SESSION TYPE: Bronchology Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: The granular cell tumors (GCT) was first described by Abrikossoff in 1926. Early classification of GCT as a myoblastic origin has been discarded; it was reclassified in 1974 as neuronal tumors with similarity to schwannomas, with positive S100 staining. GCT usually occurs in midlife, are predominantly solitary. Only 6-10% of them are found as endobronchial lesions, usually distributed in central and peripheral airways, along the bifurcation of the bronchus. Although rare, Malignant GCT (MGCT) has been described. Only 6 GCT cases have been described to be associated with bronchogenic carcinoma in the literature.
CASE PRESENTATION: 45 year old female, with discoid lupus, was referred to chest clinic for evaluation of worsening chronic cough, productive of yellow sputum especially at night, with 15 pound weight loss over last year. She has 15 pack years of smoking history, along with exposure to secondary smoke. Her surgical history was significant for resection of a posterior pharyngeal mass in 2006 diagnosed as GCT. PFT showed mild obstruction. Radiographic studies revealed bilateral emphysematous changes, predominant in upper lobes. Nodules 0.8cm in left upper lobe and 1.3cm in right upper lobe, both with spiculated margins, and with increased uptake on PET. No mediastinal lymph node involvement. Bronchoscopy revealed 10 mm serpengenous, yellow colored endobronchial lesion in the RUL anterior segment. Pathology revealed polygonal spindle shaped cells with granular cytoplasm, which was positive for Immunohistochemical stain with S100. Cytobrush and bronchoalveolar lavage were negative for malignant cells. Biopsy of both tumors showed adenocarcinoma which were surgically removed. Patient unfortunately has local right sided chest wall recurrence and is undergoing chemo- radiotherapy.
DISCUSSION: Pulmonary GCTs are uncommon and predominantly benign. MGCT is a rarer disease entity that was described in 1945. Since the originally described case, 42 additional MGCTs have been reported in various body sites, with only one case reported to involve the lungs. In most cases there is a smoking history but no established causal relationship. The coexistence of GCTs with bronchogenic carcinoma is rare, without a specific cell type predominance. Treatment of pulmonary GCTs is primarily surgical resection, with no role for medical therapy. Watchful waiting in asymptomatic cases is also a suggested approach.
CONCLUSIONS: Our case adds to the sparse literature on pulmonary GCT, and is unique in that it is associated with bilateral primary bronchogenic carcinoma.
1) Pulmonary Granular Cell Tumor Coexisting With Bronchogenic Carcinoma R.T. Cutlan, MD. Ann Diagn Pathol 5: 74-79, 2001
2) Pulmonary malignant granular cell tumor. Ming Jiang World J Surg Oncol. 2003 Oct 21;1(1):22
DISCLOSURE: The following authors have nothing to disclose: Shivanck Upadhyay, Sunil Dhunna, Peter Spiro
No Product/Research Disclosure InformationColumbia University at Harlem Hospital Center, New York, NY