Granular cell tumors: a report of six cases

Abstract Granular cell tumor is a soft tissue neoplasm that originates in the nervous system and arises at virtually any body site, but is mainly found in the skin, oral cavity or digestive tract. Most are benign and reportedly malignant cases are rare, occurring in only 1% or 2% of cases. We report on our findings in six patients who developed granular cell tumor in the mammary gland, esophagus, subcutaneous tissue and muscle. Of six patients, two had granular cell tumor located in the breast, two in the submucosa of the esophagus, and the other two under the skin of the left axillary cavity and in the right latissimus dorsi muscle, respectively. One of the two patients with tumor in the submucosa of the esophagus also had esophageal cancer. Patients’ age ranged from 41 to 70 years (average, 59.1 years). Two patients with tumor in the submucosa of the esophagus were men, and the others were women. All of them were given a diagnosis of granular cell tumor by tissue biopsy and examination of excised specimens, but no evidence of malignancy was found. No recurrence has been noted in the patients who underwent surgical tumor removal.</p

Underlying—Disease Risk for Antispasmodic Premedication in Older Patients Undergoing Investigations of the Gastrointestinal Tract

Purpose Improve risk management of patients undergoing investigations of the gastrointestinal (GI) tract, in regard to underlying diseases and choice of premedication. According to a nationwide survey in Japan, 74% of the deaths associated with premedication were patients aged 60 years or over. Methods Subjects were 418 patients undergoing investigations of the GI tract (367 endoscopy, 51 barium contrast radiography) between October 2001 and January 2004. Age distribution peaked in the 65-69 years group, and 40% of subjects were aged 65 years and over. Using a questionnaire, each subject was interviewed prior to the investigation to determine contraindications for anticholinergic agents or glucagon preparations. To confirm the risk associated with antispasmodic agents in elderly subjects, the group was subdivided into those aged under 65 years and those aged 65 and over, and compared. Results Anticholinergic agents were contraindicated in more than 50% of subjects aged 65 years and over, and glucagon was contraindicated in 11% of subjects aged 65 years and over. The proportion of elderly subjects in whom antispasmodic agents, including anticholinergics and glucagon, were contraindicated was significantly greater than for subjects aged under 65 years. Conclusions Using a written questionnaire at the time of obtaining informed consent facilitates the identification of underlying diseases and selection of appropriate premedication