Endoscopic resection of a large granular cell tumor of the esophagus

Abstract

TECHNIQUEGranular cell tumor (GCT) is an uncommon submucosal neoplasm of uncertain etiology and histogenesis. The gastrointestinal tract is a rare site of the neoplasm and the esophagus has been described as a primary location in one third of such cases [1]. A generally accepted treatment of these lesions has not been established. There is a tendency to monitor asymptomatic patients with lesions over 10 mm in diameter by annual endoscopic examination. For larger tumors, the views concerning treatment have been changing over the years. Surgical local excision of the tumor was the standard treatment for a long period [2]. Such an approach, however, has its associated risks of bleeding, perforation, mediastinitis, abscess, and stricture as well as the concern of anesthesia. In that respect, new therapeutic options including laser, diatherapy loop, and endoscopic resection have recently been introduced [3,4]. Laser treatment has the disadvantage of the expensive technique that is not always available, whereas the diatherapy loop has a high risk of perforation. In contrary, excision by biopsy forceps, or endoscopic polypectomy, is a low cost procedure, although it is not free of risk due to incomplete removal. Yasuda et al. [3] have suggested that criteria for endoscopic removal include small size (<20 mm) and nonattachment to the macularis propria. Intratumoral polidocanol injections have been used in some instances to achieve necrosis of the submucosal neoplastic cells [5]. Our report concerns a patient with a large esophageal form successfully cured by simple endoscopic resection.A 45-year-old man came for epigastric discomfort. He complained of a 5-month, non-specific, persistent indigestion and a feeling of postprandial fullness. Symptoms were not related to eating. An upper gastrointestinal endoscopy revealed a sessile yellowish polypoid tumor in the lower esophagus, 33 cm from the incisor teeth. The tumor was of firm consistency when touched with the biopsy forceps, measured about 28 mm in diameter, and was covered with and surrounded by normal-looking mucosa. The histological findings in the biopsy were consistent with GCT, showing a diffuse thickening of the mucosa and growth of large cells with numerous fine eosinophilic granules. Surface squamous epithelium dis-*Correspondence to: Vassilis G.

Single-band mucosectomy for granular cell tumor of the esophagus: safe and easy technique

“…Several authors recommend annual endoscopic follow-up evaluation for small asymptomatic lesions (<1 cm) [2]. If the lesion is large and symptomatic, surgical excision is no longer recommended, and new endoscopic procedures (laser, argon plasma coagulation, multiple biopsies) are preferred.…”

Granular cell tumors of the esophagus: report of five cases and review of diagnostic and therapeutic techniques

“…It is cheap but can be used only on tumors measuring < 2 cm, as there is a risk of incomplete resection. [25][26][27] (ii) Endoscopic mucosectomy. This technique is widely used in Japan to resection mucosal and submucosal tumors in the gastrointestinal tract.…”

Endoscopic diagnosis and resection of esophageal granular cell tumors

“…With the wide use of modern endoscopic modalities, such as endoscopic ultrasonography (EUS) and endoscopic mucosal resection (EMR), there is an opportunity to better characterize this rare lesion. Several previous case reports including one case series describe the safety and efficacy of endoscopic resection 7–13 . One series describes the EUS characteristics of GCT, but only one case report has addressed the utility of EUS‐guided aspiration or biopsy for diagnosis 14 …”