Contiguous granular cell myoblastoma and squamous cell carcinoma in the oesophagus.

Abstract

It has been stated that carcinoma must never be diagnosed in the presence of granular cell myoblastoma,' in view of the associated pseudoepitheliomatous hyperplasia. We submit a case with collision tumours of squamous cell carcinoma and granular cell myoblastoma in the oesophagus as a rare example. Case reportA 68 year old woman presented with a history of two months' dysphagia and two years' intermittent indigestion and retrosternal discomfort. She had lost 9.5 kg in weight in four months. The patient had smoked up to 20 cigarettes a day for many years. Her past medical history was unremarkable. Barium swallow showed an irregular filling defect at the junction of the middle and lower third of the oesophagus. Oesophagoscopy confirmed a ragged lesion at 31 cm. After biopsy, which showed a well differentiated squamous cell carcinoma, oesophagogastrectomy was performed. Three months after operation the patient had recurrent dysphagia and a subsequent biopsy showed recurrent squamous cell carcinoma but no granular cell myoblastoma.The operation specimen comprised an 11 cm segment of distal oesophagus with a cuff of stomach 4 cm long. In the oesophagus there were two collision tumours (fig 1). One was an annular, grey, centrally ulcerated tumour (2.8 cm long and 1.5 cm deep) and the other a yellowish grey, umbilicated, submucosal tumour 2 cm in length and 1 cm in depth. The latter was situated on the gastric side of the ulcerated tumour, directly abutting on to it.The larger tumour was a moderately well differentiated squamous carcinoma (flg 2), in some areas arising from dysplastic surface epithelium, going through to the serosa; it affected two lymph nodes and showed venous invasion. The smaller submucosal tumour blended with the muscularis mucosae in places. It was separated from the muscularis propria by a narrow margin of unaffected submucosa. It was unencapsulated and consisted of syncytial cords and islands of large cells with finely granular eosinophilic cytoplasm and faint PAS positivity separated by a scanty fibrous stroma (fig 2). No mitoses were seen. The appearance of the tumour were typical of a benign granular cell myoblastoma. In all the sections a thin fibrous septa separated the lateral border of the granular cell myoblastoma from the carcinoma. In most areas there was a distinct gap between the myoblastoma and the surface squamous epithelium. Occasional islands of dysplastic epithelium were present overlying the myoblastoma. DiscussionThe present case illustrates collision tumours with a granular cell myoblastoma occurring contiguously with an invasive squamous cell carcinoma. It has been stated2 that a review of the world literature fails to demonstrate a case of true squamous carcinoma, as evidenced by metastasis, intimately associated with or caused by a granular cell myoblastoma." In the present case, however, there is unequivocal evidence of squamous carcinoma as shown by invasion through the serosa, lymph node metastases, venous invasion, and postoperative recurrence. In the 551 on 12 May 201...

Coexistence of esophageal granular cell tumor and squamous cell carcinoma: a case report

“…On the other hand, the coexistence of GCTs with true malignant neoplasm in the same organ has also been described in the literature. There are reports of the association of esophageal, 17–23 lingual, 24 and laryngeal 25,26 GCTs with squamous cell carcinoma, or bronchial, 14,27 , 28 gastric, 9,29 and mammary 30,31 GCTs with adenocarcinoma, and bronchial GCT with small‐cell carcinoma 32 . Both tumors occurred either metachronously, 17–19 or similarly to the case presented here, synchronously 9,14 , 20,21 , 23–32 .…”

“…32 Both tumors occurred either metachronously, [17][18][19] or similarly to the case presented here, synchronously. 9,14,20,21,[23][24][25][26][27][28][29][30][31][32] In the majority of cases, including our case, there were the distinct gaps between both tumors 9,14,[18][19][20][21]23,24,26 and in only two cases the cancers arose within the epithelium overlying the GCTs. 25,29 Moreover, the association of esophageal GCTs with cancers of different organs including adenocarcinoma of the stomach 33 and the papilla of Vater, 34 or non-small cell carcinoma of the lung 6,35 was also noted.…”

“…There are reports of the association of esophageal, 17–23 lingual, 24 and laryngeal 25,26 GCTs with squamous cell carcinoma, or bronchial, 14,27 , 28 gastric, 9,29 and mammary 30,31 GCTs with adenocarcinoma, and bronchial GCT with small‐cell carcinoma 32 . Both tumors occurred either metachronously, 17–19 or similarly to the case presented here, synchronously 9,14 , 20,21 , 23–32 . In the majority of cases, including our case, there were the distinct gaps between both tumors 9,14 , 18–21,23 , 24,26 and in only two cases the cancers arose within the epithelium overlying the GCTs 25,29 .…”