Unexpected diagnosis for a gastric polyp: Granular cell tumor: Case report and review of the literature.

A granular cell tumor (GCT) is a rare neoplasia that originates from Schwann cells. It usually appears in the skin or soft tissues, but it may occur anywhere in the body. The gastrointestinal tract is an unusual developmental site for a GCT, the esophagus being the most common site of origin for this tumor. The stomach is one of the most unique sites of origin for GCT, with less than 80 cases being mentioned in the literature. Histologically, GCTs consist of fusiform and polygonal cells, with granular cytoplasm, arranged in compact 'nests'. Immunohistochemically, these tumors show positivity for S100 protein, CD68, CD56 and, in a smaller percentage, they are positive for other antibodies, most notably inhibin alpha. We report the case of a 52-year-old woman with a solitary GCT that had developed in the gastric cardia, discovered on a routine gastroscopy and successfully treated by endoscopic submucosal dissection.

Modified Whipple-Child pancreaticoduodenectomy with anastomosis on jejunal loop in continuity. Presentation of surgical technique and preliminary observations on 45 patients.

INTRODUCTION: Cephalic pancreaticoduodenectomy (CPD) is the only current treatment method that can provide long-term survival in patients with periampullary tumors. CASE PRESENTATION: This study is a prospective study conducted between 2010 and 2016 in Hepato-Biliary-Pancreatic Center of "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania, where 57 modified Whipple-Child CPDs with anastomoses on jejunal loop in continuity were performed, in patients with periampullary tumors. Twelve patients, who had undergone prior biliodigestive derivations or biliary drainage using endoscopic retrograde cholangio-pancreatography (ERCP), with stenting of the common bile duct, were excluded from the study. In 45 patients with modified Whipple-Child CPDs with anastomosis on jejunal loop in continuity, which were included in the study, overall morbidity rate was 22.22%. Postoperative mortality (within 30 days after the surgery) was 6.66% and six months and one year survival rates, excluding the four patients who died postoperatively, were 91.11% and 80%, respectively, with a median survival of 32 months. The mean operative time was 300 minutes, ranging between 240 and 390 minutes. CONCLUSIONS: Modified Whipple-Child CPD with anastomoses on jejunal loop in continuity seems to be a therapeutic method promising a decreased overall morbidity rate and a good quality of life and offering a distant survival rate, which is consistent, so far, with data reported in the literature.