1Department of Internal Medicine, The Brooklyn Hospital Center clinical affiliate of Mount Sinai Hospital, USA
2Department of Hematology and Oncology, The Brooklyn Hospital Center clinical affiliate of Mount Sinai Hospital
3Department of Gastroenterology, The Brooklyn Hospital Center clinical affiliate of Mount Sinai Hospital, USA
4Department of Pathology, The Brooklyn Hospital Center clinical affiliate of Mount Sinai Hospital, USA
5SCI2 foundation institute, USA
Submission:May 24, 2021; Published:June 04, 2021
*Corresponding author:Lohitha Dhulipalla, Department of Internal Medicine, The Brooklyn Hospital Center clinical affiliate of Mount Sinai
How to cite this article:Lohitha D, Praneeth B, Geethapriya R R, Andrew O, Febin J, et al. A Rare Case Report of Granular Cell Tumor Involving the
Cecum. Adv Res Gastroentero Hepatol, 2021; 17(2): 555957. DOI: 10.19080/ARGH.2021.17.555957.
Granular cell tumor arises from Schwann cells. It is common in females than males. It affects the age group from 10 to 50 years of age. It can
arise anywhere in the body but commonly involves the oral cavity, skin, and subcutaneous tissue. Granular cell tumor involving the cecum is very
rare. Here, we report a case of Granular cell tumor involving the cecum in a 58-year-old male..
Granular cell tumor was first described by Russian
pathologist Alexei Ivanovich Abrikossoff and is also known
as Abrikossoff’s tumor. It arises from Schwann cells based on
immunohistochemical studies. It is usually benign with 1 - 2%
of the cases being malignant. The common sites of involvement
include skin, subcutaneous tissue, and the oral cavity. Granular
cell tumor involving the gastrointestinal tract is uncommon. Here,
we describe a case of Granular cell tumor involving the cecum .
A 58-year-old male with no known past medical history
underwent a screening colonoscopy. Colonoscopy showed an 8
mm nodule with yellowish discoloration in the cecum (Figure 1).
Biopsy (Figure 2 a & b) was done which revealed a Granular cell
tumor. Immunohistochemical stains are positive (Figure 2 c & d)
for S-100, Calretinin, CD 68 and negative for AE 1/3, CK7, CK20,
CD117, SMA, vimentin, and design. Ki-67 labeling index is <1%.
PAS stain is positive for tumor cells .
CECT chest abdomen and pelvis were done which showed
multiple mesenteric lymph nodes largest of which measures up
to 7 mm but are within normal limits in size, with no evidence of
metastatic disease in the chest, abdomen, and pelvis. The Tumor
within the cecum was not visualized .
The patient subsequently underwent a right hemicolectomy.
Histopathology revealed a Granular cell tumor (0.5x0.3 cm), in the
submucosa (Figure 3 a & b) of the cecum. Immunohistochemistry
cells positive for CD 68, S-100, negative for calretinin, ki-67 <1%,
(Figure 3 c & d) with no muscular propria invasion. Twentyeight
reactive lymph nodes were removed and were negative for
metastatic carcinoma. Bilateral small bowel, colonic, and soft
tissue margins are free of tumor. The patient was discharged
without any complications .
Granular cell tumor can occur anywhere in the body but
rarely involves the Gastrointestinal tract. The common site of
involvement in the gastrointestinal tract is the esophagus. Most
cases of Granular cell tumors involving the Gastrointestinal tract
are found incidentally on endoscopy. It presents as a solitary
submucosal mass but can be multifocal as well .
Colonic GCTs tend to be asymptomatic and usually follow a
benign course. Patients who had discomfort may exhibit larger
lesions. However, this association is not strong regarding colonic
GCTs. Common symptoms are non-specific, including abdominal
discomfort, hematochezia and changes in bowel habits .
The microscopic criteria as per Fanburg-Smith et al for
Granulosa cell tumors include spindling, necrosis, nuclear
pleomorphism, high mitotic activity (2 per 10 high power fields
at 200 magnification), high nuclear to cytoplasmic ratio, vesicular
nuclei with large nucleoli. Tumors that meet 3 or more of the
criteria were classified as malignant(histologically), tumors that
meet 1 or 2 criteria were classified as atypical, and tumors that
don’t fulfill any of the criteria were classified as benign .
Malignant tumors are usually larger than 3-4 cm in size,
exhibit rapid growth, and ulcerated. The diagnosis of Granular
cell tumors is made by endoscopic biopsy, histology, and
Immunohistochemistry stains are positive for S-100, myelin
basic protein, and CD 68. Benign granular cell tumors are usually
treated with endoscopic resection.
Since there are no established guidelines for the treatment
of colorectal GCT, some physicians recommend performing
endoscopic mucosal resection (EMR), endoscopic submucosal
dissection (ESD), or polypectomy for tumors less than 2 cm.
Follow-up colonoscopies seem appropriate after resection if
multiple tumors or risk of malignancy exists.
Granular cell tumors involving the cecum are very rare.
Most of the tumors involving the gastrointestinal tract are noted
incidentally on endoscopy. Although granular cell tumor is
predominantly benign, 1-2% of tumors are malignant. Benign
granular tumors are treated by endoscopic resection. Here, we
report a rare case of Benign Granular cell tumor involving the