To resect or observe? Conservative management of a large oesophageal granular cell tumour

Granular cell tumours (GCTs) (Abrikossoff tumours) are rare neoplasms of Schwann cell origin and are infrequently encountered in the oesophagus. Although most are benign, lesion size greater than 2 cm is often cited as an indication for surgical excision due to concern for malignant potential. We describe a middle-aged African American male in whom a large oesophageal GCT was discovered incidentally during endoscopic evaluation following traumatic injury. Despite exceeding commonly referenced size thresholds for resection, the tumour demonstrated no high-risk histological features and the patient remained asymptomatic. Given substantial operative risk from prior extensive abdominal surgery, a multidisciplinary team favoured close endoscopic surveillance. This case highlights the limitations of size-based management strategies and emphasises the importance of individualised risk assessment incorporating histology, endoscopic characteristics, symptoms and surgical risk.