SESSION TYPE: Cancer Cases I
PRESENTED ON: Monday, October 22, 2012 at 01:45 PM - 03:00 PM
INTRODUCTION: Granular cell tumors (GCTs) are generally benign neoplasms of neuronal origin. They can occur in many organ systems, but rarely involve the lung; 6% of pulmonary GCTs are endobronchial. Here we report a GCT involving the left upper lobe bronchus in a patient found to have metastatic adenocarcinoma of the lung. To our knowledge, this is the 8th case of pulmonary GCT coexisting with lung cancer reported in the literature.
CASE PRESENTATION: A 60-year-old African-American male presented with progressively worsening left supraclavicular pain radiating to the back and arm for several months. He noted weight loss, productive cough with occasional hemoptysis, and fatigue. He had a 100 pack/year smoking history. The only finding on examination was left supraclavicular tenderness without palpable adenopathy. Chest X-ray suggested a left upper lobe nodule. CT scan showed a noncalcified lesion in the upper lobe measuring 3cm. A second nodule was seen in the right lung apex measuring 2.4cm with adjacent cystic changes. Emphysema was noted. No endobronchial lesions were seen. Bronchoscopy revealed submucosal bulging in a tubular shape, measuring approximately 2cm in length, involving the left upper lobe bronchus (figure 1). Endobronchial biopsy revealed GCT. Immunohistochemical stains were reactive for S-100 and NSE. MRI of the neck showed extensive tumor involvement of the cervical and upper thoracic spine infiltrating the brachial plexus, left greater than right. CT-guided needle biopsy of the left upper lobe lesion showed poorly differentiated pulmonary adenocarcinoma. Chemotherapy and radiation were planned.
DISCUSSION: GCTs rarely occur in the lung, and a minority of these is found in the airway. Simultaneous endobronchial and peripheral lesions have been reported. Typical endobronchial appearance is that of a solitary, discrete, nodular mass that is pale pink, gray, or yellow. It may be polypoid or pedunculated. The tumor is covered by a thin layer of bronchial epithelium, which accounts for the high diagnostic yield on forceps biopsy. In our case, the appearance was that of a submucosal bulging tumor in a tubular shape, which is uncharacteristic. Endobronchial GCTs may lead to obstruction or hemoptysis, but may also be asymptomatic and found incidentally on bronchoscopy. Our patient had coexisting metastatic adenocarcinoma of the lung. Seven cases of pulmonary GCT coexisting with lung cancer have been reported (4 adenocarcinoma, 2 squamous cell carcinoma and 1 small cell carcinoma).
CONCLUSIONS: It is unclear if GCTs and lung cancer have a shared etiology, such as smoking, but the relationship deserves further study.
1) Gabriel JB Jr., Thomas L, Mendoza CB, Chauhan PM. Granular cell tumor of the bronchus coexisting with a bronchogenic adenocarcinoma: A case report. J Surgic Onc. 1983;24(2):103-106.
2) Hernandez OG, Haponik EF, Summer WR. Granullar cell tumor of the bronchus: bronchoscopic and clinical features. Thorax 1986;41(12):927-931.
DISCLOSURE: The following authors have nothing to disclose: Eduardo Andre, Craig Thurm, Kelly Cervellione, Sicong Ren, Kunal Patel
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