Symptomatic granular cell tumor of the esophagus

Surgical treatment of a rare case of granular cell tumour of the cervical oesophagus

A female patient was operated upon due to cervical oesophageal stricture induced by a tumour located just below the throat. Local excision of the tumour and reconstruction of the oesophageal wall was performed using the pre-vertebral fascia due to the presence of extensive oesophageal mucosa damage. The patient also required temporary alimentation by the gastrostomy route due to swallowing disturbances. The oesophagram depicted a contrasting airway passage without any evidence of fistula and contrast medium leakage through the oesophageal lumen. Four months after the operation, the patient did not report any issue with oral intake. The postoperative histopathological and immunohistochemical examinations provided evidence of a granular cell tumour (GCT). We believe that local excision of the tumour should always be considered in cases of tumours located close to the throat because it is less invasive than partial resection of a GCT in the oesophagus or oesophagogastrectomy.

[Multifocal Abrikossoff's granular cell tumour of the oesophagus--case report]

INTRODUCTION

Granular cell tumours, relatively uncommon soft tissue tumours, have been a matter of debate among pathologists regarding histogenesis for a long time. Less common locations are in the aerodigestive tract including the oesophagus.

CASE OUTLINE

We have recently treated a rare case, a 37-year-old male, who was admitted due to dysphagia and a painful swallow with occasional pharyngo-nasal regurgitation followed with a mild loss of weight. Standard clinical examination including X-ray chest, ECG and laboratory tests did not show pathological findings. Barium contrast oesophagography demonstrated multiple ovoid defects in the wall of the oesophagus. CT scan of the chest confirmed luminal narrowing owing to the tumour of the upper oesophagus. Upper endoscopy showed unusual multifocal nodular lesions alongside the oesophageal axis covered by smooth mucosa. A primary biopsy specimen taken from the largest nodules confirmed an unusual pathological finding of the granular cell tumour. Subtotal, transpleural oesophagectomy was performed and reconstruction was derived by long colon segment interposition through the posterior mediastinum. The postoperative course was uneventful. The operative specimen consisted of four ovoid tumours alongside the oesophagus (the greatest diameter 0.5-1.8, average 1.25). All verified tumours histologicaly consisted of a spindle-shaped or polygonal cells containing small and large eosinophilic granules and central nuclei. Most tumour cells showed strongly positive immunohistochemical staining for S-100 protein. These tumour cells were partially positive for p-53 and Ki-67. No lymph node metastases were detected histologically.

CONCLUSION

Multifocal granular cell tumour of the oesophagus is an unusual finding with low incidence, and rarely caused symptoms. Pathological features and multiplicity of such tumours emphasized malignant predisposition requiring surgical resection of the oesophagus.

Benign esophageal tumors: introduction, incidence, classification, and clinical features

Benign esophageal tumors comprise a diverse group of disorders that are rare in relation to malignant tumors or other benign conditions. The current article summarizes the literature with regard to the incidence and prevalence of benign tumors of the esophagus and discusses the various methods used to categorize these conditions. Summaries of important clinical features are provided for leiomyomas, esophageal cysts, fibrovascular polyps, papillomas, granular cell tumors and others.

Multifocal granular cell tumor of the esophagus and proximal stomach with infiltrative pattern: a case report and review of the literature

The granular cell tumor is a solitary painless nodule that arises most commonly on the skin or the tongue. The vast majority are benign. Approximately 5% to 9% of granular cell tumors have been reported in the gastrointestinal tract, most commonly in the esophagus. We report a case of a 45-year-old African American woman with multifocal granular cell tumors of the esophagus and proximal stomach. Two lesions within the distal esophagus and proximal stomach were characteristic nodular granular cell tumors. Within the mid esophagus there was poorly defined transmural involvement by benign-appearing granular cells. This pattern of infiltration by benign cells is uncharacteristic. A review of the literature with emphasis on the determination of malignancy is also presented.

Strip biopsy to treat esophageal granular cell tumor

Esophageal granular cell tumors are rare neoplasms. We successfully treated a 35-year-old Japanese man with an esophageal granular cell tumor without any complications using strip biopsy. Endoscopic ultrasonography revealed a hypoechoic tumor with a diameter of 8 mm that was confined to the submucosal layer. A strip biopsy done with a two-channel endoscope completely resected the tumor. Six months later, no abnormal findings were recognized in the resected area. Therefore we propose that strip biopsy be considered as a viable alternative treatment for esophageal granular cell tumor, depending on the histologic character, tumor size, and depth of tumor infiltration.