SESSION TYPE: Bronchology Global Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Bronchial granular cell tumors are rare lesions affecting the respiratory tract. We report a case of a 17 year old girl with multicentric bronchial granular cell tumors presenting with recurrent pneumonia.
CASE PRESENTATION: A 17 year old Indian girl first presented to our hospital in September 2011 for fever and productive cough of 3 days’ duration. Chest radiograph showed consolidation at the right lower zone. Further questioning revealed that she was treated twice previously in August 2007 and December 2009 for similar right lower lobe pneumonia at another hospital. In view of the recurrent nature of the infection, an outpatient Computed Tomography scan of the thorax was arranged and it revealed a partial right lower lobe collapse with a soft tissue density in the medial segment of the right lower lobe bronchus. The patient was temporarily lost to follow-up until she was hospitalized for right lower lobe pneumonia again in February 2012. Flexible bronchoscopy showed an endobronchial mass completely occluding the bronchus intermedius, with other smaller nodules in the proximal left main bronchus and the left lower lobe orifice. Separate biopsies were taken from these lesions and all of them revealed the presence of polygonal cells with granular cytoplasm which stained positive for S-100 protein, consistent with granular cell tumor. A repeat Computed Tomography of the thorax revealed an enlarging endobronchial mass in the bronchus intermedius now causing total collapse of the right lower lobe with consolidative changes. Computed Tomography scan of the abdomen and pelvis was unremarkable except for bilateral bulky ovaries with prominent follicles. The patient underwent rigid bronchoscopy and Nd YAG laser was employed to debulk the bronchus intermedius tumor. Patency of the airways leading to the right middle and lower lobes was restored. The smaller nodules in the left bronchial tree were also coagulated with laser. The patient remained well clinically, and a repeat bronchoscopy 6 weeks later demonstrated continued patency of the airways.
DISCUSSION: Granular cells tumors were first described by Abrikossoff in 1926. They are mostly benign tumors of Schwann cell origin, although malignant behavior has been reported1. Frequently affected sites include the skin, tongue and breast, with respiratory involvement seen in less than 10% of the time. There are no established risk factors or sex predilection for the development of bronchial granular cell tumors. Patients may present with respiratory symptoms from airway obstruction or irritation. Chest imaging and bronchoscopy are useful to localize the lesions. Multicentric tumors, as seen in our case, are uncommon and are detected during bronchoscopy in only 18% of patients2. On histological exam, granular cell tumors appear as polygonal cells with granular eosinophilic cytoplasm and small hyperchromatic ovoid nuclei. Immunohistochemical staining for S-100 protein and neuron-specific enolase are often positive. The choice of treatment modality should be individualized based on the location and extent of the tumor. Bronchoscopic laser or argon plasma coagulation may be performed for smaller lesions, although lesions larger than 1cm are associated with a higher rate of recurrence3. In such cases, surgical resection may be curative. The prognosis remains excellent in most cases.
CONCLUSIONS: Multicentric bronchial granular cell tumors are rare. Histology reveals characteristic features indicative of the diagnosis. The prognosis is generally good with either bronchoscopic or surgical treatment.
1) Jiang M, Anderson T, Nwogu C, Tan D. Pulmonary malignant granular cell tumor. World J Surg Oncol. 2003,1(1):22.
2) Hernandez OG, Haponik EF, Summer WR. Granular cell tumour of the bronchus: bronchoscopic and clinical features. Thorax. 1986;41(12):927-31
3) Sachdeva A, Paparo M, Weller CL, Nayak RP. Effective treatment of granular cell tumor of the bronchus using argon plasma coagulation. Chest. 2008;134:24001S.
DISCLOSURE: The following authors have nothing to disclose: Huiying Xu, Wee See Yap, Khoon Leong Chuah
No Product/Research Disclosure InformationTan Tock Seng Hospital, Singapore, Singapore