Esophageal granular cell tumor successfully resected by endoscopic submucosal dissection

Abstract

Granular cell tumors of the esophagus are rare neoplasms and their diagnosis is mainly based on histopathologic examination of endoscopic biopsies. With the development of endoscopic techniques, there has been a marked increase in local treatment modalities for early esophageal neoplasms. In this case report, we describe the removal of a granular cell tumor by the endoscopic submucosal dissection technique, and briefly discuss the literature on clinicopathologic aspects and management of granular cell tumors.

Granular cell tumor of the esophagus in an adolescent

“…This tumor has polygonal and fusiform cells with small dark nuclei and fine, abundant, and granular cytoplasm. The cytoplasm is eosinophilic, periodic acid-Schiff positive, and diastase resistant10). IHC staining for S100 protein demonstrates that the tumor has a Schwann cell origin, while the EM examination shows a prominent basement membrane and a cytoplasm packed with lysosomes2).…”

“…Malignant esophageal GCT are usually larger (>40 mm), grow rapidly, tend to frequently recur after resection, and have subtle histological features. Fanburg-Smith used 6 histologic criteria to classify GCTs, including nuclear pleomorphism, high nuclear/cytoplasm ratio, increased mitotic rate (>2/10 high power fields), vesicular nuclei, large nucleoli, and tumor cell necrosis and spindling101112). Neoplasms were classified as histologically malignant, atypical, or benign according to number of fulfilled criteria.…”

“…The treatment is conservative management with regular endoscopic follow-up for tumors <10 mm in diameter without malignant features. Surgical or endoscopic excision is warranted for tumors >20 mm in diameter, patients who complain of symptoms, or cases of suspected malignancy10). However, other studies recommend endoscopic excision for small and asymptomatic lesions because benign and malignant lesions may be indistinguishable based on clinical symptoms211).…”

“…Endoscopic mucosal resection (EMR) was an effective treatment in a recently reported case, and EUS is the most useful method for determining whether the tumor is a candidate for endoscopic removal, with parameters including small size (<20 mm) and no muscle layer invasion10). EMR is less invasive and has fewer complications than esophagectomy10).…”

“…EMR is less invasive and has fewer complications than esophagectomy10). In the current reports, endoscopic resection or surgical excision is recommended for patients with esophageal GCT due to the potential of malignancy611).…”