Procedures: Student/Resident Case Report Poster - Procedures |

Rare Granular Cell Tumor of the Central Airways: Best Management Strategy? FREE TO VIEW

Nisha Ajit, MBBS; Francis Wiser, MD; Kovid Trivedi, MBBS; Robert Holladay, MD; Satish Kalanjeri, MD
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Louisiana State University of Health Sciences, Shreveport, LA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1028A. doi:10.1016/j.chest.2016.08.1134
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SESSION TITLE: Student/Resident Case Report Poster - Procedures

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Granular cell tumors are rare, almost always benign tumors, which mostly manifest in the skin and tongue. Tracheobronchial presentation is extremely rare, and usually asymptomatic. . We present a case of granular cell tumor causing symptomatic central airway obstruction, and the first instance of successful treatment of this tumor with Holmium laser therapy.

CASE PRESENTATION: A 55-year-old asymptomatic female with a 20 pack-year history of smoking was diagnosed in 2008 with a 6 mm left main stem endobronchial granular cell tumor. She was followed in clinic with yearly CT scans, which showed a gradual increase in the size of the tumor. In 2015 she developed dyspnea on exertion. Physical examination was unremarkable. CT chest showed a left main stem tumor arising from the posterior wall and causing significant obstruction of the airway. Bronchoscopy revealed a gray lesion with an irregular surface occluding more than 50 % of the proximal left main stem bronchus (Figure 1a). Biopsy of the lesion confirmed granular cell tumor. Holmium laser ablation of the tumor resulted in near complete patency of the airway (Figure 1b). Post procedure, the patient’s symptoms resolved completely, and she continues to follow-up in clinic with CT surveillance.

DISCUSSION: Airway involvement with granular cell tumor is extremely rare .1-2 Often asymptomatic, these indolent tumors affect the central airways only in a third of the cases.1 Symptoms may include cough, dyspnea & rarely stridor. Traditionally, management has included watchful waiting, laser resection, argon plasma coagulation, electrocautery, and surgical resection.1-2 Previously described cases have used Nd-YAG laser, while we used the holmium laser. The different wavelength of the holmium laser allows for precise cutting ability while retaining its ablative potential. A multimodality bronchoscopic management such as the use of cryoextraction followed by APC or laser therapy may also be used.1-2 Availability and increased use of these techniques will help defer surgical morbidity and mortality in patients with benign locally growing tumors.

CONCLUSIONS: There are no guidelines to manage slow growing benign lesions in the central airways. Significant narrowing of a central airway, even without critical narrowing may lead to mucous plugging, bronchitis and atelectasis. We suggest radiographic surveillance and intervention when 50% or greater of the central airway is obstructed, even in the absence of symptoms. Intervention of tracheal lesions probably should occur sooner.

Reference #1: van der Maten J, Blaauwgeers JLG, Sutedja TG, Kwa HB, Postmus PE, Wagenaar SS. Granular cell tumors of the tracheobronchial tree. J Thorac Cardiovasc Surg. 2003 Sep;126(3):740-3.

Reference #2: Epstein LJ, Mohsenifar Z. Use of Nd:YAG Laser in Endobronchial Granular Cell Myoblastoma. Chest. 1993 Sep;104(3):958-60.

DISCLOSURE: The following authors have nothing to disclose: Nisha Ajit, Francis Wiser, Kovid Trivedi, Robert Holladay, Satish Kalanjeri

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