Granular cell tumor of the esophagus

In 1931, Abrikossoff described the first case of granular cell tumor (GCT) in the esophagus. These tumors can develop in any part of the body.1 Eight percent of GCTs are found in the gastrointestinal tract and the esophagus is the most frequently affected organ.2 The majority present as solitary lesions, but 10% of the cases are multifocal.2 We present herein the case of a 21-year-old man, referred for endoscopy due to gastroesophageal reflux symptoms of oneyear progression and dysphagia and retrosternal pain of recent onset. During the endoscopy, a yellow, hard, mobile, 15 mm lesion with a nodular aspect was seen at the middle esophagus (fig. 1). Diagnosis from the histopathologic analysis was a GCT of the esophagus and immunohistochemical staining showed protein S-100, CD56, and CD68 expression (fig. 2). The patient was re-evaluated through endoscopy that revealed a residual lesion of 4 mm in diameter. Endoscopic ultrasound (EUS) identified a hypoechoic lesion that completely depended on the esophageal mucosa. Musectomy was performed with the band ligation technique with no complications. GCT is a white-to-gray lesion representing 0.0019-0.3% of all tumors. Most GCTs are solitary, as in our patient, but 10-15% can be multiple and pink or yellow in color.1--3 Even though we found the tumor at the middle third of the esophagus, the most frequent location is at the distal third of the esophagus. Esophageal GCTs are located at the distal third, middle third, and proximal third in 65, 20, and 15% of cases, respectively.4 The origin and nature of a subepithelial tumor cannot be determined through endoscopy alone, and GCTs are no exception. EUS is currently the most accurate imaging technique for determining the gastrointestinal wall layer from which the tumor originates. This information, combined with the echogenicity of the study, helps make the differential diagnosis and evaluate the probability of endoscopic resection. In our patient, the endoscopic ultrasound showed a hypoechoic lesion that depended entirely on the mucosa, but it is important to point out that through EUS,