Endoscopic submucosal dissection of esophageal granular cell tumor

Abstract

BackgroundEsophageal 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.MethodsFourteen 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.ResultsEsophageal 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.ConclusionsEsophagoscopy 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.

The role of endoscopy in subepithelial lesions of the GI tract

“…Endoscopic resection of small granular cell tumors may be considered, possibly obviating the need for further surveillance. 83,84 Removal often can be accomplished by snare excision or EMR. 83,85,86 It is unknown whether small, unresected granular cell tumors or larger lesions resected endoscopically should undergo surveillance.…”

“…ESD has been applied for resection of carcinoid tumors, granular cell tumors, and also SELs arising from the muscularis propria. Lu et al 83 reported en-bloc resection of esophageal granular cell tumors by using ESD in 92.9% (13/14) of cases. Procedure time ranged from 25 to 60 minutes, and no adverse events were seen.…”

Gastrointestinal and biliary granular cell tumor: diagnosis and management

“…Nie et al reported that, when ESD was used to treat 17 patients with esophageal GCTs, only one developed bleeding, which was managed by endoscopic hemostasis [ 33 ]. In a study by Lu et al , ESD was performed on 14 patients with esophageal GCT with no complications [ 39 ]. ESD using Clutch Cutter ® (Fujifilm Corporation, Odawara, Japan) was described with no complications for submucosal tumors that had not invaded the muscularis propria [ 26 ].…”

“…In other cases, patients presented with hematochezia, abdominal pain, loose stool or constipation [ 10 ]. When GCT involves the appendix, patients can present with appendicitis [ 39 ]. GCT can also be detected incidentally during major abdominal surgery [ 54 ].…”

Endoscopic submucosal dissection of an esophageal granular cell tumor

“…First described by Abrikossoff 1 in 1926, GCTs are a benign entity with malignant potential that evolve from the Schwann cells of the nervous system. Principally, they can occur at any site of the human body 2, 3. About 2% of GCTs are in the esophagus4, 5; other parts of the GI system are rarely involved.…”