Abstract
Introduction
Granular cell tumors are uncommonly found in the gastrointestinal tract with slow progression and are usually benign though they may have propensity for malignant transformation. Initially attributed to neuronal origin through immunohistochemistry, there has been controversy with increasing reports of granular cell tumors of non-neural origin.
Case Report
We report a case of multifocal granular cell tumor involving the esophagus and stomach in a young female with history of dysphagia for 9 years with worsening symptoms. She had been managed at another facility with repeated dilations for presumed benign peptic stricture. Radial endosonography (EUS) of the proximal end of stricture showed a posterior submucosal esophageal mass that was heterogeneous and invaded into the muscularis propria. Fine-needle aspiration (FNA) showed large cells with granular cytoplasm along with spindle nuclei. Cells were initially checked for CD117 stain alone and found to be negative. A follow-up CT-guided core needle biopsy revealed similar granular cells that were positive for S-100. She underwent a two-stage transhiatal esophagogastrectomy as the tumor circumferentially involved the cervical esophagus and was adherent to the trachea and recurrent laryngeal nerve bilaterally. At surgery, there were two additional foci palpable in the proximal stomach.
Discussion and Conclusion
As these tumors may have potential for malignant transformation and locoregional invasion, they should be considered while evaluating submucosal lesions of the esophagus even in young patients. A large number of granular cell tumors may be missed in the absence of S-100 staining, which should be requested when granular cells are seen on cytology obtained by EUS FNA as this can be a minimally invasive diagnostic modality for these tumors. Other foci should be sought at surgery as they have a propensity for locoregional spread.
Similar content being viewed by others
References
Abrikossoff A. Uber Myome, ausgehend von der quergestreiften willkurlichen Muskulatur. Virchows Arch Pathol Anat. 1926;260:215–33. doi:10.1007/BF02078314.
Abrikossoff A. Weitere Untersuchunger uber Myoblastemyome. Virchow’s Arch Pathol Anat. 1931;280:723–40. doi:10.1007/BF02038883.
Fischer ER, Wechsler H. Granular cell myoblastoma- a misnomer. Electron microscopic and histochemical evidence concerning its Schwann cell derivation and nature (granular cell schwannoma). Cancer. 1962;15:936–43. doi:10.1002/1097-0142(196209/10)15:5<936::AID-CNCR2820150509>3.0.CO;2-F.
Seo I, Warner TF. Multiple visceral and cutaneous granular cell tumors. Ultrastructural and immunocytochemical evidence of Schwann cell origin. Cancer. 1984;53:2104–10. doi:10.1002/1097-0142(19840515)53:10<2104::AID-CNCR2820531019>3.0.CO;2-F.
Damm DD, Ctbull ML, Geissler BS, et al. Investigation into the histogenesis of congenital epulis of the newborn. Oral Surg Oral Med Oral Pathol. 1993;76:205–212. doi:10.1016/0030-4220(93)90206-J.
Ulrich J, Heitz PU, Fischer T, et al. Granular Cell tumors: evidence for heterogenous tumor cell differentiation. Virchows Arch B Cell Pathol Incl Mol Pathol. 1987;53(1):52–7. doi:10.1007/BF02890224.
Yeh I, Tran DT, Davis TL, Argenyi ZB. An infiltrative variant of non-neural granular cell tumor: a case report. J Cutan Pathol. 2009; 9999: 1–6. doi:10.1111/j.1600-0560.2008.01214.x
Chaudhry IH, Calonje E. Dermal non-neural granular cell tumour (so-called primitive polypoid granular cell tumour): a distinctive entity further delineated in a clinicopathological study of 11 cases. Histopathology. 2005;47(2):179–85. doi:10.1111/j.1365-2559.2005.02192.x.
Blandamura S, Altavilla G, Castoro C, Antonini C, Piazza M. Combined granular cell tumour of the oesophagus and stomach: a case report and review of the literature. Ital J Gastroenterol. 1993;25:259–64.
Rubesin S, Herlinger H, Sigal H. Granular cell tumors of the esophagus. Gastrointest Radiol. 1985;10:11–15. doi:10.1007/BF01893063.
Johnson J, Helwig EB. Granular cell tumors of the gastrointestinal tract and perianal region: a study of 74 cases. Dig Dis Sci. 1981;26:807–16. doi:10.1007/BF01309613.
Harikumar R. Abrikosoff’s tumor of the esophagus: case report and review of literature. Trop Gastroenterol. 2006;27:52–3.
Parfitt JR. Granular cell tumours of the gastrointestinal tract: expression of nestin and clinicopathological evaluation of 11 patients. Histopathology. 2006;48:424–30. doi:10.1111/j.1365-2559.2006.02352.x.
Paskin DL, Hull JD, Cookson PJ. Granular cell myoblastoma: a comprehensive review of 15-ears experience. Ann Surg. 1972;175:501–4. doi:10.1097/00000658-197204000-00007.
Lack E, Worsham G, Callihan M. Granular cell tumor: a clinicopathologic study of 110 patients. J Surg Oncol. 1980;13:301–16. doi:10.1002/jso.2930130405.
Billeret Lebranchu V. Granular cell tumor Epidemiology of 263 cases. Arch Anat Cytol Pathol. 1999;47:26–30.
Obiditsch-Mayer I, Salzer-Kuntschik M. Malignes, “getorntzelliges neurom” sogenanntes, “myoblastenmyom”, des oesophagus. Beitr Pathol Anat. 1961;125:357–73.
Flood CA. Granular cell tumor of the esophagus. Gastrointest Endosc. 1981;27:225–7. doi:10.1016/S0016-5107(81)73228-0.
Patel RM. Granular cell tumor of the esophagus. Am J Gastroenterol. 1981;76:519–23.
Giacobbe A. Granular cell tumor of the esophagus. Am J Gastroenterol. 1988;83:1398–400.
Narra SL, Tombazzi C, Datta V, Ismail MK. Granular cell tumor of the esophagus: report of five cases and review of the literature. Am J Med Sci. 2008;355:338–41. doi:10.1097/MAJ.0b013e3181568197.
Goldblum JR, Rice TW, Zuccaro G, et al. Granular cell tumors of the esophagus: a clinical and pathologic study of 13 cases. Ann Thorac Surg. 1996;62:860–865. doi:10.1016/S0003-4975(96)00443-2.
Orlowska J, Pachlewski J, Gugulski A, Butruk E. A conservative approach to granular cell tumors of the esophagus: four case reports and literature review. Am J Gastroenterol. 1993;88:311–5.
Joshi A, Chandrasoma P, Kiyabu M. Multiple granular cell tumors of the gastrointestinal tract with subsequent development of esophageal squamous cell carcinoma. Dig Dis Sci. 1992;37:1612–8. doi:10.1007/BF01296510.
Fried KS, Arden JL, Gouge TH, Balthazar EJ. Multifocal granular cell tumor of the gastrointestinal tract. Am J Gastroenterol. 1984;79:751–5.
Strong EW, McDivitt RW, Brasfield RD. Granular cell myoblastoma. Cancer. 1970;25:415–22. doi:10.1002/1097-0142(197002)25:2<415::AID-CNCR2820250221>3.0.CO;2-T.
Perego P, Bovo G, Brenna G, Bratina G. Associazione di tumore a cellule granulose e carcinoma epidermoide dell`esofago. Pathologica. 1995;87:551–553.
Vinco A, Vettoretto N, Cervi E, et al. Association of multiple granular cell tumors and squamous carcinoma of the esophagus: case report and review of the literature. Dis Esophagus. 2001;14:262–264. doi:10.1046/j.1442-2050.2001.00198.x.
Saito K, Kato H, Fukai Y, et al. Esophageal granular cell tumor covered by intramucosal squamous cell carcinoma: report of a case. Surg Today. 2008;38:651–5. doi:10.1007/s00595-007-3694-2.
Palazzo L. Endosonographic features of esophageal granular cell tumors. Endoscopy. 1997;29:850–3. doi:10.1055/s-2007-1004320.
Subramanyam K, Shannon CR, Patterson M, Davis M, Gourley WK. Granular cell myoblastoma of the esophagus. J Clin Gastroenterol. 1984;6:113–8. doi:10.1097/00004836-198404000-00003.
Yasuda I, Nakazawa S, Yoshino J, et al. Indication for endoscopic resection of submucosal tumor by endoscopic ultrasonography. Gastroenterol Endosc. 1993;35:2041–7.
Fanburg-Smith JC. Malignant granular cell tumor of soft tissue: diagnostic criteria and clinicopathologic correlation. Am J Surg Pathol. 1998;22:779–94. doi:10.1097/00000478-199807000-00001.
Wieczorek TJ, Krane JF, Domanski HA, et al. Cytologic findings in granular cell tumors, with emphasis on the diagnosis of malignant granular cell tumor by fine-needle aspiration biopsy. Cancer. 2001;93(6):398–408. doi:10.1002/cncr.10143.
Ordonez NG. Granular cell tumor: a review and update. Adv Anat Pathol. 1999;6:186–203. doi:10.1097/00125480-199907000-00002.
Yoshizawa A, Ota H, Sakaguchi N, et al. Malignant granular cell tumor of the esophagus. Virchows Arch. 2004;444:304–6. doi:10.1007/s00428-003-0957-1.
Tada S. Granular cell tumor of the esophagus: endoscopic ultrasonographic demonstration and endoscopic removal. Am J Gastroenterol. 1990;85:1507–11.
Yasuda I, Tomita E, Nagura K, et al. Endoscopic removal of granular cell tumor. Gastrointest Endosc. 1995;41:163–7. doi:10.1016/S0016-5107(05)80604-2.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
John, B.K., Dang, N.C., Hussain, S.A. et al. Multifocal Granular Cell Tumor Presenting as an Esophageal Stricture. J Gastrointest Canc 39, 107–113 (2008). https://doi.org/10.1007/s12029-009-9056-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12029-009-9056-0