A Tale of 2 Tumors: A Case Report of Concomitant Esophageal Squamous Papilloma and Granular Cell Tumor

Abstract

Benign esophageal tumors are rare. This includes granular cell tumors (GCT), which comprise 1% of benign esophageal tumors, and incidence during esophagogastroduodenoscopy (EGD) is estimated at 0.033%. Squamous papillomas (SP) of the esophagus are also rare, with an incidence during EGD estimated from 0.01 to 0.45%. We present a unique case of a patient incidentally found to have esophageal GCT as well as esophageal SP successfully treated with endoscopic mucosal resection (EMR). A 45-year-old male with a past history of renal cell carcinoma status post left nephrectomy who was referred to our tertiary care digestive disease center for esophageal polyps seen on EGD. Patient underwent an EGD and colonoscopy for an episode of hematochezia where the EGD showed incidental findings of two polypoid lesions in the mid-esophagus. One lesion was biopsied and demonstrated a GCT, while another more proximal lesion was not biopsied at that time. After evaluation in clinic, an endoscopic ultrasound (EUS) was performed during which two subepithelial lesions in the mid-esophagus were seen. The proximal lesion was 11 mm and the distal lesion was 9 mm in size. EMR of the distal esophageal lesion was performed and pathology was consistent with a GCT. A repeat EGD was scheduled and EMR of the proximal lesion was performed at that time, with pathology demonstrating esophageal SP. No complications occurred during the procedures. The patient was discharged and scheduled for surveillance EGD in one year. Esophageal GCTs and SPs are rare esophageal tumors. To our knowledge, this is the first reported case of concomitant GCT and SP. In a small, single center retrospective analysis, GCTs less than 10mm in diameter underwent successful EMR without complication. In another reported series of patients with esophageal SP resected endoscopically, follow-up endoscopy between 18 and 48 months demonstrated no further lesions at the site of resection or at any other locations within the esophagus. Transformation of esophageal SP to squamous cell carcinoma has been described, but occurred only in cases where numerous polyps were present. Currently, there are no clear guidelines regarding surveillance of these lesions after resection.