Esophageal granular cell tumor: A case report

BACKGROUND

Esophageal granular cell tumor (eGCT) is a relatively rare, usually benign neoplasm of the neuroectoderm. It is derived from Schwann cells. Clinical symptoms of this disease are non-specific. However, the most common presenting symptom is dysphagia, which is mostly misdiagnosed as esophageal polyps under gastroscopy, yet it has a 2% chance of forming cancers. We report the case of a 52-year-old woman with solitary eGCT, then analysed retrospectivelyanalyze the clinical features and elucidate on the reduction of misdiagnosis and missed diagnosis.

CASE SUMMARY

A 52-year-old woman was diagnosed with “esophageal granulossoma” after esophagoscopy, which was mistaken for eGCT.

CONCLUSION

eGCT diagnosis depends on characteristic pathomorphologies and detection of the S-100 protein. Endoscopic mucosal resection is the preferred therapeutic method.

Esophageal granular cell tumors: Report of 9 cases and a literature review

Esophageal granular cell tumors (GCTs) are rare tumors of the esophagus. We evaluated the clinical and pathologic features of 9 esophageal GCT patients (5 men and 4 women) from our institute and reviewed the related disease literature. Patient age ranged from 25 to 53 years (mean: 41 years). All the patients were asymptomatic or presented with non-specific symptoms. Most GCTs occurred in the distal esophagus and were less than 6 mm in diameter. Computational analysis showed that the average gray-scale endoscopic ultrasound images of esophageal GCTs were greater than that of esophageal leiomyomas. Eight patients were treated by endoscopic resection, and 1 patient underwent surgical excision. No post-therapy recurrence or metastasis developed during follow-up (mean: 36.4 mo, range: 1-72 mo).

Endoscopic submucosal dissection for esophageal granular cell tumor using the clutch cutter

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.