A unique case of gastric epithelioid stromal tumor (leiomyoma) demonstrating granular changes is reported. Microscopically, the tumor was composed of polygonal or fusiform cells with a coarse, granular eosinophilic cytoplasm, focally admixed with fascicles of spindle-shaped cells. A marked lymphoid infiltrate forming follicles was also a characteristic finding. Immunohistochemically, these cells were positive for alpha-smooth-muscle actin, HHF-35 (muscle-specific actin), and NKI/C3 but negative for desmin, S100 protein, vimentin, lysozyme, and Mac-387. This case demonstrates that granular cell changes and prominent lymphoid aggregates are not limited to gastric stromal tumors with neural differentiation.
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