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Large Mid-Esophageal Granular Cell Tumor: Benign Versus Malignant.

Christopher PR, Kingsley PA, Singh Bedi H, Singh Kwatra K, Rathore S, Das KC - Rare Tumors (2015)

Bottom Line: Granular cell tumors are rare soft tissue neoplasms, among which only 2% are malignant, arising from nervous tissue.Here we present a case of a large esophageal granular cell tumor with benign histopathological features which metastasized to the liver, but showing on positron emission tomography-computerized tomography standardized uptake value suggestive of a benign lesion.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiotherapy, Christian Medical College , Ludhiana, India.

ABSTRACT
Granular cell tumors are rare soft tissue neoplasms, among which only 2% are malignant, arising from nervous tissue. Here we present a case of a large esophageal granular cell tumor with benign histopathological features which metastasized to the liver, but showing on positron emission tomography-computerized tomography standardized uptake value suggestive of a benign lesion.

No MeSH data available.


Related in: MedlinePlus

a,b) Contrast enhanced computed tomography (CT) chest images showing the intramural mass (arrow) in the right posterolateral wall of esophagus in axial and sagittal sections respectively. c) Positron emission CT (PET CT) showing non 18-fluoro deoxy glucose avid lesion (arrow) in segment Vll of liver. d) PET CT showing the FDG avid esophageal mass (arrow) of standardized uptake value 2.
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fig001: a,b) Contrast enhanced computed tomography (CT) chest images showing the intramural mass (arrow) in the right posterolateral wall of esophagus in axial and sagittal sections respectively. c) Positron emission CT (PET CT) showing non 18-fluoro deoxy glucose avid lesion (arrow) in segment Vll of liver. d) PET CT showing the FDG avid esophageal mass (arrow) of standardized uptake value 2.

Mentions: Mrs. B.N., a 60-year-old lady, presented to our outpatient department with a history of progressive dysphagia of 1 year duration, cough and hoarseness of voice for 3 months. She was evaluated at our center and was found to have a large mediastinal mass compressing on the esophagus and underwent an endoscopic examination and biopsy which was reported as doubtful of malignant pathology. No intraluminal mass or ulceration of mucosa was found on upper gastrointestinal endoscopy (UGIE). Contrast enhanced computerized tomography (CECT) chest and abdomen done, showed a large well defined intramural enhancing mass lesion arising from the right posterolateral wall of the esophagus measuring approximately 9.1×4.8×4.8 cm with areas of necrosis within, involving the middle third of esophagus (T3-T7) with complete luminal compromise (Figure 1). Enlarged subcentimetric lymph nodes were seen in the celiac axis and bilateral axillary regions. Multiple centrilobular pulmonary nodules and ground glass opacities in bilateral lung fields and a hypodense lesion in segment VII of liver were visualized. In view of the inconclusive histopathology a repeat biopsy was done, the histopathological examination of which revealed, fragments of hyperplastic stratified squamous epithelium along with a tumor composed of sheets of polygonal cells with abundant granular eosinophilic cytoplasm. The nuclei were round to irregular with non-descript chromatin and inconspicuous nucleoli. No mitosis could be identified. On immunohistochemistry (IHC), the tumor showed a low Ki67 proliferative index. S-100, CD 68 and Desmin were positive while myf-4 was negative. The histopathological features supported a diagnosis of benign granular cell tumor. In view of the indeterminate lung nodules and a solitary lesion on segment Vll of right lobe of liver, a positron emission tomography-computerized tomography (PET-CT) scan was performed. It showed the esophageal mass to be metabolically active with 18-fluoro deoxy glucose (FDG) uptake suggestive of a benign tumor and the liver lesions to be non FDG avid. Ultrasound guided fine needle aspiration cytology (FNAC) of the liver lesion was performed which revealed metastatic granular cell tumor.


Large Mid-Esophageal Granular Cell Tumor: Benign Versus Malignant.

Christopher PR, Kingsley PA, Singh Bedi H, Singh Kwatra K, Rathore S, Das KC - Rare Tumors (2015)

a,b) Contrast enhanced computed tomography (CT) chest images showing the intramural mass (arrow) in the right posterolateral wall of esophagus in axial and sagittal sections respectively. c) Positron emission CT (PET CT) showing non 18-fluoro deoxy glucose avid lesion (arrow) in segment Vll of liver. d) PET CT showing the FDG avid esophageal mass (arrow) of standardized uptake value 2.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508643&req=5

fig001: a,b) Contrast enhanced computed tomography (CT) chest images showing the intramural mass (arrow) in the right posterolateral wall of esophagus in axial and sagittal sections respectively. c) Positron emission CT (PET CT) showing non 18-fluoro deoxy glucose avid lesion (arrow) in segment Vll of liver. d) PET CT showing the FDG avid esophageal mass (arrow) of standardized uptake value 2.
Mentions: Mrs. B.N., a 60-year-old lady, presented to our outpatient department with a history of progressive dysphagia of 1 year duration, cough and hoarseness of voice for 3 months. She was evaluated at our center and was found to have a large mediastinal mass compressing on the esophagus and underwent an endoscopic examination and biopsy which was reported as doubtful of malignant pathology. No intraluminal mass or ulceration of mucosa was found on upper gastrointestinal endoscopy (UGIE). Contrast enhanced computerized tomography (CECT) chest and abdomen done, showed a large well defined intramural enhancing mass lesion arising from the right posterolateral wall of the esophagus measuring approximately 9.1×4.8×4.8 cm with areas of necrosis within, involving the middle third of esophagus (T3-T7) with complete luminal compromise (Figure 1). Enlarged subcentimetric lymph nodes were seen in the celiac axis and bilateral axillary regions. Multiple centrilobular pulmonary nodules and ground glass opacities in bilateral lung fields and a hypodense lesion in segment VII of liver were visualized. In view of the inconclusive histopathology a repeat biopsy was done, the histopathological examination of which revealed, fragments of hyperplastic stratified squamous epithelium along with a tumor composed of sheets of polygonal cells with abundant granular eosinophilic cytoplasm. The nuclei were round to irregular with non-descript chromatin and inconspicuous nucleoli. No mitosis could be identified. On immunohistochemistry (IHC), the tumor showed a low Ki67 proliferative index. S-100, CD 68 and Desmin were positive while myf-4 was negative. The histopathological features supported a diagnosis of benign granular cell tumor. In view of the indeterminate lung nodules and a solitary lesion on segment Vll of right lobe of liver, a positron emission tomography-computerized tomography (PET-CT) scan was performed. It showed the esophageal mass to be metabolically active with 18-fluoro deoxy glucose (FDG) uptake suggestive of a benign tumor and the liver lesions to be non FDG avid. Ultrasound guided fine needle aspiration cytology (FNAC) of the liver lesion was performed which revealed metastatic granular cell tumor.

Bottom Line: Granular cell tumors are rare soft tissue neoplasms, among which only 2% are malignant, arising from nervous tissue.Here we present a case of a large esophageal granular cell tumor with benign histopathological features which metastasized to the liver, but showing on positron emission tomography-computerized tomography standardized uptake value suggestive of a benign lesion.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiotherapy, Christian Medical College , Ludhiana, India.

ABSTRACT
Granular cell tumors are rare soft tissue neoplasms, among which only 2% are malignant, arising from nervous tissue. Here we present a case of a large esophageal granular cell tumor with benign histopathological features which metastasized to the liver, but showing on positron emission tomography-computerized tomography standardized uptake value suggestive of a benign lesion.

No MeSH data available.


Related in: MedlinePlus