Esophageal Granular Cell Tumor With Symptomatic Presentation

Document Type

Conference Proceeding

Publication Date


Publication Title

American Journal of Gastroenterology


Introduction: Granular cell tumors make up 0.5% of all soft tissue tumors and were first thought to be muscular in origin, but now shown to have mostly neural cell origins from Schwannian derivation. They are most often benign lesions found in the skin, with other notable sites being tongue, respiratory tract, bladder, breast and gastrointestinal tract. Approximately 10 percent arise in the GI tract with the esophagus being the most common; however, it represents just 1% of benign esophageal tumors (1). Case Description/Methods: A 65-year-old woman with a past medical history of morbid obesity presented with heartburn and dysphagia to solids and liquids. Hemoglobin on presentation was 8.3 g/dL (unknown baseline). Esophagogastroduodenoscopy (EGD) demonstrated hyperemic esophageal mucousa with erosions of 1-2 mm. Narrow band imaging with dual focus was suggestive of intestinal metaplasia. A submucosal neoplasm of hemispherical shape was found 27 cm from the incisors along the posterior wall of the esophagus and had a diameter of 1.0 cm (Figure 1A). Endoscopic ultrasound found a subepithelial neoplasm in the lower third of the esophagus on the back wall measuring 11.0 x 8.0 mm with an intact muscle layer (Figure 1B). The mass was hypoechoic and heterogeneous with clear contours. Endoscopic submucosal dissection (ESD) was performed (Figure 1C). Immunohistochemical staining of the tumor cells yielded the following results: CD68 (PG-M1) positive, S100 (Polyclonal) positive, and SmoothMuscleActin (1A4) negative. The pathohistological diagnosis was Granular cell tumor of the esophagus and Barrett’s esophagus with mild epithelial dysplasia (Figure 1D). Discussion: A gastrointestinal tract granulosa cell tumor is a rare tumor that even an experienced gastroenterologist may not encounter throughout their career. The next step after identifying a mass is endoscopic ultrasound (EUS) in order to asses tumor size, location, and depth of invasion then resection for lesions over 1 cm (2). The rate of reoccurrence after resection has not been reported.





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American College of Gastroenterology Annual Scientific Meeting, October 20-25, 2023, Vancouver, Canada