University of Texas Rio Grande Valley at Doctor's Hospital at Renaissance Edinburg, TX, United States
Grigoriy Rapoport, MD1, Mariana Gonzalez Del Hierro, MD2, Mohammed Shakhatreh, MD3, Arturo Suplee Rivera, MD4, Asif Zamir, MD, FACG3 1University of Texas Rio Grande Valley at Doctor's Hospital at Renaissance, Edinburg, TX; 2University of Texas at Rio Grande Valley, Mcallen, TX; 3University of Texas Rio Grande Valley at Doctors Hospital at Renaissance, Edinburg, TX; 4University of Texas Rio Grande Valley at Doctors Hospital at Renaissance, McAllen, TX
Introduction: Granular cell tumors (GCT) are rare tumors that are most commonly found in the skin and subcutaneous tissues. Only 6-10% occur in the GI tract, predominantly in the lower esophagus. They are usually discovered incidentally on endoscopy and most patients are asymptomatic at the time of diagnosis. GCTs are typically benign and have a neurogenic origin. Only 1-2% are malignant. EUS plays an important role in both diagnosis and management to determine size, location, depth of invasion, origin and exclusion of lymph nodes. The classification of esophageal GCTs as benign or malignant remains poorly defined. With the development of EUS and access to EGD malignant characteristics are easier to identify. These procedures remain important tools for surveillance and monitoring for growth or recurrence. The following is a case of a patient diagnosed with a GCT.
Case Description/Methods: A 31 year old woman with a history of epigastric pain and heartburn underwent upper endoscopy. During the procedure a yellowish-grey lesion was visualized in the distal esophagus, 25 cm from the incisors, likely representing a GCT. Biopsies of the lesion were obtained, and pathology confirmed granular cell tumor. The patient was followed for the last 13 years and was noted to have spontaneous resolution of the tumor after 6 years, observed on subsequent surveillance EUS and EGD.
Discussion: GCTs are rare tumors that are usually found incidentally on endoscopy. After histological diagnosis, EUS plays an important role in determining prognosis. Characteristic ultrasound findings include a hypoechoic, homogeneous, and smooth-margined tumor within the mucosa (95%) or submucosa. The classic appearance of an esophageal GCT on EGD is a submucosal pill, a yellow-gray, intramural lesion with a firm to hard consistency, covered by normal-appearing mucosa. Histology shows nests of polygonal or fusiform cells with abundant eosinophilic or granular amphophilic cytoplasm, a consequence of enlarged lysosome and small pyknotic nuclei. Even though the percentage of malignancy is very low, identifying malignant features is very important because of the poor prognosis associated with metastatic disease. Endoscopic resection is considered a safe and therapeutic approach to management.
Figure: a. Granular Cell Tumor in the Esophagus b. Repeat EGD with resolution of the Granular Cell Tumor
Disclosures: Grigoriy Rapoport indicated no relevant financial relationships. Mariana Gonzalez Del Hierro indicated no relevant financial relationships. Mohammed Shakhatreh indicated no relevant financial relationships. Arturo Suplee Rivera indicated no relevant financial relationships. Asif Zamir indicated no relevant financial relationships.
Grigoriy Rapoport, MD1, Mariana Gonzalez Del Hierro, MD2, Mohammed Shakhatreh, MD3, Arturo Suplee Rivera, MD4, Asif Zamir, MD, FACG3. P1407 - An Unusual Case of a Granular Tumor of the Esophagus, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.