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Pulmonary Procedures |

Granular Cell Tumor: Rare but Real FREE TO VIEW

Mohan Rudrappa, MD; Nikhil K. Meena, MD; Clinton Colaco, MD; Brendon Colaco, MD; Penchala Mittadodla, MD
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University of Arkansas for Medical Sciences, Little Rock, AR


Chest. 2014;146(4_MeetingAbstracts):758A. doi:10.1378/chest.1994077
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Abstract

SESSION TITLE: Bronchology/Interventional Procedures Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: First described by Dr. Abriskossoff in 1926, Granular cell tumor continues to a fascinating tumor due to its rarity, diverse occurrence and much debated histogenesis. So far only 32 cases of tracheobronchial granular tumor have been described in literature. We present another case of a multicentric granular tumor of trachea and bronchi.

CASE PRESENTATION: A 31 year male, with a 3 year history of dyspnea, intermittent wheezing and nonproductive cough, was diagnosed with asthma and treated unsuccessfully with inhalers. A chest xray done during one of his exacerbation was concerning for a mass and a subsequent CT scan confirmed the presence of a right hilar mass with obstruction of right bronchus with mediastinal lymphadenopathy. He was not in any respiratory distress but there showed presence of right side monophonic wheeze. Bronchoscopy showed a proximal tracheal mass partially compromising the luminal diameter and a separate cauliflower shaped mass at the beginning of right main bronchus with near total occlusion of the lumen. The biopsy from the both lesions showed granular cells with eosinophilic cytoplasm and small eccentric round nuclie without any evidence of significant nuclear atypia, mitotic activity or necrosis. On immunohistochemistry the cells expressed S100 diffusely consistent with granular tumor. Based on these findings, a diagnosis of benign multicentric granular cell tumor was made. Patient underwent right bronchoscopy with local ablation with argon plasma coagulation which reclaimed 90% of airway and is presently being followed up.

DISCUSSION: Granular cell tumor can arise from many organs but mostly confined to upper aero-digestive tract and only 11% are arise from airways. Up to 4% can be malignant and well known for recurrence. So far tracheal malignant granular tumor has not been described . There are also reported cases of multi-centric but benign arising from trachea and esophagus. Granular cell tumors are believed to arise from Schwann cells as they show positive IHC stains like S100, neuron specific enolase and CD 68. Resection has been the main treatment for these tumors

CONCLUSIONS: Granular tumor are rare, begin multicentric tumor and should be in the considered when intraluminal tumor is detected.

Reference #1: Ipakchi, R. (2004). Granular cell tumor of the trachea in pregnancy: a case report and review of literature. The Laryngoscope, 114(1), 143-147

Reference #2: Thaller, S (1985). Symptomatic solitary granular cell tumor of the trachea. CHEST, 88(6), 925-928

DISCLOSURE: The following authors have nothing to disclose: Mohan Rudrappa, Nikhil K. Meena, Clinton Colaco, Brendon Colaco, Penchala Mittadodla

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