1841 An Unusual Case of Persistent Globus Due to Granular Cell Tumor of the Distal Esophagus

Abstract

INTRODUCTION: Granular cell tumors (GCT) are rare soft tissue tumors arising from the Schwann cells. Most common sites involved are head and neck, although the gastrointestinal tract can be rarely involved. GCT of the esophagus are rare; their incidence in endoscopy series has been estimated to be approximately 0.033 percent, representing approximately 1 percent of benign esophageal tumors. GCT are mostly benign but rarely can turn malignant in 2% cases1. Patient are usually asymptomatic, although when symptomatic, patients can experience GERD, dysphagia and rarely Globus. We present an unusual case of persistent Globus due to granular cell tumor of the distal esophagus. CASE DESCRIPTION/METHODS: 46 yo male with past history of asthma referred to the Gastroenterology clinic for symptoms of intermittent dysphagia to solids along with a feeling of persistent Globus sensation for 3 months. He was also experiencing symptoms of intermittent dysphagia to solids but none to liquids. Barium Esophagogram failed to reveal any pathology. Patient subsequently underwent EGD which revealed a 5mm sub mucosal lesion in the esophagus at 32 cms from the incisors (Figure 1). EUS demonstrated the lesion limited to the submucosa. Biopsy from the lesion revealed Granular cell tumor confirmed with immunostain positive for S 100 (Figure 2). The esophageal lesion was subsequently removed en bloc using band assisted EMR (Figure 3). A follow up clinic visit revealed complete resolution of globus and dysphagia. DISCUSSION: GCT are rare soft tissue tumors most commonly arising from the tongue, skin and subcutaneous tissue. Intestinal involvement is rare. Esophagus is the most commonly involved site in the GI tract and these lesions can present as subtle submucosal lesions. Although asymptomatic, GCT have been reported to cause dysphagia and rarely globus. Immunostain is usually positive for S-100 protein. Early recognition followed by en bloc endoscopic mucosal resection has been associated with complete resolution of symptoms.