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Lung Pathology |

Rare Incidence of Endobronchial Granular Cell Tumors

Courtney Tabaka, DO; Kathryn Heal, DO; Philip Kaplan, DO; Michael Abrash, MD; Wilfred VanderRoest, DO
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Botsford General Hospital, Royal Oak, MI


Chest. 2015;148(4_MeetingAbstracts):607A. doi:10.1378/chest.2263895
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Abstract

SESSION TITLE: Lung Pathology Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Granular cell tumors (GCTs) of the lung are extremely rare. There have been less than 80 cases reported since 1930 (3). We present a case of two benign endobronchial granular cell tumors in conjunction with primary adenocarcinoma of the lung.

CASE PRESENTATION: Patient is a 57 y/o AAF who presented to the pulmonary office with an abnormal CT chest demonstrating an 8mm RUL spiculated, PET avid with 1.4 SVU, lesion with a 60% malignancy risk. Patient underwent a navigational bronchoscopy with biopsy and endobronchial ultrasound. Upon bronchoscopic exam, two endobronchial lesions were noted in the LUL/lingula and RUL. These lesions were excised using cryoablation. Pathology was consistent with benign granular cell tumor. The RUL spiculated nodule seen on PET was negative for malignancy. However, fine needle aspirations of lymph node stations 7, 4R, and 11R were consistent with primary pulmonary adenocarcinoma. No parenchymal lesion with adenocarcinoma pathology has been identified. Follow up bronchoscopy four months after diagnosis demonstrated no recurrence of GCTs.

DISCUSSION: Granular cell tumors of the lung are exceedingly rare with less than 80 cases known (3). Most cases reported are located in the oropharynx, skin, subcutaneous tissue, breast, and intestinal tract. GCTs of the lung are mostly benign, with 1-2% reported as malignant (2). They usually occur as an isolated nodule. Differentiation between benign and malignant GCTs is difficult and relies heavily on histologic appearance and immunohistochemical staining (3). Treatment is typically endobronchial excision or surgical resection based on size (1). In our case, bronchoscopic cryoablation was the primary mode of removal.

CONCLUSIONS: In conclusion, granular cell tumors of the lung are exceedingly rare. Most are benign, with 1-2% being malignant (2). Excision is the treatment of choice. In our case, cryoablation therapy was a successful method of removal and treatment.

Reference #1: Deavers, M., Guinee, D., Koss, MN, et al. Granular cell tumors of the lung, clinicopatholoic study of 20 cases. Am J surg Pathol. 1995 June:19(6): 627-35.

Reference #2: Mnaos, E., Kokkori, I., Panagou, P., et al. Rare case of granular cell tumor of the lung in a patient with multiple endocrine neoplasia syndrome and mass of the left lung. Journal of Thoracic Disease. 2012 Nov 4:1

Reference #3: Jing, M., Anderson, T., Nwogu, C., et al. Pulmonary malignant granular cell tumor. World Journal of Surgical Oncology. 2003, 1:22

DISCLOSURE: The following authors have nothing to disclose: Courtney Tabaka, Kathryn Heal, Philip Kaplan, Michael Abrash, Wilfred VanderRoest

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