Kawashima Kazumasa, Hikichi Takuto, Onizawa Michio, Gunji Naohiko, Takeda Yutaro, Mochimaru Tomoaki, Ishizaki Yuto, Murakami Mai, Kobayashi Reiko, Shioya Yasuo, Suzuki Osamu, Hashimoto Yuko, Kobayakawa Masao, Ohira Hiromasa
Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan.
Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.
Case Rep Gastroenterol. 2022 Mar 31;16(1):216-222. doi: 10.1159/000523963. eCollection 2022 Jan-Apr.
This report describes a granular cell tumor (GCT) with insufficient endoscopic manipulation in the hepatic flexure (HF) of the colon, which was treated by endoscopic submucosal dissection (ESD) using a splinting tube and the spring S-O clip traction method. A 44-year-old man presented with a 10 mm subepithelial tumor in the HF near the ascending colon on colonoscopy. The lesion had a smooth surface without erosion. The histology of biopsied specimen from the lesion was suspected as a GCT. Most GCTs are considered low-grade malignant, but ESD was chosen to treat the lesion due to the patient's insistence on endoscopic treatment. Because the lesion was located in the HF, it was assumed that the scope manipulation during ESD would be difficult. During ESD, a splinting tube was utilized to stabilize endoscopic manipulation and the spring S-O clip traction method to keep clear visualization of the submucosa, and the procedure was completed without adverse events. An 8 × 7 mm lesion with negative margins was removed by ESD. Hematoxylin and eosin staining showed atypical cells with round-to-oval nuclei and acidophilic vesicles, and immunohistochemical staining for S-100 protein was strongly positive with a Ki-67 labeling index of 5%. The lesion was pathologically confirmed as a GCT. This case showed the usefulness and safety of ESD for GCT with insufficient endoscopic manipulation in the HF.
本报告描述了一例位于结肠肝曲（HF）的颗粒细胞瘤（GCT），因内镜操作空间不足，采用夹闭管和弹簧S-O夹牵引法行内镜黏膜下剥离术（ESD）进行治疗。一名44岁男性在结肠镜检查时发现升结肠附近的肝曲处有一个10 mm的上皮下肿瘤。病变表面光滑，无糜烂。病变活检标本的组织学检查怀疑为颗粒细胞瘤。大多数颗粒细胞瘤被认为是低度恶性的，但由于患者坚持内镜治疗，故选择ESD治疗该病变。由于病变位于肝曲，预计ESD术中的操作空间会很困难。ESD术中，使用夹闭管稳定内镜操作，并采用弹簧S-O夹牵引法保持黏膜下层清晰可见，手术顺利完成，无不良事件发生。ESD切除了一个8×7 mm、切缘阴性的病变。苏木精-伊红染色显示细胞非典型，核呈圆形至椭圆形，有嗜酸性小泡，S-100蛋白免疫组化染色呈强阳性，Ki-67标记指数为5%。病理证实该病变为颗粒细胞瘤。本病例显示了ESD治疗肝曲处内镜操作空间不足的颗粒细胞瘤的有效性和安全性。
