International Journal of Clinical Medicine, 2013, 4, 355-356 Published Online August 2013 ( 355
Granular Cell Tumor of the Esophagus: A Patient Treated
by Endoscopic Mucosal Resection with Long Term
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: *
Received April 28th, 2012; May 10th, 2013; accepted June 2nd, 2013
Copyright © 2013 Siu-Kee Leung et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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
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
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-
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
*Corresponding a uthor.
Copyright © 2013 SciRes. IJCM
Granular Cell Tumor of the Esophagus: A Patient Treated by Endoscopic Mucosal
Resection with Long Term Follow-Up
Figure 3. Low power, Hematoxylin and Eosin stain (H & E
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
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
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
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.
[1] K. Stefansson and R. L. Wollmann, “S-100 Protein in
Granular Cell Tumors (Granular Cell Myoblastomas),”
Cancer, Vol. 49, No. 9, 1982, pp. 1834-1838.
[2] J. R. Goldblum, T. W. Rice, G. Zuccaro and J. E. Richter,
“Granular Cell Tumors of the Esophagus: A Clinical and
Pathologic Study of 13 Cases,” Annals of Thoracic Sur-
gery, Vol. 62, No. 3, 1996, pp. 860-865.
[3] L. De Rezende, A. J. Lucendo and H. Alvarez-Arguelles,
“Granular Cell Tumors of the Esophagus: Report of Five
Cases and Review of Diagnostic and Therapeutic Tech-
niques,” Diseases of the Esophagus, Vol. 20, No. 5, 2007,
pp. 436-443. doi:10.1111/j.1442-2050.2007.00692.x
[4] D. U. Kim, G. H. Kim, D. Y. Ryu, D. G. Lee, J. H.
Cheong, B. E. Lee, G. A. Song, Y. Park do, N. R. Shin, I.
H. and M. Kida, “Endosonographic Features of Esophag-
eal Granular Cell Tumors Using a High-Frequency Cathe-
ter Probe,” Scandinavian Journal of Gastroenterology,
Vol. 46, No. 2, 2011, pp. 142-147.
[5] M. Esaki, K. Aoyagi, K. Hizawa, S. Nakamura, K. Hira-
kawa, H. Koga, T. Yao and M. Fujishima, “Multiple
Granular Cell Tumors of the Esophagus Removed Endo-
scopically: A Case Report,” Gastrointestinal Endoscopy,
Vol. 48, No. 5, 1998, pp. 536-539.
[6] L. Palazzo, B. Landi, C. Cellier, G. Roseau, S. Chaussade,
D. Couturier and J. Barbier, “Endosonographic Features
of Esophageal Granular Cell Tumors,” Endscopy, Vol. 29,
No. 9, 1997, pp. 850-853. doi:10.1055/s-2007-1004320
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