Benign Granular Cell Tumor of the Cecum

Abstract

Granular cell tumors (GCT) are usually benign, soft tissue tumors that are mostly found in the oral cavity, skin, and subcutaneous tissue. GCTs in the gastrointestinal (GI) tract are mainly located in the esophagus. A 63-year-old male was referred to the gastroenterology clinic for a major complaint of six months of painless rectal bleeding. Laboratory results showed mild macrocytic anemia. He denied any prior colonoscopies and hence, a lower endoscopic procedure was done. The colonoscopy showed multiple polyps, one of them located at the cecum. The cecal polyp showed polygonal cells with abundant eosinophilic infiltration and S100 stain positive. This confirmed a diagnosis of GCT. GCTs are thought to be derived from the neural tissue (Schwann cells). This entity is usually asymptomatic; however, tumors located at the lower GI tract can present with hematochezia. Only 2% of GCTs follow a malignant course, with associated poor prognosis. This case is being presented because of its asymptomatic nature. It is important to monitor these lesions in order to recognize early signs/symptoms concerning for malignancy.

Granular cell tumour of cecum mimicking a neuroendocrine tumor

“…Follow-up colonoscopies are advised if multiple tumors or risk of malignancy exists. 4 In conclusion, colonic GCTs are very unusual and pose a diagnostic challenge due to lack of symptoms or nonspecific symptoms. Awareness of this entity helps in preventing misdiagnosis as happened in this case and avoids further unnecessary treatment.…”

“…1 Approximately, 20% of all the gastrointestinal GCTs are located in the colorectal region. 4 To date, about 130 cases have been reported in English literature. 2 In the colon, Right side -Ascending colon and Cecum is primarily favoured location.…”

“…The gold standard for the diagnosis is the typical histological findings: nests and clusters of epithelioid or spindle cells, with a small round nucleus and abundant eosinophilic granular cytoplasm. 4 The granules are periodic acid Schiff (PAS) -positive and diastase -resistant. On IHC, the neural markers, S-100 and neuron-specific enolase (NSE) are diffusely positive.…”

“…The characteristic features that have been proposed to predict malignant potential are tumour necrosis, tumor cell spindling, pleomorphism, high nuclear to cytoplasmic ratio, large nucleoli, and increased mitotic activity. If malignancy is found, this has a high propensity for metastasis, recurrence, and poor prognosis, 4 Since there are no established guidelines for the treatment of colorectal GCT, some physicians recommend performing endoscopic mucosal resection, endoscopic submucosal dissection, or polypectomy for tumors less than 2 cm. Follow-up colonoscopies are advised if multiple tumors or risk of malignancy exists.…”

A Rare Granular Cell Tumor with a Center Ulcer of the Rectum

“…Colorectal GCT occurs predominantly between the ages of 30 and 50 years [4]. It is found incidentally during screening colonoscopy and tends to be asymptomatic.…”