Minimal invasive endoscopic management of synchronous granular cell tumours in the colon and posterior mediastinum
A 3 × 2-cm posterior mediastinal mass was discovered in January 2011 on a computed tomography (CT) scan in a 52-year-old woman with a medical history of status-post right modified radical mastectomy in November 2007 for a T2N1M0, stage 2B invasive ductal carcinoma of the breast. She had no significant complaints. Due to the prior history of breast cancer, video-assisted thoracoscopic removal was planned and performed under general anaesthesia with double-lumen endotracheal tube. Inspection of the left hemithorax revealed a 2.5 cm mass in the left paravertebral area near the apex of the lung []. Excision was carried out using a combination of blunt and sharp dissection. Initial histopathological diagnosis yielded a spindle-cell neoplasm. After a 9 month of follow-up, screening colonoscopy revealed a submucosal mass measuring approximately 1 cm in diameter []. The patient was over 40-years old and had a history of breast cancer. Because of this, the colon was evaluated as a part of the screening program. The mass was excised en bloc by endoscopic mucosal resection (EMR) using a snare []. No other similar lesions were detected on her esophagogastroduodenoscopy.\nMacroscopic examination revealed submucosal lesion measuring 1.0 × 1.0 × 0.8 cm with a hard consistency. In cut sections, a solid lesion that was composed of yellowish and whitish portions was detected. H and E-stained sections of the lesion revealed a tumour, which was located in the submucosa and partly in the mucosa []. The tumour was characterized by solid masses of plump histiocyte-like cells. The tumour cells with abundant granular eosinophilic cytoplasm were containing acidophilic Periodic acid-Schiff (PAS)-positive diastase-resistant granules []. Immunohistochemical analysis revealed diffuse expression of S100 protein []. Desmin and cytokeratin stains remained negative.\nImmunohistochemical evaluation with a broader panel of antibodies of the mediastinal and colonic lesion were carried out again and revealed similar and immunohistological patterns, and the diagnosis was consistent with GCT.