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Endoscopic submucosal dissection of esophageal granular cell tumor.

Lu W, Xu MD, Zhou PH, Zhang YQ, Chen WF, Zhong YS, Yao LQ - World J Surg Oncol (2014)

Bottom Line: Clinical diagnosis was confirmed by pathology and immunohistochemical examination (positive for S-100 and vimentin).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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai 200032, PR China. xu.meidong@zs-hospital.sh.cn.

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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Related in: MedlinePlus

Endoscopic and endoscopic ultrasound (EUS) image of different esophageal granular cell tumors (GCTs). (a) Small yellowish peanut-like half protrusion under the smooth overlying mucosa. (b) A submucosal knurl with a small tuberculum. (c) EUS view of esophageal GCT (mildly heterogeneous solid pattern originating from the muscularis mucosa layer).
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Figure 1: Endoscopic and endoscopic ultrasound (EUS) image of different esophageal granular cell tumors (GCTs). (a) Small yellowish peanut-like half protrusion under the smooth overlying mucosa. (b) A submucosal knurl with a small tuberculum. (c) EUS view of esophageal GCT (mildly heterogeneous solid pattern originating from the muscularis mucosa layer).

Mentions: A total of 14 patients aged 29 to 75 years with GCTs of the esophagus were identified including 8 men and 6 women. The patient clinical data are listed in Table 1 and Table 2. The median age at time of diagnosis was 48.5 years. Five patients suffered epigastric discomfort; three had retrosternal discomfort and regurgitation; two suffered regurgitation and belching; two suffered from dysphagia, and the remaining two non-symptomatic patients were discovered by routine physical examination and gastric endoscopy. All patients had a single esophageal GCT. Eight were in the distal thoracic or abdominal part of the esophagus, three in the proximal part, and three in the mid-thoracic esophagus.The endoscopic appearance of esophageal GCTs showed variation in size, location, and coating layer of mucosa in our study. All GCTs were described as well circumscribed raised lesions under the mucosal layer. Eight cases were small tumors, most of which (five cases) exhibited a small yellowish peanut-like half protrusion under the smooth overlying mucosa (Figure 1a). However, the larger tumors (>10 mm) appeared as a submucosal knurl with a small tuberculum (one case, Figure 1b) or smooth edge (five cases). Among them, four cases had a yellowish or pale color. Among all GCTs, three cases were covered with a rough mucosal layer due to mucosal inflammatory disease of the esophagus and were of a similar color to the surrounding mucosa. One case showed the same color as the mucosa without inflammatory changes.


Endoscopic submucosal dissection of esophageal granular cell tumor.

Lu W, Xu MD, Zhou PH, Zhang YQ, Chen WF, Zhong YS, Yao LQ - World J Surg Oncol (2014)

Endoscopic and endoscopic ultrasound (EUS) image of different esophageal granular cell tumors (GCTs). (a) Small yellowish peanut-like half protrusion under the smooth overlying mucosa. (b) A submucosal knurl with a small tuberculum. (c) EUS view of esophageal GCT (mildly heterogeneous solid pattern originating from the muscularis mucosa layer).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4126351&req=5

Figure 1: Endoscopic and endoscopic ultrasound (EUS) image of different esophageal granular cell tumors (GCTs). (a) Small yellowish peanut-like half protrusion under the smooth overlying mucosa. (b) A submucosal knurl with a small tuberculum. (c) EUS view of esophageal GCT (mildly heterogeneous solid pattern originating from the muscularis mucosa layer).
Mentions: A total of 14 patients aged 29 to 75 years with GCTs of the esophagus were identified including 8 men and 6 women. The patient clinical data are listed in Table 1 and Table 2. The median age at time of diagnosis was 48.5 years. Five patients suffered epigastric discomfort; three had retrosternal discomfort and regurgitation; two suffered regurgitation and belching; two suffered from dysphagia, and the remaining two non-symptomatic patients were discovered by routine physical examination and gastric endoscopy. All patients had a single esophageal GCT. Eight were in the distal thoracic or abdominal part of the esophagus, three in the proximal part, and three in the mid-thoracic esophagus.The endoscopic appearance of esophageal GCTs showed variation in size, location, and coating layer of mucosa in our study. All GCTs were described as well circumscribed raised lesions under the mucosal layer. Eight cases were small tumors, most of which (five cases) exhibited a small yellowish peanut-like half protrusion under the smooth overlying mucosa (Figure 1a). However, the larger tumors (>10 mm) appeared as a submucosal knurl with a small tuberculum (one case, Figure 1b) or smooth edge (five cases). Among them, four cases had a yellowish or pale color. Among all GCTs, three cases were covered with a rough mucosal layer due to mucosal inflammatory disease of the esophagus and were of a similar color to the surrounding mucosa. One case showed the same color as the mucosa without inflammatory changes.

Bottom Line: Clinical diagnosis was confirmed by pathology and immunohistochemical examination (positive for S-100 and vimentin).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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai 200032, PR China. xu.meidong@zs-hospital.sh.cn.

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.

Show MeSH
Related in: MedlinePlus