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Granular Cell Tumor in a Patient with Familial Adenomatous Polyposis

69

Gill, Jefferey MD; Marin, Cristina MD; Amodeo, Donald MD; Vidyarthi, Gitanjali MD; Boyd, William MD

American Journal of Gastroenterology: October 2010 - Volume 105 - Issue - p S25–S26
Abstracts: ESOPHAGUS
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James A. Haley VA Hospital, Tampa, FL.

Purpose: This is the first reported case of an association of familial adenomatous polyposis and granular cell tumor of esophagus. Our patient is a 39 y/o gentleman who presented to our hospital for follow-up EGD for surveillance as he had history of familial adenomatous polyposis. He had past surgical history of colectomy and J pouch about 19 years ago. He had no EGDs in the last 9 years. He wanted his care to be transferred to our VA hospital. His EGD was remarkable for multiple polyps in stomach body and fundus about 2-3 mm in size. Small polyps were noted in duodenum as well, papilla was normal. Biopsy of these polyps revealed it to be tubular adenoma. On follow-up EGD in 6 months, a 5 mm nodule with yellowish hue was noted and removed. Rest of the EGD was similar, in terms of small polyps in stomach and duodenum, to the prior endoscopy. Histology of stomach and duodenal polyps unchanged, specifically, they were adenomas. Rather surprising was the finding in esophagus which was reviewed by AFIP as well. It was granular cell tumor. The patient has done well since the granular cell tumor was removed and on follow-up endoscopy, he has shown no recurrence. It has been eighteen months since his lesion was removed. Patients with familial adenomatous polyposis have an accelerated growth of polyp and require frequent EGDs for early detection of neoplasm. However, no known association between familial adenomatous polyposis and granular cell has been reported before. Therefore, in patients with familial adenomatous polyposis, the association with neuroectodermal tumors needs to be borne in mind as well. It is remarkable this lesion was detected in only six months since his last EGD indicating a very rapid growth which is worrisome. It also illustrates the importance of close follow-up with EGDs as well; not just colonoscopies. Granular cell tumor accounts for less than 1% of gastrointestinal tumors. Esophagus is the most common site in the gastrointestinal tract. They are thought to arise from Schwann cells in submucosa. These lesions are typically submucosal and have a yellowish hue as in our patient. Malignant degeneration is known to occur.

Figure. [69

Figure. [69

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