Case Report

Four Cases of Patients with Gastrointestinal Granular Cell Tumors

Authors: Douglas L. Lowe, MD, Ayaz J. Chaudhary, MD, FACG, Jeffrey R. Lee, MD, Sherman M. Chamberlain, MD, FACG, Robert R. Schade, MD, FACG, Urias Cuartas-Hoyos, MBBS, FACG

Abstract

We present four cases of gastrointestinal granular cell tumors (GCT) with a literature review. Gastrointestinal granular cell tumors, a benign neural tumor thought to arise from Schwann cells, can occur in several areas, including the gastrointestinal tract. Studies suggest that endoscopic ultrasound and endoscopic removal is the treatment of choice for esophageal GCTs if they are small in size (<2 cm) and do not involve the muscularis propria. GCTs are malignant less than 2% of the time. Although most GCTs are benign and can be followed endoscopically without resection, the malignant potential warrants evaluation with endoscopic ultrasound for possible endoscopic or surgical resection.


Key Points


* Granular cell tumors (GCTs) occur in several areas including the gastrointestinal tract in 1–8% of cases.


* Studies suggest that endoscopic ultrasound and endoscopic removal is the treatment of choice for esophageal GCTs if they are small in size (<2 cm) and do not involve the muscularis propria.


* Although most GCTs are benign and can be followed endoscopically, the malignant potential warrants evaluation with endoscopic ultrasound for possible endoscopic or surgical resection.

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References

1. Kojima T, Takahashi H, Parra-Blanco P, et al. Diagnosis of submucosal tumor of the upper GI tract by endoscopic resection. Gastrointest Endosc 1999;50:516–522.
 
2. Weiss S, Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors. 4th Edition. St Louis, CV Mosby, 2001.
 
3. Tada S, Iida M, Yao T, et al. Granular cell tumor of the esophagus: endoscopic ultrasonographic demonstration and endoscopic removal. Am J Gastroenterol 1990;85:1507–1511.
 
4. Bin-Sagheer S, Brady P, Brantley S, et al. Granular cell tumor of the pancreas: presentation with pancreatic duct obstruction. Am J Gastroenterol 2000;95:2564.
 
5. Okano A, Takakuwa H, Nishio A. Granular cell tumor of the rectum. Gastrointest Endosc 2001;54:624.
 
6. Rossi GB, de Bellis M, Marone P, et al. Granular cell tumors of the colon: report of a case and review of the literature. J Clin Gastroenterol 2000;30:197–199.
 
7. Cohen MG, Greenwald ML, Grabus JE, et al. Granular cell tumor-a unique neoplasm of the internal anal sphincter: report of a case. Dis Colon Rectum 2000;43:1444–1446.
 
8. Palazzo L, Landi B, Cellier C, et al. Endosonographic features of esophageal granular cell tumors. Endoscopy 1997;29:850–853.
 
9. Melo CR, Melo IS, Schmitt FC, et al. Multicentric granular cell tumor of the colon: report of a patient with 52 tumors. Am J Gastroenterol 1993;88:1785–1787.
 
10. Joshi A, Chandrasoma P, Kiyabu M. Multiple granular cell tumors of the gastrointestinal tract with subsequent development of esophageal squamous carcinoma. Dig Dis Sci 1992;37:1612–1618.
 
11. Onoda N, Kobayashi H, Satake K, et al. Granular cell tumor of the duodenum: a case report. Am J Gastoenterol 1998;93:1993–1994.
 
12. White JG, el-Newihi HM, Hauser CJ. Granular cell tumor of the stomach presenting as gastric outlet obstruction. Am J Gastoenterol 1994;89:2259–2260.
 
13. Martin R, Stulc J. Multifocal granular cell tumor of the biliary tree: case report and review. Gastrointest Endosc 2000;51:238–240.
 
14. Orlowska J, Pachlewski J, Gugulski A, et al. A conservative approach to granular cell tumors of the esophagus: four case reports and literature review. Am J Gastroenterol 1993;88:311–315.
 
15. David O, Jakate S. Multifocal granular cell tumor of the esophagus and proximal stomach with infiltrative pattern: a case report and review of the literature. Arch Pathol Lab Med 1999;123:967–973.
 
16. White J, El-Newihi H, Hauser C. Granular cell tumor of the stomach presenting as gastric outlet obstruction. Am J Gastoenterol 1994;89:2259–2260.
 
17. Esaki M, Aoyagi K, Hizawa K. Multiple granular cell tumors of the esophagus removed endoscopically: a case report. Gastrointest Endosc 1998:48;536–539.
 
18. Shikuwa S, Matsunaga K, Osabe M, et al. Esophageal granular cell tumor treated by endoscopic mucosal resection using a ligating device. Gastrointest Endosc 1998;47:529–532.
 
19. Polkowski M. Endoscopic ultrasound and endoscopic ultrasound-guided fine-needle biopsy for the diagnosis of malignant submucosal tumors. Endosocpy 2005;37:635–645.
 
20. Kawamoto K, Yamada Y, Utsunomiya T, et al. Gastrointestinal submucosal tumors: evaluation with endoscopic US. Radiology 1997;205:733–740.
 
21. Wiech T, Walch A, Werner M. Histopathological classification of nonneoplastic and neoplastic gastrointestinal submucosal lesions. Endoscopy 2005;37:630–634.
 
22. Vanstapel J, Peeters B, Cordell J, et al. Production of monoclonal antibodies directed against antigenic determinants common to the alpha- and beta-chain of bovine brain S-100 protein. Lab Invest 1985;52:232–238.
 
23. Yasuda I, Tomita E, Nagura K, et al. Endoscopic removal of granular cell tumors. Gastrointest Endosc 1995;41:163–167.