MULTIPLE METACHRONOUS GRANULAR CELL TUMORS OF BOTH GASTROINTESTINAL TRACT AND SKIN: AN UNCOMMON CLINICAL ENTITY
Katic V, Petrovic A, Simonovic M., Grgov S., Rankovic G., Rankovic A., Todorovic J., Mladenovic M
Granular cell tumor ( GCT ) is soft tissue neoplasm occuring in the skin and internal organs. Its clinical behavior is usually benign, although both histological and clinical malignant forms can occur. We report a 52 years man , musician with very hard, sesile, vericous tumor in distal oesophagus, discovered endoscopically. It appeared as a yellow hemispheric protrusion with a thin mucous membrane known as "sweet corn".Patient was presented with dysphagia, gastralgia and substernal pain, 6 years ago. Wide local excision of the verrucous lesion has been done endoscopically. Histologically, oesophagus showed the overlying pseudoepitheliomatous hyperplasia, so extensive that it has been mimick a squamous carcinoma. However, on the base of histologically, histochemically and immunohistochemically examinations , GCT diagnosis has been revealed. In the skin, solitary, brownish domeshaped nodus has been discovered on periumbilical skin, surrounded by generaluzed lentiginosis without any symptom (" beauty mark", by patient s opinion ), existing during last 15 years. The excised lesions did not recur, but newer lesions continued to discover during the last four years: in stomach, duodenum and coecoascendens. On colonoscopy, induced by abdominal colic, the large ( to 3 cm ) and numerous submucous, nodular yellowish masses with hyalinisation and calcification were found in caecoascendens. GCT diagnosis of colon,on small endoscopical biopsies, was pointed out, followed by right colectomy, 23 cm of length, with good clinical course ( 24 - month follow-up ). Eight months after surgery, patient experienced hemathemesis and melena. Gastroduodenoscopy was performed, revealing numerous white solid and confluent nodules, up to 1 cm in diameter in stomach, while the only one ulcerous change was found in duodenum. By using the biopsies and S- 100 protein, marker, has been also confirmed GCT. Two Years after right colectomy, the new lesions did not revealed in gross appearance. Except he is afraid of dead, the patient is with good health, " living for music and from music", how he likes to say.
Keywords: granular cell tumor, gastrointestinal tract, skin, histopathology, diagnosis, therapy.
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