Granular Cell Tumor of the Ascending Colon: A Case Report and Review

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Introduction: Granular cell tumor (GT) is an uncommon benign soft tissue neoplasm that is typically located on the skin, tongue, breast, and gastrointestinal (GI) tract. The GI tract is involved in roughly 10% of the cases, with 65% of those arising in the esophagus. The duodenum and stomach are the next most common locations in the GI tract, with the colon and rectum having the least incidences of this type of soft tissue tumor. These tumors are often asymptomatic and are found incidentally during screening colonoscopy. Case Report: A 36-year-old man with 2 episodes of blood per rectum presented to the ambulatory surgical center for a diagnostic colonoscopy. On examination, the proximal ascending colon revealed a 2.5-cm submucosal, pale-colored, polypoid lesion on a talk. The surface of the polyp was smooth and a central depression was present (Figure 1). The polyp was resected using the endoscopic mucosal resection (EMR) technique. Histopathology of the polyp revealed many histiocyte-like cells with granular eosinophilic cytoplasm (Figure 2). The cells stained positive with periodic acid-Schiff. Immunohistochemistry showed S-100 reactivity, thus confirming the diagnosis of a GCT.Figure 1Discussion: Granular cell tumors were first described by Weber in 1854 as a gathering of large cells with granular eosinophilic cytoplasm. The neuronal origin of the tumor was first discovered in 1952 by Feyrter. On endoscopy, these tumors are typically sessile, have a yellow tint and a slight rough surface. Histopathology of the tumor has characteristic histiocyte-like cells with PAS positive granular eosinophilic cytoplasm and small uniform nuclei in which mitotic features are not present. They stain positive for S-100 protein. Endoscopic removal is often sufficient if the tumor is less than 2 cm. In the event that pathology specimen has positive margins, further surgical resection is required. If there are multiple tumors or if there is increased risk of malignancy, follow-up colonoscopy is highly recommended. Although exceedingly rare, GCT is an important consideration in the differential diagnosis of colonic lesions.

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