2020 Volume 62 Issue 7 Pages 764-770
Granular cell tumors of the esophagus are generally benign tumors and occur in the mucosal lamina propria. We report a 59-year-old woman who presented with a granular cell tumor of the esophagus with adventitia invasion, despite being pathologically benign. She had been suffering from dysphagia for two years and then recently had begun to vomit. She was referred to our hospital after detection of an esophageal lesion in an upper gastrointestinal X-ray. Contrast-enhanced computed tomography and endoscopy identified an elevated lesion in the cervical esophagus, measuring 40mm, which was coated with normal mucosa. Endoscopic ultrasound-guided fine needle aspiration was performed under general anesthesia, but a definitive diagnosis could not be obtained. Therefore, incision biopsy was carried out and the retrieved specimen revealed stroma infiltrated by cells with eosinophilic cytoplasm of granular aspect. However, the central nuclei showed no evidence of atypia or mitotic figures and were immunohistochemically proven to be positive for S-100 protein. Although the pathological diagnosis was benign, thoracoscopic and laparoscopic subtotal esophagectomy was performed due to devastating dysphagia. In the mediastinal inlet, the tumor adhered partially but firmly to the tracheal membrane and she was finally diagnosed as having adventitia invasion pathologically. This case was pathologically benign, but met the diagnostic criteria for malignant granular cell tumor. If a granular cell tumor is much larger than the average size of granular cell tumors, the large granular cell tumor may invade the adventitia despite being pathologically benign. Surgical resection should be optimized to ensure the patient’s quality of life.
