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Large Mid-Esophageal Granular Cell Tumor: Benign Versus Malignant.

Christopher PR, Kingsley PA, Singh Bedi H, Singh Kwatra K, Rathore S, Das KC - Rare Tumors (2015)

Bottom Line: Granular cell tumors are rare soft tissue neoplasms, among which only 2% are malignant, arising from nervous tissue.Here we present a case of a large esophageal granular cell tumor with benign histopathological features which metastasized to the liver, but showing on positron emission tomography-computerized tomography standardized uptake value suggestive of a benign lesion.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiotherapy, Christian Medical College , Ludhiana, India.

ABSTRACT
Granular cell tumors are rare soft tissue neoplasms, among which only 2% are malignant, arising from nervous tissue. Here we present a case of a large esophageal granular cell tumor with benign histopathological features which metastasized to the liver, but showing on positron emission tomography-computerized tomography standardized uptake value suggestive of a benign lesion.

No MeSH data available.


Related in: MedlinePlus

a) Esophageal tumor nodule at low magnification, Hematoxylin & Eosin (H&E, 100×). b) High magnification showing tumor composed of sheets of polygonal cells with eosinophilic cytoplasm, H&E 400×. c) Low Ki67 proliferative fraction, DAB chromogen 400×. d) Liver aspirate showing loose clusters of polygonal cells with variation in nuclear size and abundant cytoplasm, MGG 400×.
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fig002: a) Esophageal tumor nodule at low magnification, Hematoxylin & Eosin (H&E, 100×). b) High magnification showing tumor composed of sheets of polygonal cells with eosinophilic cytoplasm, H&E 400×. c) Low Ki67 proliferative fraction, DAB chromogen 400×. d) Liver aspirate showing loose clusters of polygonal cells with variation in nuclear size and abundant cytoplasm, MGG 400×.

Mentions: Though endosonography can suggest a GCT, there are other differential diagnosis like leiomyoma from which we cannot differentiate by imaging. Histopathology with immunohistochemistry studies is the diagnostic procedure for the tumors. On gross examination, these are solid, firm, and non-enveloped tumors with a yellow or yellowish cross section usually located in the mucosa or submucosa. Characteristic microscopic picture is that of sheets or nests of round or polygonal large cells with abundant eosinophilic granular cytoplasm and small, round, central uniform nuclei (Figure 2).13 Histological criteria for diagnosing a malignant GCT as proposed by Fanburg-Smith et al. are: i) necrosis, ii) spindling, iii) vesicular nuclei with large nucleoli, iv) high nuclear-to-cytoplasmic ratio, v) increased mitotic activity (more than 2 mitoses per 10 high-power fields at 200× magnification), vi) pleomorphism. Those tumors which meet atleast 3 of these criteria are classified as malignant. Those that meet one or two are atypical. If there is only focal pleomorphism and none of the other criteria are satisfied, then they are classified as benign.14 So our patient fits into the criteria of a benign tumor, immunohistologically supported by a low Ki67 proliferative index. On PET-CT scan the FDG uptake of the esophageal tumor was suggestive of a benign pathology with a maximum standardized uptake value (SUV) of 2.21 and the liver lesion was non FDG avid. Hoess et al. have reported on the PET evaluation of breast GCT and according to them, in a population of 51 patients at their centre, a threshold SUV of 2.5 was able to best differentiate benign from malignant lesions.15 But there is not sufficient data on PET evaluation of esophageal GCT.


Large Mid-Esophageal Granular Cell Tumor: Benign Versus Malignant.

Christopher PR, Kingsley PA, Singh Bedi H, Singh Kwatra K, Rathore S, Das KC - Rare Tumors (2015)

a) Esophageal tumor nodule at low magnification, Hematoxylin & Eosin (H&E, 100×). b) High magnification showing tumor composed of sheets of polygonal cells with eosinophilic cytoplasm, H&E 400×. c) Low Ki67 proliferative fraction, DAB chromogen 400×. d) Liver aspirate showing loose clusters of polygonal cells with variation in nuclear size and abundant cytoplasm, MGG 400×.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508643&req=5

fig002: a) Esophageal tumor nodule at low magnification, Hematoxylin & Eosin (H&E, 100×). b) High magnification showing tumor composed of sheets of polygonal cells with eosinophilic cytoplasm, H&E 400×. c) Low Ki67 proliferative fraction, DAB chromogen 400×. d) Liver aspirate showing loose clusters of polygonal cells with variation in nuclear size and abundant cytoplasm, MGG 400×.
Mentions: Though endosonography can suggest a GCT, there are other differential diagnosis like leiomyoma from which we cannot differentiate by imaging. Histopathology with immunohistochemistry studies is the diagnostic procedure for the tumors. On gross examination, these are solid, firm, and non-enveloped tumors with a yellow or yellowish cross section usually located in the mucosa or submucosa. Characteristic microscopic picture is that of sheets or nests of round or polygonal large cells with abundant eosinophilic granular cytoplasm and small, round, central uniform nuclei (Figure 2).13 Histological criteria for diagnosing a malignant GCT as proposed by Fanburg-Smith et al. are: i) necrosis, ii) spindling, iii) vesicular nuclei with large nucleoli, iv) high nuclear-to-cytoplasmic ratio, v) increased mitotic activity (more than 2 mitoses per 10 high-power fields at 200× magnification), vi) pleomorphism. Those tumors which meet atleast 3 of these criteria are classified as malignant. Those that meet one or two are atypical. If there is only focal pleomorphism and none of the other criteria are satisfied, then they are classified as benign.14 So our patient fits into the criteria of a benign tumor, immunohistologically supported by a low Ki67 proliferative index. On PET-CT scan the FDG uptake of the esophageal tumor was suggestive of a benign pathology with a maximum standardized uptake value (SUV) of 2.21 and the liver lesion was non FDG avid. Hoess et al. have reported on the PET evaluation of breast GCT and according to them, in a population of 51 patients at their centre, a threshold SUV of 2.5 was able to best differentiate benign from malignant lesions.15 But there is not sufficient data on PET evaluation of esophageal GCT.

Bottom Line: Granular cell tumors are rare soft tissue neoplasms, among which only 2% are malignant, arising from nervous tissue.Here we present a case of a large esophageal granular cell tumor with benign histopathological features which metastasized to the liver, but showing on positron emission tomography-computerized tomography standardized uptake value suggestive of a benign lesion.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiotherapy, Christian Medical College , Ludhiana, India.

ABSTRACT
Granular cell tumors are rare soft tissue neoplasms, among which only 2% are malignant, arising from nervous tissue. Here we present a case of a large esophageal granular cell tumor with benign histopathological features which metastasized to the liver, but showing on positron emission tomography-computerized tomography standardized uptake value suggestive of a benign lesion.

No MeSH data available.


Related in: MedlinePlus