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Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e3181fb47b8
Image of the Month

Cecal Granular Cell Tumor

Sultan, Mutaz I MD*,†; Suchi, Mariko MD, PhD; Werlin, Steven L MD*

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*Division of Pediatric Gastroenterology, Department of Pediatrics, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, Wisconsin, WI, USA

Department of Pediatrics, Makassed Hospital, Jerusalem, Israel

Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

Address correspondence and reprint requests to Steven L. Werlin, MD, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226 (e-mail: swerlin@mcw.edu).

The authors report no conflicts of interest.

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at www.jpgn.org, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.

A 10-year-old girl presented with hematochezia. Physical examination and routine blood tests were normal. Colonoscopy revealed a 30- × 22-mm friable polyp in the transverse colon and a yellowish polypoid sessile lesion, 12 × 10 mm, covered by intact mucosa in the cecum (Fig. 1).

Figure 1
Figure 1
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Both were removed by snare polypectomy and hematochezia resolved. The transverse colon polyp was a juvenile polyp. Histological examination of the cecal lesion revealed a well-circumcised mainly submucosal tumor composed of nests of large cells with abundant granular eosinophilic cytoplasm and small oval to spindled nuclei, consistent with granular cell tumor (GCT) (Fig. 2). Tumor cells exhibited nuclear and cytoplasmic positivity for S100 protein by immunohistochemistry. We believe that the GCT was an incidental finding.

Figure 2
Figure 2
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GCT is an uncommon, largely benign neoplasm that originates from a Schwann-like cell (1,2). They are more common between the ages 40 and 50 years. GCT is relatively rare in the gastrointestinal tract, accounting for 5% to 9% of reported cases (3). The most common gastrointestinal site is the esophagus (3). Endoscopically, GCTs are yellow submucosal nodules covered by normal mucosa.

Most GCTs are asymptomatic. Endoscopic ultrasound can be helpful in evaluating GCTs to ensure that the tumor is suitable for endoscopic removal, and mucosal lift may be necessary before resection to reduce the risk of perforation. Endoscopic resection is the treatment of choice for gastrointestinal GCTs because they are usually benign (4,5).

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REFERENCES

1. Johnston J, Helwig EB. Granular cell tumors of the gastrointestinal tract and perianal region: a study of 74 cases. Dig Dis Sci 1981; 26:807–816.

2. Armin A, Connelly EM, Rowden G. An immunoperoxidase investigation of S-100 protein in granular cell myoblastomas: evidence for Schwann cell derivation. Am J Clin Pathol 1983; 79:37–44.

3. Lack EE, Worsham GF, Callihan MD, et al. Granular cell tumor: a clinicopathologic study of 110 patients. J Surg Oncol 1980; 13:301–316.

4. Yasuda I, Tomita E, Nagura K, et al. Endoscopic removal of granular cell tumors. Gastrointest Endosc 1995; 41:163–167.

5. Lowe DL, Chaudhary AJ, Lee JR, et al. Four cases of patients with gastrointestinal granular cell tumors. South Med J 2007; 100:298–300.

Copyright 2011 by ESPGHAN and NASPGHAN

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