GI Endoscopy · 1 min read
Granular Cell Tumor (GCT)
Experienced teaching points
Clinical Pearls
- The decision to resect a granular cell tumor (Abrikosoff's tumor) should be driven by histological criteria rather than just the presence or absence of symptoms, as they can be malignant from the outset.
- Use the Fanburg-Smith histological classification system to risk-stratify granular cell tumors; key malignant features include tumor necrosis, mitotic activity (>2 mitosis/10 HPF), spindle cells, and nuclear pleomorphism.
- Even benign-appearing granular cell tumors require careful assessment, as approximately 2% of histologically benign GCTs will eventually progress to malignancy.
Although some guidelines dichotomize the decision to resect granular cell tumors (also called Abrikosoff's tumor) based on presence or absence of symptoms, others, including ourselves support the decision to resect based in histological criteria.
Let's not forget that GCT can be malignant from the outset, regardless of their size or presence of symptoms. Indeed, GCT are classified as malignant, benign and indeterminate. Furthermore, 2% of benign GCT progress to malignancy.
Thus, I like to use the classification of Fanburg-Smith (see table), which takes various histological features into consideration, such as tumor necrosis, spindle cells, vesicular nuclei with prominent nucleoli, mitotic activity (>2 mitosis/10 high-power fields), high nucleocytoplasmic ration, nuclear pleomorphism.
I am enclosing a table (from ref. No 2) comparing three classification systems to highlight that necrosis and mitotic activity are used in all of them to risk-stratify the lesion.
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References:
Aksoy S, Abali H, Kilickap S, Harputluoglu H, Erman M. Metastatic granular cell tumor: a case report and review of the literature. Acta Oncol. 2006;45:91–4.
Salaouatchi M, T, De Breucker S, Rouvière H, et al. A Rare Case of a Metastatic Malignant Abrikossoff Tumor. Case Rep Oncol 2021:1868-1875.
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