© 2016 by the American College of Gastroenterology The American Journal of GASTROENTEROLOGY Abstracts S1493 2678_A Figure 1. Endoscopic Finding: submucosal nodule in the fundus of the stom- ach 2678_B Figure 2. Histological findings: hematoxylin-eosin staining. Sheet of polygonal large cells with eccentrically located, round to oval nuclei and eosinophilic granular cytoplasm between normal gastric glands 2678_C Figure 3. Histological findings: Positive immunohistochemical staining for S-100 protein 2679 A Rare Case of Severe Ischemic Gastropathy Causing Upper GI Bleed Jonathan Pinto, MD, Joan Culpepper-Morgan, MD, Jeff C. Anucha, MD, Alvaro Genao, MD, Neil Resnick, MD. Harlem Hospital Center, New York, NY Ischemic gastropathy is an uncommon diagnosis due to the extensive arterial collaterals that supply the stomach. Hence, its diagnosis is infrequently entertained in patients presenting with upper GI bleed. 2677_B Figure 2. Computed tomography of the abdomen (day 4) shows that the internal bolster is dislodged in the dilated gastric wall. 2677_C Figure 3. Upper endoscopy (day 4) shows the internal bolster is eroding the gastric wall with surrounding edematous gastric mucousa 2678 Gastric Granular Cell Tumor: A Case Report and Review of the Literature Pawel Szurnicki, MD 1 , Ahmed Alansari, MD 2 , Tarek Alansari, MD 2 , Gulam Khan, MD 3 . 1. Woodhull Hospital, Brooklyn, NY; 2. New York Medical College/Metropolitan Hospital Center/Woodhull Hospital, Brooklyn, NY; 3. New York University School of Medicine, Woodhull Medical and Mental Health Center, Brooklyn, NY A granular cell tumor (GCT) is an uncommon soft tissue tumor that arises from the central nervous system and appears to originate from Schwann Cells based on immunohistochemical studies. While case reports show that tumor can occur at any site, it is predominantly found in the skin, subcutaneous soft tissue and in 8% of cases, in the gastrointestinal tract. They are commonly found incidentally and are often small and asymptomatic at diagnosis. We present a case of a 31 year old woman with no medical history who was admitted to our hospital with biliary colic. Patient was found to have cholelithiasis on abdominal ultrasound and choledocholithiasis that was confirmed on MRCP. She then had an esophagogastroduodenoscopy (EGD) and Endoscopic Retrograde Cholangiopancreatography (ERCP) where an incidental 8mm submucosal nodule was found in the fundus of the stomach. The biopsied nodule revealed gastric mucosa positive for PAS in cyto- plasmic granules, S-100, CD56, CD68 and negative for synaptophysin and chromogranin on immunos- taining which was consistent with a Granular Cell Tumor. The patient underwent cholecystectomy and follow up EGD with endoscopic ultrasound (EUS) for further evaluation. The nodule was found to be too small to characterize sonographically and inaccessible for endoscopic resection. The repeat nodule biopsy confirmed the earlier biopsy findings and the benign nature of the nodule. Surgical resection of the nodule was offered to the patient, but she chose the option of surveillance endoscopy in 6-12 months. Literature review shows that GCT's are frequently found in patients in their fourth to sixth decades of life, with no difference in prevalence among the genders. Endoscopically, gastric GCTs are seen as submucosal nodules ranging in size from few millimeters to few centimeters. They are usually benign in nature, however, some malignant cases have been reported. Some features associated with malignancy on macroscopic and microscopic levels include: rapid growth in size (greater than 4 cm), local recurrence, cell necrosis, tumor cells spindling, cytological atypia, high mitotic activity, vesicular nuclei with large nucleoli, and a high nuclear-to-cytoplasm ratio. In our case, malignant features were not seen macro- scopically or on histological examination.