Augusta University-Medical College of Georgia Augusta, GA, United States
Anabel Liyen Cartelle, MD1, Ahmad Alkaddour, MD2, John Erikson Yap, MD3 1Beth Israel Deaconess Medical Center, Boston, MA; 2Augusta University-Medical College of Georgia, Augusta, GA; 3Medical College of Georgia at Augusta University, Augusta, GA
Introduction: A granular cell tumor (GCT) is a rare soft tissue neoplasm of neurogenic origin that is often benign, although malignant potential has been described. It is often detected within the oral cavity, skin, and subcutaneous tissue. Although rarely found within the digestive tract, the most reported site is the esophagus. In this case, we detail the incidental finding of an esophageal GCT via esophagogastroduodenoscopy (EGD).
Case Description/Methods: 55-year-old female was referred for evaluation of chronic epigastric pain non-responsive to PPI therapy. She denied any dysphagia, NSAID use, heartburn or other reflux symptoms. Physical exam revealed epigastric tenderness for which an EGD was performed. During the procedure, a 4 mm sub-epithelial lesion with overlying white plaque was detected in the mid-esophagus (figure 1). Pathology revealed a benign GCT with overlying epithelial hyperplasia that stained positive for both CD68 and S100. Rest of her laboratory work-up including CBC, electrolytes, LFTs were normal.
Discussion: Approximately 8% of GCTs develop within the digestive tract, of which almost 2/3 of cases involve the esophagus. It is the second most common esophageal stromal tumor after leiomyoma. Grossly, they appear as small grayish white to yellow nodules or plaques. They are theorized to originate from Schwann cells that form part of the submucosal neuronal plexus of the esophagus. Histological stains support this theory demonstrating diastase resistance and frequently positive periodic acid–Schiff, nestin, S100, and CD68. Detection of these lesions is often incidental; however, for those with a diameter > 1 cm, it may present with dysphagia.
Malignant GCTs are usually >4 cm and are characterized by rapid growth and invasion of adjacent tissues resulting in a high recurrence rate after excision. Endoscopic ultrasound pattern of esophageal GCTs appears as a solid hypoechoic lesion with smooth borders and a mildly inhomogeneous echo pattern which is useful for differentiating from leiomyomas. Endoscopic follow-up is recommended for asymptomatic patients with tumors less than 10 mm in size; while endoscopic resection and/or surgical excision is recommended for tumors ranging from 10–20 mm or >20 mm, respectively. Excision is generally recommended regardless of size in symptomatic patients, although optimum management remains controversial. Increased awareness of these lesions by endoscopist and pathologist is necessary for accurate diagnosis and management when encountered.
Figure: Figure 1: Subepithelial lesion with white plaque appearance seen in mid-esophagus on EGD.
Disclosures: Anabel Liyen Cartelle indicated no relevant financial relationships. Ahmad Alkaddour indicated no relevant financial relationships. John Erikson Yap indicated no relevant financial relationships.
Anabel Liyen Cartelle, MD1, Ahmad Alkaddour, MD2, John Erikson Yap, MD3. P2454 - Granular Cell Tumor of the Esophagus: A Case Report, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.