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      A case of a gastric granular cell tumor preoperatively diagnosed and successfully treated by single-incision laparoscopic surgery

      case-report

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          Abstract

          Background

          Granular cell tumors (GCT) in the gastrointestinal tract are rare. Herein, we describe a case of a gastric GCT diagnosed preoperatively by endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) and successfully resected by single-incision laparoscopic surgery (SILS).

          Case presentation

          A 46-year-old Japanese woman had a tumor located in the angle of the stomach that was approximately 1.5 cm in diameter. Abdominal computed tomography (CT) revealed a submucosal tumor (SMT), which was finally diagnosed as a gastric GCT using EUS-FNAB. The tumor was not identified by CT 1 year and 4 months before diagnosis; therefore, because there was a possibility that the tumor was malignant, we performed surgical wedge resection using SILS. The patient had an uneventful recovery postoperatively and was discharged without complications 3 days after surgery. The tumor was pathologically diagnosed as a benign GCT that remained within the muscular layer. No recurrence or complications have occurred in the first 16 months since the surgery.

          Conclusion

          Because gastric GCTs are generally benign and are rarely associated with lymph node metastasis, SILS seems to be a safe and feasible surgical approach for treating GCTs.

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          Most cited references19

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          Granular cell tumor: a clinicopathologic study of 110 patients.

          S Klappenbach, G Worsham, B Chun … (1979)
          The clinicopathologic features of 118 granular cell tumors (GCT) encountered at two affiliated hospitals were reviewed. A total of 110 patients were affected over this 32-year period of study (71 men, 39 women), and in 5% GCT were multiple. Patients ranged in age from 16 to 58 years (average 32 years) and were symptomatic for an average duration of 11 months prior to diagnosis. There was a greater than expected frequency of GCT among black patients (29%). Although tongue was the single most common anatomic site involved, relatively more GCT (44%) occurred in skin or subcutaneous tissue. Less common locations were breast parenchyma (10 cases), rectal mucosa and anus (6), vulva (4), esophagus and larynx (2 cases each). The correct preoperative diagnosis of this protean tumor was made in only three patients. GCT were surgically treated with the average diameter of resected tumor being 1.2 cm (range 0.2--3.5 cm). Pseudoepitheliomatous hyperplasia was noted in 11 tumors and in one vulvar GCT there was overlying in situ squamous cell carcinoma. Tumors were incompletely excised in 24 of 56 patients having adequate followup; only five of these 24 patients experienced a local recurrence of tumor. Malignant behavior was not observed. Results of histochemical and ultrastructural study are briefly discussed. The precise histogenesis of GCT is uncertain but Schwann cell origin is favored in most cases.
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            Malignant granular cell tumor of the breast: case report and literature review.

            KAZUHISA AKAHANE, Kazuo Kato, Seiji Ogiso … (2015)
            Granular cell tumors (GCTs) are uncommon soft tissue tumors that mostly occur in patients between 40 and 60 years of age and can occur at various body sites. Malignant granular cell tumors (MGCTs) comprise less than 2 % of GCTs and are mostly found on the lower extremities, especially the thighs. These tumors grow more rapidly than benign GCTs, and most importantly, they can metastasize. We describe an MGCT that presented as a right breast mass in a 79-year-old Japanese woman. Local excision was performed for the primary tumor, which was diagnosed as an atypical GCT, but 15 months later, the tumor recurred at the same site. Thereafter, right mastectomy with axillary lymph node dissection was performed. Metastatic disease was identified in 2 of 12 lymph nodes. The pathological examination revealed that the tumor had progressed to an MGCT after recurrence. Multiple liver, lung and bone metastases were revealed 4 months after the second surgery, and the patient died 34 months after the primary surgery. Our findings highlighted the difficulty in diagnosing MGCTs using histological features alone and suggested the usefulness of Ki67 values. A tumor with a high level of Ki67 should be treated as malignant, even if the tumor has few pathological features of malignancy.
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              Granular cell tumor. Clinical spectrum of the benign and malignant entity.

              T Khansur, M Tavassoli, L Balducci (1987)
              The clinical records of all patients with granular cell tumor seen at our institution over a 20-year period were reviewed. Three patients with malignant, and 37 with benign tumor, were identified. Eleven patients had multiple benign lesions. Three had a history of familial occurrence. Clinical and pathologic features and the management of this nebulous entity, in both its benign and malignant forms, are reviewed and discussed.
              Article 0 comments Cited 21 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Atsushi Yasuda:
                ORCID: http://orcid.org/0000-0001-6708-290X
                a-yasuda@med.kindai.ac.jp
                Journal
                Journal ID (nlm-ta): Surg Case Rep
                Journal ID (iso-abbrev): Surg Case Rep
                Title: Surgical Case Reports
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Electronic): 2198-7793
                Publication date (Electronic): 27 February 2020
                Publication date PMC-release: 27 February 2020
                Publication date Collection: December 2020
                Volume: 6
                Electronic Location Identifier: 44
                Affiliations
                [1 ]GRID grid.258622.9, ISNI 0000 0004 1936 9967, Department of Surgery, , Kindai University Faculty of Medicine, ; 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511 Japan
                [2 ]GRID grid.413111.7, ISNI 0000 0004 0466 7515, Cancer Center, , Kindai University Hospital, ; 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511 Japan
                Author information
                http://orcid.org/0000-0001-6708-290X
                Article
                Publisher ID: 809
                DOI: 10.1186/s40792-020-00809-w
                PMC ID: 7046852
                PubMed ID: 32107653
                SO-VID: 7a3fb508-aba7-42ec-978d-961604cc7d55
                Copyright © © The Author(s) 2020
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 6 January 2020
                Date accepted : 17 February 2020
                Categories
                Subject: Case Report
                Custom metadata
                issue-copyright-statement © The Author(s) 2020

                Keywords: granular cell tumor,stomach,sils,eus-fnab
                Data availability:
                Keywords: granular cell tumor, stomach, sils, eus-fnab

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