Granular Cell Tumor of the Esophagus: A Patient Treated by Endoscopic Mucosal Resection with Long Term Follow-Up

doi:10.4236/ijcm.2013.48063

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International Journal of Clinical Medicine, 2013, 4, 355-356

http://dx.doi.org/10.4236/ijcm.2013.48063 Published Online August 2013 (http://www.scirp.org/journal/ijcm) 355

Granular Cell Tumor of the Esophagus: A Patient Treated

by Endoscopic Mucosal Resection with Long Term

Follow-Up

Siu-Kee Leung1*, Shing-Hoi Fung2, Siu-Chuen Chiu3

1Department of Surgery, Tuen Mun Hospital, Hong Kong, China; 2Department of Pathology, Pamela Youde Nethersole Eastern Hos-

pital, Hong Kong, China; 3Department of Pathology, Tuen Mun Hospital, Hong Kong, China.

Email: *[email protected]

Received April 28th, 2012; May 10th, 2013; accepted June 2nd, 2013

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Granular cell tumors (GCTs) of the esophagus are uncommon. We report a case of granular cell tumor of esophagus

treated by endoscopic mucosal resection (EMR) with long term follow-up.

Keywords: Granular Cell Tumor; Esophagus; Endoscopic Mucosal Resection; Long Term Follow-Up

1. Introduction

Granular cell tumors (GCTs) of the esophagus are un-

common. They are usually small and well circumscribed.

Evaluation by endoscopic ultrasound (EUS) is useful. If

the lesion is limited to the submucosa, endoscopic re-

moval is feasible. We report a case treated by endoscopic

mucosal resection (EMR) with long-term follow-up.

2. Case Report

A 40-year-old man presented with mild epigastric pain

for one year. He was a heavy smoker with chronic ob-

structive pulmonary disease. There was no symptom of

gastroesophageal reflux. He could tolerate full solid diet

and there was no weight loss. Physical examination was

unremarkable.

Upper gastrointestinal endoscopy revealed a nodular,

yellowish-white lesion over mucosa of esophagus, at 35

cm from incisor (Figure 1). EUS using a 20 MHz probe

was performed. The tumor was 1 cm in maximal diame-

ter. It was hyperechoeic compared with muscularis pro-

pria, and confined to the submucosa (Figure 2). Endo-

scopic mucosal resection (EMR) was performed, using

submucosal injection of normal saline and loop snaring

technique.

Histological examination showed sheets of spindled

and polygonal cells with small bland regular nuclei and

Figure 1. Endoscopic view of granular cell tumor of eso-

phagus.

Figure 2. Endoscopic ultrasound view.

abundant palely eosinophilic granular cytoplasm.

Low power view with Hematoxylin and Eosin (H & E)

stain (Figure 3) showed a small oval, well-demarcated

submucosal nodule, composed of sheets of spindled and

polygonal cells. Cytologically (Figure 4), they showed

small round or slightly irregular nuclei and abundant

palely eosinophic granular cytoplasm. Mitosis was not

seen and pleomorphism was minimal. Immunohisto che-

mical stain with S100 showed strong positivity (Figure

5).

*Corresponding a uthor.

Granular Cell Tumor of the Esophagus: A Patient Treated by Endoscopic Mucosal

Resection with Long Term Follow-Up

356

Figure 3. Low power, Hematoxylin and Eosin stain (H & E

stain).

Figure 4. High power view, H & E stain.

Figure 5. S100 stain.

Follow-up endoscopy was performed at 1, 3 months

and then yearly for 4 years. The findings were normal.

The patient remained asymptomatic for 10 years after

EMR.

3. Discussion

First described by Abriko ssoff in 1931, GCTs of the eso-

phagus are uncommon tumors. They are stromal lesions

originating from the Schwann cells of the submucosal

neuronal plexus [1-3]. They constitute the second largest

group of non-epithelial tumors in the esophagus after

leiomyoma [3,4].

The lesion is commonly located in the distal one third

of the esophagus. GCTs are generally considered benign,

although a few malignant cases have been reported [3].

They may be multiple and synchronous [2].

The history of determining the histogenesis of GCTs is

interesting. Initially they were called granular cell myo-

blastomas. However, histochemical studies show that

they are intensely stained with antiserum to S-100 pro-

tein, which is a marker of Schwann cells [1].

Endoscopically, GCTs appear as small, yellow mucosa

lesions.

In endoscopic ultrasonography, GCTs arise from the

submucosal layer. Compared with esophageal leiomyoma,

they are more hyperechoeic. The use of high frequency

ultrasound probes is usef ul to differentiate the two [4,5].

When EUS shows that there is no evidence of in-

volvement of muscularis propria (MP), endoscopic mu-

cosal resection (EMR) is a feasible treatment modality

[5,6].

When the lesion is large or when there is invasion of

MP, surgical treatment may become necessary. However,

consensus is lacking on the treatment and follow-up of

this tumor.

The reported case is a patient with GCT treated by

EMR. He remained well for 10 years after the procedure.

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