Lung Metastases from Esophageal Granular Cell Tumor: An Undoubted Criterion for Malignancy Isidro Machado, MD, PhD, Julia Cruz, MD, PhD, Estanislao Arana,

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Lung Metastases from Esophageal Granular Cell Tumor: An Undoubted Criterion for Malignancy Isidro Machado, MD, PhD, Julia Cruz, MD, PhD, Estanislao Arana, MD, Juan Carlos Peñalver-Cuesta, MD, Miguel Arraras-Martínez, MD, Javier Lavernia, MD, Antonio Llombart-Bosch, MD, PhD Journal of Thoracic Oncology Volume 12, Issue 8, Pages 1320-1322 (August 2017) DOI: 10.1016/j.jtho.2017.05.001 Copyright © 2017 International Association for the Study of Lung Cancer Terms and Conditions

Figure 1 (A) Coronal maximum intensity projection computed tomography image obtained 33 months after surgery for primary esophageal tumor showing an increase in the size of both lung metastases (arrows). (B) A cut surface from the nodule involving the left lower lobe. (C) Histological image from the lung metastasis of a malignant granular cell tumor (larger nodule) and the normal lung parenchyma around the tumor, hematoxylin and eosin (hematoxylin and eosin staining; original magnification, ×10). (D) Strong cytoplasmic S100 expression in metastatic granular cell tumor (original magnification, ×20). (E) Low proliferation index (4%) (Ki-67 staining; original magnification, ×10). Journal of Thoracic Oncology 2017 12, 1320-1322DOI: (10.1016/j.jtho.2017.05.001) Copyright © 2017 International Association for the Study of Lung Cancer Terms and Conditions

Figure 2 (A and B) Histological examination of the larger nodule reveals fibrosis (asterisk), a predominant spindle cell formation (arrow) with nuclear pleomorphism, and nucleoli (arrowhead) (hematoxylin and eosin [HE] staining; original magnification, ×10 and ×100, respectively.) (C and D) The smaller nodule shows a granular cell proliferation with abundant eosinophilic cytoplasm, striking vascular invasion (arrow), and scant fibrosis (HE staining; original magnification, ×10 and ×40, respectively). (E and F) The intermediate-size nodule shows a combined pattern with conventional granular tumor cells, spindle cell formation, and mitosis (arrow) (HE staining; original magnification, ×10 and ×60). Journal of Thoracic Oncology 2017 12, 1320-1322DOI: (10.1016/j.jtho.2017.05.001) Copyright © 2017 International Association for the Study of Lung Cancer Terms and Conditions