University of Niš, Serbia
Granular cell tumor (GCT) is uncommon soft tissue neoplasm occurring in the skin and internal organs. Its clinical behavior is usually benign, although both histological and clinical malignant forms can occur. We report a 52 years man, singer, with very hard, sessile, verrucous tumor in distal o e s o p h a g u s , discovered endoscopically. It appeared ( looked ) as a yellow hemispheric protrusion with a thin mucous membrane known as “sweet corn”. Patient was presented with dysphagia, gastralgia and substernal pain, 6 years ago. Wide local excision of the verrucous lesion has been done endoscopically. Histologically, oesophagus showed the overlying pseudoepitheliomatous hyperplasia, so extensive that it has been mimick a squamous carcinoma. However, on the base of histologically, histochemically (PAS positive ) and immunohistochemicaly (S-100 positive granular cytoplasm ) examinations, GCT diagnosis has been confirmed. ( revealed ).
In the s k i n, solitary, brownnish dome-shaped nodus has been discovered on periumbilical skin, surounded by generalized lentiginosis without any symptom ( „ beauty mark“ by patient, s opinion), existing during last 15 years.
The excised lesions did not recur, but newer lesions continued to discover, during the last four years: in stomach, duodenum and caecoascendens. On colonoscopy, induced by both abdominal colic, the large ( to 3 cm.) and numerous ( 26 ) submucous, nodular, yellowish masses with hyalinization and calcification were found in cecoascendens. GCT diagnosis of colon, on small endoscopical biopsies was pointed out, followed by right colectomy with good clinical course after 24-month follow-up. Eight months after the surgery, patient experienced hematemesis and melena. Gastroduodenoscopy was performed, revealing numerous white, solid and confluent nodules, up to 1cm in diameter in stomach, while the only one ulcerous change was found in duodenum. Immunohistochemical ABC method, by using S-100 marker, also confirmed GCT. Therapy : right colectomy, 23 cm. of length, has been done. The patient is with a good health , 24 months after right colectomy