Advertisement

Pancreatic granular cell tumor diagnosed by endoscopic ultrasound-guided fine needle aspiration biopsy

  • Chonlada Krutsri
  • Tomohisa IwaiEmail author
  • Mitsuhiro Kida
  • Hiroshi Imaizumi
  • Toshihiro Kawano
  • Masayoshi Tadehara
  • Masafumi Watanabe
  • Kosuke Okuwaki
  • Hiroshi Yamauchi
  • Koizumi Wasaburo
Case Report

Abstract

Pancreatic granular cell tumors (GCTs) are rare and making an imaging diagnosis of pancreatic GCT is difficult because it has no definite characteristics on contrast-enhanced computed tomography (CE-CT) or magnetic resonance imaging (MRI) owing to varying findings. We report about a 32-year-old woman who presented with an incidental finding of a pancreatic tumor with a past history of excision of a right forearm GCT nodule 12 years ago. CE-CT revealed a 23-mm-sized homogeneous low enhancement tumor in the arterial phase in the pancreatic body. Abdominal MRI revealed a lobulated hypointense mass in T1WI and high signal in DWI. Endoscopic ultrasonography (EUS) revealed that the tumor was oval, hypoechoic with posterior echo enhancement, and had a well-defined border. Although EUS-guided fine needle aspiration revealed benign granular cells of the pancreas, she underwent laparoscopic surgery because the metastatic tumor from the past lesion was not excluded. The pathological finding was benign GCT of the pancreas and it was considered as an original lesion. In the previous reports, most of the resected cases were considered to be pancreatic cancer or neuroendocrine tumor preoperatively. Compared to CE-CT and MRI, EUS imaging and EUS-FNA are more reliable diagnosis tools for pancreatic GCT. Although malignant GCT accounts for approximately 1–2% of all cases, surgical resection or strict follow-up should be considered because it is difficult to predict its biological behavior.

Keywords

Granular cell tumors (GCT) Pancreatic GCT Endoscopic ultrasound-guided fine needle aspiration biopsy 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Human and animal rights

This study does not include any data about human specimen. All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

This is a case report and does not involve human subjects and does not apply to giving informed consent.

References

  1. 1.
    Abrikossoff A. Ueber Myome ausgehened von der quergestreiften willkuerlichen Muskulatur. Virchows Arch A Pathol Anat. 1926;260:215–33.CrossRefGoogle Scholar
  2. 2.
    Takuya Nojiri Y, Unemura K, Hashimoto, et al. Pancreatic granular cell tumor combined with carcinoma in situ. Pathol Int. 2001;51:879–82.CrossRefGoogle Scholar
  3. 3.
    Patel AJ, Shriram M. Jakate granular cell tumor of the biliary tract. Gastroenterol Hepato(NY). 2010 May;6:331–6.Google Scholar
  4. 4.
    Rejas RA, Campos MS, Cortes AR, et al. The neural histogenetic origin of the oral granular cell tumor: an immunohistochemical evidence. Med Oral Patol Oral Cir Bucal. 2011;16:e6–10.CrossRefGoogle Scholar
  5. 5.
    Wellmann KF, Tsai CY, Reyes FB. Granular-cell myoblastoma in pancreas. NY State J Med. 1975;75:1270.Google Scholar
  6. 6.
    Seidler A, Burstein S, Drweiga W, et al. Granular cell tumor of the pancreas. J Clin Gastroenterol. 1986;8:207–9.CrossRefGoogle Scholar
  7. 7.
    Sekas G, Talamo TS. Julian TB obstruction of the pancreatic duct by a granular cell tumor. Dig Dis Sci. 1988;33:1334–7.CrossRefGoogle Scholar
  8. 8.
    Bin-Sagheer ST, Brady PG, Brantley S, et al. Granular cell tumor of the pancreas: presentation with pancreatic duct obstruction. J Clin Gastroenterol. 2002;35:412–3.CrossRefGoogle Scholar
  9. 9.
    Méklati EHM, Lévy P, O’Toole D, et al. Granular cell tumor of the pancreas. Pancreas. 1004; 31:296–8.Google Scholar
  10. 10.
    Kanno A, Satoh K, Hirota M, et al. Granular cell tumor of the pancreas: a case report and review of literature. World J Gastrointest Oncol. 2010;2:121–4.CrossRefGoogle Scholar
  11. 11.
    Takahashi K, Mikata R, Tsuyuguchi T, et al. Granular cell tumor of the pancreas diagnosed by endoscopic ultrasound guide fine-needle aspiration. Clin J Gastroenterol. 2018 Jun;11:193–9.CrossRefGoogle Scholar
  12. 12.
    Alejandro Garces-Descovich. Callery MP, Anderson KR, et al. Synchronous granular cell tumors of the pancreas and cecum. Clin Imaging 52(2018) 95–9.CrossRefGoogle Scholar
  13. 13.
    Sarah M, Bean MA, Eloubeidi MA, Eltoum IA, et al. Preoperative diagnosis of a mediastinal granular cell tumor by EUS-FNA: a case report and review of literature. Cyto J. 2005;2:8.Google Scholar
  14. 14.
    Lee TY, Cheon YK. and Chan sup shim. Clinical role of contrast-enhanced harmonic endoscopic ultrasound in differentiating solid lesions of the pancreas: a single-center experience in Korea. Gut Liver. 2013;7:599–604.CrossRefGoogle Scholar
  15. 15.
    Sachin Wani MD, Raman Muthusamy V. Srinadh Komanduri EUS-guide tissue acquisition: an evidence-based approach (with videos). Gastrointes Endosc. 2014 80:939–59.e7.CrossRefGoogle Scholar
  16. 16.
    Barakat M, Kar AA, Pourshahid S, et al. Gastrointestinal and biliary granular cell tumor: diagnosis and management. Am Gastroenterol 2018. 31:439447.Google Scholar
  17. 17.
    Sercan Aksoy H, Abali S, Kilickap, et al. Metastasis granular cell tumor: a case report and review of literature. Acta Oncologica. 2006;45:1, 91–94.CrossRefGoogle Scholar
  18. 18.
    Sonobe H, Iwata J, Furihata M, et al. Granular cell tumor: report of a case and review of the literature. Pathol Res Pract. 1998;194:507–13.CrossRefGoogle Scholar
  19. 19.
    Chen J, Wang L, Xu J, et al. Malignant granular cell tumor with breast metastasis: A case report and review of the literature. Oncol Lett. 2012;4:63–6.CrossRefGoogle Scholar
  20. 20.
    Fanburg-Smith JC, Meis-Kindblom, et al. Malignant granular cell tumor of soft tissue: diagnostic criteria and clinicopathologic correlation. Am J Surg Pathol. 1998;22(7):779–94.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2019

Authors and Affiliations

  • Chonlada Krutsri
    • 1
  • Tomohisa Iwai
    • 2
    Email author
  • Mitsuhiro Kida
    • 2
  • Hiroshi Imaizumi
    • 2
  • Toshihiro Kawano
    • 2
  • Masayoshi Tadehara
    • 2
  • Masafumi Watanabe
    • 2
  • Kosuke Okuwaki
    • 2
  • Hiroshi Yamauchi
    • 2
  • Koizumi Wasaburo
    • 2
  1. 1.Department of Surgery, Faculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
  2. 2.Department of Gastroenterology, Kitasato University School of MedicineKitasato University HospitalSagamiharaJapan

Personalised recommendations