resection was performed. The final pathologic diagnosis was a benign granular cell tumor, positive for S-100 protein. The patient was doing well with normal CA 19-9 levels and no recurrence more than 5 years after surgery. To the best of our knowledge, this is the first report of a granular cell tumor with elevated serum CA 19-9.
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10
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An S, Jang J, Min K, Kim MS, Park H, Park YS, Kim J, Lee JH, Song HJ, Kim KJ, Yu E, Hong SM. Granular cell tumor of the gastrointestinal tract: histologic and immunohistochemical analysis of 98 cases. Hum Pathol 2015; 46:813-9. [PMID: 25882927 DOI: 10.1016/j.humpath.2015.02.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/11/2015] [Accepted: 02/13/2015] [Indexed: 12/24/2022]
Abstract
Granular cell tumors (GCTs) are uncommon benign neoplasms in the gastrointestinal (GI) tract, and our current understanding of GCT in GI tract is limited. A total of 98 GCTs were retrieved from 95 patients, and the clinicopathological and immunohistochemical features were compared. The male-to-female ratio was 2.2:1 and with a mean age of 49 years. The mean tumor size was 0.37 cm. Seventy-three esophageal (75%), 21 colorectal (21%), and 4 gastric (4%) GCTs were included. Gastric (mean, 0.75 cm) and colorectal (0.6 cm) GCTs were significantly larger than esophageal tumors (0.27 cm; P<.001). Colonic and gastric GCTs showed a more infiltrative growth pattern (P<.001) and peritumoral lymphoid cuffs (P<.001) than esophageal tumors. Involvement of mucosa, submucosa, and both were noted in 58 cases (59%), 11 cases (11%), and 28 cases (29%), respectively. One GCT from the sigmoid colon (1%) had infiltration to pericolic soft tissue and with lymph node metastasis. High frequency of immunolabeling for S-100 protein (81/81, 100%), CD56 (55/58, 95%), CD68 (58/61, 95%), SOX-10 (54/58, 93%), and inhibin-α (30/58, 52%) were observed. In summary, GCTs in the GI tract were observed with the following frequency: esophagus, colorectum, and stomach. Colorectal and gastric GCTs were larger and had infiltrative growth and more lymphoid cuffs than esophageal GCTs. Although invasive GCT was rare, it could be observed in the GI tract. Inhibin-α expression were more common in colonic GCTs than esophageal tumors. High S-100 protein, CD56, CD68, and SOX-10 expression rates were observed in GCTs from GI tracts.
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Affiliation(s)
- Soyeon An
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea
| | - Jaejung Jang
- Department of Pathology, Anyang Sam Hospital, Anyang, 430-733, Republic of Korea
| | - Kwangseon Min
- Department of Pathology, Anyang Sam Hospital, Anyang, 430-733, Republic of Korea
| | - Min-Sun Kim
- Asan Institute for Life Science, Asan Medical Center, Seoul, 138-736, Republic of Korea
| | - Hosub Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea
| | - Young Soo Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea
| | - Jihun Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea
| | - Jeong Hoon Lee
- Department of Pathology, Anyang Sam Hospital, Anyang, 430-733, Republic of Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea
| | - Kyung-Jo Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea
| | - Eunsil Yu
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea.
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11
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Multifocal Synchronous Granular Cell Tumors of the Gastrointestinal Tract. ACG Case Rep J 2014; 1:193-5. [PMID: 26157873 PMCID: PMC4435316 DOI: 10.14309/crj.2014.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 06/10/2014] [Indexed: 11/17/2022] Open
Abstract
Granular cell tumors (GCT) are rare and unusual tumors, which are usually benign and asymptomatic. Only 5-10% of cases involve the gastrointestinal tract, most commonly as singular, non-cancerous lesions in the esophagus. We report a rare case of symptomatic, multifocal, synchronous GCT involving the esophagus, stomach, and cecum.
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12
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Lewis RB, Mehrotra AK, Rodriguez P, Levine MS. From the radiologic pathology archives: esophageal neoplasms: radiologic-pathologic correlation. Radiographics 2014; 33:1083-108. [PMID: 23842973 DOI: 10.1148/rg.334135027] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Esophageal neoplasms have a wide spectrum of clinical features, pathologic findings, and imaging manifestations. Leiomyomas are the most common benign esophageal neoplasm, typically appearing as smoothly marginated intramural masses. Fibrovascular polyps arise in the cervical esophagus, gradually elongating as they are pulled inferiorly by esophageal peristalsis. Granular cell tumors are generally incidental small intramural masses with an appearance similar to that of leiomyomas. Malignant esophageal neoplasms are a common cause of cancer mortality, particularly squamous cell carcinoma (SCC) and adenocarcinoma. Both of these tumors occur in older men, most often appearing as irregular infiltrative lesions at barium examination, with evidence of tumor spread beyond the esophagus at cross-sectional imaging. Adenocarcinoma arises from Barrett esophagus and is much more likely than SCC to involve the gastroesophageal junction. Esophageal involvement by lymphoma is usually secondary to tumor spread from the stomach or mediastinum. Spindle cell carcinoma is a biphasic malignancy with carcinomatous and sarcomatous elements that forms a bulky polypoid intraluminal mass. Neuroendocrine carcinoma is an aggressive neoplasm that may be hypervascular and is usually associated with metastatic disease at presentation. Understanding the imaging appearances and pathologic bases of esophageal neoplasms is essential for their detection, differential diagnosis, staging, and treatment planning.
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Affiliation(s)
- Rachel B Lewis
- American Institute for Radiologic Pathology, 1010 Wayne Ave, Suite 320, Silver Spring, MD 20910, USA.
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Cambruzzi E, Pruinelli R, Milani DM, Cruz RP, Cunha O, Clivatti N. Tumor esofágico de células granulares associado à carcinoma epidermoide: relato de caso. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2013; 26:156-8. [DOI: 10.1590/s0102-67202013000200020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Huang AT, Dominguez LM, Powers CN, Reiter ER. Granular cell tumor of the cervical esophagus: case report and literature review of an unusual cause of Dysphagia. Head Neck Pathol 2012; 7:274-9. [PMID: 23143390 PMCID: PMC3738753 DOI: 10.1007/s12105-012-0408-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 11/04/2012] [Indexed: 10/27/2022]
Abstract
Granular cell tumors (GCT) of the head and neck are not uncommon; however, involvement of the cervical esophagus is rare. Characterized by an infiltrative growth pattern, these benign tumors are historically difficult to surgically excise and are radioresistant. We present here a case of dysphagia caused by a GCT of the cervical esophagus. Work up with ultrasound-guided fine needle aspiration was suggestive of a GCT due to the presence of cohesive cells with granular cytoplasm that were S-100 and CD68 positive with immunostaining, and PAS positive with histochemistry. Resection required removal of a portion of the muscular wall of the esophagus sparing the overlying mucosa. The patient is currently asymptomatic and without recurrence after 10 month follow-up. Review of the literature revealed 19 reports of cervical esophageal GCTs. There is a female preponderance (75%), with an average age of 41 years. Dysphagia and weight loss are the most common presenting symptoms. The average tumor size on presentation was 2.7 cm, with symptomatic tumors being significantly larger than asymptomatic lesions; the latter was present in 25% of patients. Concurrent GCTs in the upper aerodigestive tract were identified in 35% of cases. Approximately 30% of tumors required segmental cervical esophageal resection. The purpose of this report is to describe the epidemiology and treatment of GCTs of the cervical esophagus. Lesions should be addressed early with complete surgical excision to prevent growth necessitating more morbid surgery. Due to the high rate of concurrent GCTs, upper endoscopy is advised in the workup of these patients.
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Affiliation(s)
- Andrew T. Huang
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, Box 980146, Richmond, VA 23298 USA
| | - Laura M. Dominguez
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, Box 980146, Richmond, VA 23298 USA
| | - Celeste N. Powers
- Department of Pathology, Virginia Commonwealth University, Richmond, VA USA
| | - Evan R. Reiter
- Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University, Box 980146, Richmond, VA 23298 USA
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Abstract
Granular cell tumors are peripheral neuroectodermal tumors. Within the gastrointestinal tract, they have to be differentiated from gastrointestinal stromal tumors (GIST). We present the case of a 61-year-old patient who was diagnosed with a granular cell tumor of the stomach. The tumor cells showed transmural infiltration form the mucosa into the adipose tissue of the lesser curvature. The tumor cells were diffusely positive for S100-protein and negative for KIT, CD34 und SMA. The MIB1-proliferation index was below 2%. Granular cell tumors rarely occur within the gastrointestinal tract. Oesophagus and colon are most commonly affected. Diagnostic criteria and differential diagnosis of this peculiar lesion are thoroughly discussed.
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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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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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18
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Veit AC, Painter JT, Miller RA, Hardisty JF, Dixon D. Characterization of uterine granular cell tumors in B6C3F1 mice: a histomorphologic, immunohistochemical, and ultrastructural study. Vet Pathol 2008; 45:654-62. [PMID: 18725470 DOI: 10.1354/vp.45-5-654] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The granular cell tumor is most often a benign neoplasm of uncertain origin. Four uterine granular cell tumors in control and treated female B6C3F1 mice were identified in chronic studies at the National Toxicology Program. Two tumors occurred in untreated control animals and 2 in treated animals receiving different compounds. Tissue sections were evaluated histologically and stained with hematoxylin and eosin, periodic acid-Schiff with diastase resistance, Masson's trichrome, toluidine blue, phosphotungstic acid-hematoxylin, and stained immunohistochemically with a panel of antibodies to muscle (desmin, alpha smooth muscle actin), neural (S-100, neuron specific enolase), epithelial (wide-spectrum cytokeratin), and macrophage (F4/80) markers. The main histomorphologic feature of tumor cells was the presence of abundant cytoplasmic eosinophilic granules that stained positive for periodic acid-Schiff with diastase resistance. Tumors varied in appearance and were comprised of sheets and nests of round to polygonal cells with distinct borders. Nuclei were hyperchromatic, pleomorphic, and centrally to eccentrically located and often contained single nucleoli. Occasional multinucleated giant cells were observed. Tumors were pale pink and homogeneous with trichrome stain and negative with toluidine blue. Three tumors had positive to weakly positive immunoreactivity for desmin, and 1 was positive for alpha smooth muscle actin. Expression of S-100, wide-spectrum cytokeratin, and neuron-specific enolase was negative for all tumors. Ultrastructurally, prominent electron-dense cytoplasmic granules were abundant and contained secondary lysosomes with heterogeneous lysosomal contents. The characteristics of these uterine granular cell tumors were suggestive of a myogenic origin.
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Affiliation(s)
- A C Veit
- Cellular and Molecular Pathology Branch, National Institute of Environmental Health Sciences, PO Box 12233, MD C2-09, 111 T.W. Alexander Drive, Bldg. 101, Research Triangle Park, NC 27709 (USA)
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19
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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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20
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Mitomi H, Matsumoto Y, Mori A, Arai N, Ishii K, Tanabe S, Kobayashi K, Sada M, Mieno H. Multifocal granular cell tumors of the gastrointestinal tract: Immunohistochemical findings compared with those of solitary tumors. Pathol Int 2008; 54:47-51. [PMID: 14674995 DOI: 10.1111/j.1440-1827.2004.01579.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Granular cell tumors (GCT) are infrequently found in the gastrointestinal tract (GIT), and only four previous reports have described lesions occurring simultaneously in different sites. The present case of 11 GCT, located in the esophagus, stomach, colon and pericolic adipose tissue, occurred in a 50-year-old Japanese woman. All GCT appeared histologically benign and there was no sign of recurrence at 3 years after surgery. Immunohistochemical analysis and comparison between this case of multifocal GCT and six cases of solitary benign GCT of the GIT, which were taken from the files of the Department of Pathology at Kitasato University (1986-2000), demonstrated the follow-ing: (1) all diffusely expressed S-100, DCC and bcl-2, and (2) median labeling indices for Ki-67, cyclin D1, p53 (Pab1801), and p21WAF1/CIP1 of 4%, 24%, 1% and 28%, respectively, for the multifocal tumors, and 3.5%, 23%, 1% and 29%, respectively, for the solitary lesions, with no significant difference between the two groups. Thus, the expression of cyclin D1 and p21WAF1/CIP1 may be involved in the tumorigenesis of both types of GCT. The present case emphasizes the need to evaluate the entire GIT when a single GCT is identified. Multifocal lesions should be treated conservatively by local excision because, as with the solitary tumors, they exhibit a benign biological behavior, consistent with their low Ki-67 immunoreactivity.
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Affiliation(s)
- Hiroyuki Mitomi
- Department of Clinical Research Laboratory (Pathology), National Sagamihara Hospital, Sagamihara, Japan.
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21
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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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22
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Finck C, Moront M, Newton C, Timmapuri S, Lyons J, Rozans M, de Chadarevian JP, Halligan G. Pediatric granular cell tumor of the tracheobronchial tree. J Pediatr Surg 2008; 43:568-70. [PMID: 18358305 DOI: 10.1016/j.jpedsurg.2007.11.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 11/05/2007] [Accepted: 11/08/2007] [Indexed: 11/25/2022]
Affiliation(s)
- Christine Finck
- Connecticut Children's Medical Center, Hartford, CT 06106, USA
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23
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Benign Esophageal Tumors. POLISH JOURNAL OF SURGERY 2008. [DOI: 10.2478/v10035-007-0127-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ponsaing LG, Kiss K, Loft A, Jensen LI, Hansen MB. Diagnostic procedures for submucosal tumors in the gastrointestinal tract. World J Gastroenterol 2007; 13:3301-10. [PMID: 17659668 PMCID: PMC4172709 DOI: 10.3748/wjg.v13.i24.3301] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This review is part one of three, which will present an update on diagnostic procedures for gastrointestinal (GI) submucosal tumors (SMTs). Part two identifies the classification and part three the therapeutic methods regarding GI SMTs. Submucosal tumors are typically asymptomatic and therefore encountered incidentally. Advances in diagnostic tools for gastrointestinal submucosal tumors have emerged over the past decade. The aim of this paper is to provide the readers with guidelines for the use of diagnostic procedures, when a submucosal tumor is suspected. Literature searches were performed to find information on diagnostics for gastrointestinal submucosal tumors. Based on the searches, the optimal diagnostic procedures and specific features of the submucosal tumors could be outlined. Standard endoscppy, capsule endoscopy and push-and-pull enteroscopy (PPE) together with barium contrast X-ray do not alone provide sufficient information, when examining submucosal tumors. Endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance imaging (MRI) and fluorodeoxyglucose-labeled positron emission tomography (FDG-PET) are recommended as supplementary tools.
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Affiliation(s)
- Laura-Graves Ponsaing
- Department of Surgical Gastroenterology K, Bispebjerg University Hospital of Copenhagen, Bispebjerg Bakke 23, 2400 NV Copenhagen, Denmark.
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25
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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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26
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Marin VP, Yu P, Weber RS. Isolated cervical esophageal reconstruction for rare esophageal tumors. Head Neck 2006; 28:856-60. [PMID: 16835909 DOI: 10.1002/hed.20442] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Isolated defects in the cervical esophagus in patients who have not undergone total laryngectomy are uncommon. We report 2 cases of rare esophageal tumors requiring reconstruction of the cervical esophagus after tumor resection. METHODS AND RESULTS The patients were a 51-year-old woman with an esophageal granular cell tumor and a 54-year-old woman with an esophageal schwannoma. Both defects were reconstructed with a radial forearm flap. A small subclinical leak developed in 1 patient and healed spontaneously within 2 weeks. At 1 year and 2 years of follow-up, both patients were consuming a normal diet and had normal voices. CONCLUSIONS A thin and well-vascularized flap such as the radial forearm flap is essential for reconstructing an isolated cervical esophageal defect so as to maximize functional outcome.
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Affiliation(s)
- Vincent P Marin
- Department of Plastic Surgery, Unit 443, FC8.2000, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030
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27
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Kuroda N, Kohno N, Iwamura SI, Hamaguchi N, Ohara M, Hirouchi T, Zuno K. Granular cell tumor arising metachronously in the bronchus and esophagus. APMIS 2006; 114:659-62. [PMID: 16948821 DOI: 10.1111/j.1600-0463.2006.apm_490.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We present a case of granular cell tumor (GCT) occurring in the esophagus 7 years after operation for bronchial GCT. A 59-year-old Japanese man complained of epigastralgia, and endoscopic examination of the upper digestive tract disclosed a submucosal tumor in the lower esophagus. Histological examination of the endoscopic mucosal resection of the esophageal tumor showed a proliferation of neoplastic cells with an eosinophilic and granular cytoplasm. The cytoplasm of the neoplastic cells was histochemically positive for PAS stain and immunohistochemically positive for S-100. This tumor did not fulfill any of the diagnostic criteria for malignancy at either the macroscopic or microscopic level. I believe that this is the first case of GCT occurring metachronously in the respiratory and digestive tracts. Clinicians and pathologists should bear in mind that GCT may arise metachronously in the respiratory and digestive tracts.
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Affiliation(s)
- Naoto Kuroda
- Department of Pathology and Laboratory Medicine, Kochi Red Cross Hospital, Shinhonmachi 2-chome 13-51, Kochi City, Kochi 780-8562, Japan.
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28
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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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29
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Sailors JL, French SW. The Unique Simultaneous Occurrence of Granular Cell Tumor, Gastrointestinal Stromal Tumor, and Gastric Adenocarcinoma. Arch Pathol Lab Med 2005; 129:e121-3. [PMID: 15859656 DOI: 10.5858/2005-129-e121-tusoog] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Granular cell tumors are generally benign oncocytoid lesions of schwannian origin that are often incidental findings in many locations. Gastrointestinal stromal tumors occur in older adults and express the c-Kit protein (CD117). Both of these tumors have been described in association with many other entities; however, they have never been reported to occur jointly. This report is prompted by the simultaneous appearance of 2 granular cell tumors, a gastrointestinal stromal tumor, and a gastric adenocarcinoma in a 65-year-old woman with a history of breast carcinoma and granular cell tumor. To our knowledge, this is the first case report of these tumors occurring simultaneously.
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Affiliation(s)
- Joseph L Sailors
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9073, USA.
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30
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Prematilleke IV, Sujendran V, Warren BF, Maynard ND, Piris J. Granular cell tumour of the oesophagus mimicking a gastrointestinal stromal tumour on frozen section. Histopathology 2004; 44:502-3. [PMID: 15140000 DOI: 10.1111/j.1365-2559.2004.01820.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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31
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Buratti S, Savides TJ, Newbury RO, Dohil R. Granular cell tumor of the esophagus: report of a pediatric case and literature review. J Pediatr Gastroenterol Nutr 2004; 38:97-101. [PMID: 14676603 DOI: 10.1097/00005176-200401000-00021] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Silvia Buratti
- Division of Pediatric Gastroenterology and Nutrition, University of California, San Diego, and Children's Hospital San Diego, USA
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33
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Sato J, Tsurukame M, Edamoto H, Kusuoka O, Tamura K. Spontaneous Granular Cell Tumor of Cecum in a Laboratory Beagle. J Toxicol Pathol 2003. [DOI: 10.1293/tox.16.275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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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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