Gastrointestinal and biliary granular cell tumor: diagnosis and management

Abstract

Granular cell tumors (GCTs) are generally thought to be of Schwann cell origin and are typically S-100 positive. Up to 11% of these tumors affect the gastrointestinal tract, most commonly the esophagus, colon, and stomach. While GCTs are mostly benign, malignant and metastatic GCTs have been reported. GCTs are usually found incidentally during esophagogastroduodenoscopy, colonoscopy, imaging studies or during the evaluation of non-specific symptoms. Endoscopically, they are typically yellow in appearance with intact mucosa. On endoscopic ultrasound, they usually are hypoechoic, homogenous, smooth-edged lesions that appear to originate from the submucosal layer, although other endoscopic and ultrasound appearances have been described. There is no consensus on how to treat GCT. Surgical and conservative approaches have been described in the literature. GCTs can also affect the biliary tract, where patients may be misdiagnosed with cholangiocarcinoma. We explore the epidemiology, histology, clinical presentation, diagnosis and treatment of these tumors in the gastrointestinal tract, including the pharynx, esophagus, stomach, small intestine, large intestine and the perianal region. In addition, GCTs in the biliary tract are reviewed.

Gastric granular cell tumour, a rare entity

“…Diagnosis can be achieved by endoscopic biopsy through boring or performing a jumbo biopsy. However, up to 50% of the cases may not be conclusive 11…”

“…Table 1 compares some clinical, imagiological and pathological features of GCTs, carcinoid tumours and GISTs 2 8 10–12…”

“…As with all gastrointestinal GCTs, there is no consensus on treatment because of the rarity of these lesions 11…”

Benign Granular Cell Tumor of the Cecum

“…Patients with small intestine tumors can present with upper gastrointestinal bleeding or abdominal pain. Colorectal GCT can present with hematochezia, abdominal pain, and change in bowel habits [1,6]. The patient presented with a polyp in the cecal area, and we believe that the intermittent rectal bleeding he experienced was a result of the multiple adenomatous polyps present along with the GCT.…”

“…Granular cell tumors (GCT) are usually benign, soft tissue tumors that can be located in any part of the body, but are mostly found in the oral cavity, skin, and subcutaneous tissues [1]. These rarely occur in the gastrointestinal (GI) tract, showing only a frequency of 4% to 6%.…”