Elias Estifan, MD, Abdalla Mohamed, MD, Yana Cavanagh, MD, Matthew Grossman, MD
St. Joseph's University Medical Center, Paterson, NJ
Introduction: Granular cell tumors (GCT) are rare neoplasms that can occur throughout the body. They were first described in the tongue by Abrikossoff in 1926 and initially known as Abrikossoff tumor. Most GCTs are benign neoplasms with a schwann cell origin however they may also be locally aggressive.
Case Description/Methods: We encountered a 38 years-old Female with no past medical history who underwent gastroscopy for non-specific abdominal pain. She was incidentally found to have a 1cm, oval, submucosal lesion at 29 cm from the incisors (Figure 1). Endoscopic ultrasound (EUS) was pursued and revealed a hyperechoic lesion that appeared to be located within the luminal interface/superficial mucosa (Figure 2). The mass measured 8 mm in maximal thickness on EUS. Cap-assisted endoscopic mucosal resection was planned. A solution of saline and methylene blue was injected with the adequate lifting of the lesion from the underlying muscularis propria. A distally attaching cap was fitted with a snare in anticipation of endoscopic mucosal resection (EMR). The lesion and a peripheral margin (total area of 18mm) were successfully resected and retrieved by suctioning into the cap (Figure 3). Pathology of the specimen showed a granular cell tumor with affirmative S100 and no evidence of intestinal metaplasia or dysplasia. Surveillance EGD, performed 3 months after the initial EMR, confirmed complete resection with no recurrence. Biopsies revealed benign esophageal squamous mucosa.
Discussion: Cap-assisted EMR is a valuable tool in the armamentarium of the gastroenterologist. It offers the benefits of EMR, in that this technique is able to obtain larger tissue samples compared to biopsy without the loss of a safety profile and provides the added pleasantry of a short learning curve. It is limited by the size of the cap and is unable to resect more extensive lesions en-bloc. Lesions smaller than 3 cm in diameter that is confined to mucosal or submucosal layers are the ideal candidates for this technique, as evidenced by our case.
Citation: Elias Estifan, MD, Abdalla Mohamed, MD, Yana Cavanagh, MD, Matthew Grossman, MD. P1232 - ESOPHAGEAL GRANULAR CELL TUMOR TREATED WITH CAP-ASSISTED ENDOSCOPIC MUCOSAL RESECTION. Program No. P1232. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.