Granular cell tumor presenting with perforation of fourth part of the duodenum: A case report

Granular cell tumors (GCT) are relatively rare neoplasms most commonly occurring in skin or soft tissues. GCT are thought to be of Schwann cell origin and strongly positive for s100 protein. GCT of the intestinal tract are usually asymptomatic and found incidentally in the esophagus on endoscopy.

Here, we present a case of GCT jejunum and the fourth part of the duodenum. The patient is a 41-year-old female who presented with abdominal pain and was subsequently found to have pneumoperitoneum with a perforation of the fourth part of the duodenum. Intraoperatively, there were multiple enlarged and hard mesenteric lymph nodes, which were found to be due to GCT involving the fourth duodenum and proximal jejunum.

The occurrence of GCT in the gastrointestinal (GI) tract are even less common accounting for 5-9% of all GCT with very few cases reported in the duodenum. GCT of the GI tract are often asymptomatic, consequently leading to misdiagnosed delays in treatment.

In the setting of GCT in the fourth part of the duodenum with evidence of locally advanced disease, local resection is the preferred treatment.