Granular Cell Tumor in the Thorax of a Patient With HIV

SESSION TITLE: Lung Pathology Cases SESSION TYPE: Affiliate Case Report Slide PRESENTED ON: Tuesday, October 27, 2015 at 04:30 PM - 05:30 PM INTRODUCTION: Granular cell tumor or Abrikossoff's tumor is a soft tissue neoplasm that originates in the nervous system (Schwann cells) and arises at virtually any body site, but is mainly found in the skin, oral cavity or digestive tract1. Most of them are benign and reportedly malignant cases are rare, occurring in only 1% or 2% of cases2. We report an unusual thoracic location of this tumor . CASE PRESENTATION: 51 year old postmenopausal female with HIV, well controlled (CD4 count> 700cells/mm3) on antiretroviral medications presents with right sided chest pain, worse with lying supine and exertional dyspnea. She also reports 80lbs weight loss in the past 6 months. Review of systems is negative otherwise. She is a current smoker with 30 pack years smoking history. Chest X-ray shows a globular opacity in the right upper lobe with a CT chest showing presence of a right upper lobe well marginated pleural based homogenous mass measuring 6.5 X 5.1cm. Work up reveals urine to be positive for hCG and cocaine. Serum beta hCG is 29.4mIU/ml (normal non pregnant state 0-5mIU/ml; early gestation >39.1mIU/ml). Transabdominal and transvaginal ultrasound show no intrauterine or extrauterine gestation. Bronchoscopic transbronchial biopsy of this lesion is done using radial ultrasound probe and shows presence of granular cell tumor based on the finding of atypical cells positive for S100, CD68, neuron specific enolase (NSE) and CD56. Patient is referred to cardiothoracic surgery for resection of this mass. DISCUSSION: Since the first case of granular cell tumor from the trachea and bronchus was described in the late 1930s, less than 100 cases have been reported as originating from the tracheobronchial tree, all of which were benign3. Our case is considered to be benign in the absence of any obvious metastases. Elevation of beta hCG usually seen in malignacies of germ cell origin has never been reported in association with granular cell tumors. CONCLUSIONS: We present a case of granular cell tumor presenting as a lung mass. Peculiar finding in our case was the presence of an elevated urine and serum beta hCG level, which in our knowledge, has never been reported in conjunction with granular cell tumors. Reference #1: Lack EE et al: Granular cell tumor: a clinicopathologic study of 110 patients. J Surg Oncol 1980, 13:301-316. Reference #2: Khansur T et al: Granular cell tumor. Clinical spectrum of the benign and malignant entity. Cancer 1987, 60:220-222. Reference #3: Ming Jiang et al. Pulmonary malignant granular cell tumor; World J Surg Oncol. 2003; 1: 22. DISCLOSURE: The following authors have nothing to disclose: Gaurav Dutta, Joshua Kagan, Samir Fahmy, Sikander Zulqarnain No Product/Research Disclosure Information