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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

Histopathological evaluation of the esophageal granular cell tumor (GCT) (×100). (a) The H&E stain of esophageal GCT. (b) Immunohistochemistry (IHC) positive for S-100. (c) IHC positive for vimentin.
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Figure 3: Histopathological evaluation of the esophageal granular cell tumor (GCT) (×100). (a) The H&E stain of esophageal GCT. (b) Immunohistochemistry (IHC) positive for S-100. (c) IHC positive for vimentin.

Mentions: Standardized ESD procedures were performed in all patients in our study. The wound surface of the esophageal GCT during ESD procedure is shown in Figure 2a to c and the excised specimen is showed in Figure 2d. The procedure time was from 25 to 60 minutes (mean 38.2 ± 10.1 minutes). As shown in Table 4, it took significantly more time (P < 0.05) to remove the large tumors (6 cases, mean 46.7 ± 8.2 minutes) than the small tumors (8 cases, mean 31.9 ± 5.9 minutes). The procedure time for the tumors in the submucosal layer (8 cases, mean 41.3 ± 11.3 minutes) was more than for tumors in the muscularis mucosa layer (6 cases, mean 34.2 ± 7.4 minutes), but this was not statistically significant. Severe complications of ESD including perforation and delayed bleeding were not observed in all patients. The length of hospital stay was two to four days for each patient.Pathological diagnosis was confirmed in all cases after ESD (Figure 3a). All the lesions were well-circumscribed but without an obvious capsule. The margins were negative in 13/14 cases (complete resection rate 92.9%). One case with an unrecognized eschar in the vertical margins was designated treatment Rx (Resection margin unclear) margin. The pathological diagnosis was supported by IHC with the characteristic positive for S-100 and vimentin (positive in all esophageal GCTs in our study, Figure 3b and c).


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)

Histopathological evaluation of the esophageal granular cell tumor (GCT) (×100). (a) The H&E stain of esophageal GCT. (b) Immunohistochemistry (IHC) positive for S-100. (c) IHC positive for vimentin.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Histopathological evaluation of the esophageal granular cell tumor (GCT) (×100). (a) The H&E stain of esophageal GCT. (b) Immunohistochemistry (IHC) positive for S-100. (c) IHC positive for vimentin.
Mentions: Standardized ESD procedures were performed in all patients in our study. The wound surface of the esophageal GCT during ESD procedure is shown in Figure 2a to c and the excised specimen is showed in Figure 2d. The procedure time was from 25 to 60 minutes (mean 38.2 ± 10.1 minutes). As shown in Table 4, it took significantly more time (P < 0.05) to remove the large tumors (6 cases, mean 46.7 ± 8.2 minutes) than the small tumors (8 cases, mean 31.9 ± 5.9 minutes). The procedure time for the tumors in the submucosal layer (8 cases, mean 41.3 ± 11.3 minutes) was more than for tumors in the muscularis mucosa layer (6 cases, mean 34.2 ± 7.4 minutes), but this was not statistically significant. Severe complications of ESD including perforation and delayed bleeding were not observed in all patients. The length of hospital stay was two to four days for each patient.Pathological diagnosis was confirmed in all cases after ESD (Figure 3a). All the lesions were well-circumscribed but without an obvious capsule. The margins were negative in 13/14 cases (complete resection rate 92.9%). One case with an unrecognized eschar in the vertical margins was designated treatment Rx (Resection margin unclear) margin. The pathological diagnosis was supported by IHC with the characteristic positive for S-100 and vimentin (positive in all esophageal GCTs in our study, Figure 3b and c).

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