2009 Southern Regional Meeting Abstracts

Case Report: A 46-year-old woman presented with progressive dysphagia to solids and odynophagia. She denied heartburn, nausea and vomiting. Upper Endoscopy revealed a small 5 mm submucosal mass at the distal esophagus. Endoscopic Ultrasound(EUS) revealed a corresponding hypoechoic mass with well-defined border arising from deep mucosa (Layer 2). Endoscopic mucosal resection(EMR) of lesion was performed using snare after submucosal saline and epinephrine injection. Histopathology showed a benign neoplasm composed predominantly of cells with spindle-shaped nuclei and round nuclei with granular eosinophilic cytoplasm. Immunohistochemistry was stained positive for S100 and negative for smooth muscle actin, CD34 and CD117. This is consistent with a granular cell tumor. Patient’s symptoms of dysphagia and odynophagia were completely resolved at 3 months follow up.
This is an unusual case of granular cell tumor of esophagus presenting with dysphagia and odynophagia. It is an uncommon tumor found in the esophagus. Patients are usually asymptomatic and the lesion are found incidentally. There are case reports of symptomatic large lesions which are recommended to be removed surgically. We used EUS to determine the original layer of this mass and performed endoscopic mucosal resection with snare using saline and epinephrine assisted technique. Use of EUS and EMR has not been reported in the context of granular cell tumors to the best of our knowledge.