1830 Granular Cell Tumor as a Rare Cause of Dysphagia

Abstract

INTRODUCTION: Granular cell tumors are a rare cause of dysphagia and dyspepsia. While rare and difficult to detect, diagnosis and resection of GCTs can often provide symptomatic relief in patients. We present a case of a patient with chronic dyspepsia and dysphagia, with a seemingly incidental finding of an esophageal granular cell tumor. CASE DESCRIPTION/METHODS: Patient was a 32-year-old female with a past medical history significant for SLE-Sjogren’s overlap syndrome who presented to the GI clinic for a follow-up appointment with new complaint of dysphagia for two weeks. Patient was evaluated one year prior with complaints of nausea, vomiting, and dyspepsia which was managed with levbid and amitripyline; however, she continued to have symptoms of epigastric abdominal pain. Physical exam was unremarkable. Given continued epigastric abdominal pain and now dysphagia, PPI was increased to twice daily. Repeat EGD showed a nodule in the esophagus, and pathology was consistent with granular cell tumor (GCT) (Figure 1). Patient underwent endoscopic ultrasound (EUS) which showed a sub epithelial 7x3mm hypoechoic nodule in upper third of esophagus within the luminal interface/superficial mucosa and deep mucosa (Figure 2). Patient underwent endoscopic mucosal resection (EMR) of the nodule one month later. On histological evaluation, the resection appeared complete, but there was one margin with tumor extending to the margin, so there was a plan for the patient to repeat EUS/EGD in six months. At six month follow-up, her dysphagia had resolved and her functional abdominal pain had improved enough to allow decreasing her medication requirements. DISCUSSION: Thought to originate from Schwann cells, GCTs are extremely rare tumors that can occur at any anatomical location. Nestin expression in GCTs indicates that they may arise from a common stem cell in the GI tract, which can differentiate along both interstitial cells of Cajal and peripheral nerve pathways, leading to the common abdominal symptoms of abdominal pain, distention, and dysphagia. Decision for removal is determined based on size, with those less than 1 cm in diameter usually being treated conservatively, and those greater than 1cm typically removed, regardless of symptoms, due to increased incidence of malignancy. Our case highlights that GCTs are a rare cause of non-specific abdominal symptoms and of dysphagia but should be considered in all middle aged patients presenting with these symptoms.