Indian Journal of Dermatology
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CASE REPORT
Year : 2006  |  Volume : 51  |  Issue : 3  |  Page : 196-197
Granular cell tumour on vaccination scar in a young girl


Department of Dermatology, Venereology, and Leprosy, R. G. Kar Medical College, Kolkata - 700 004, India

Correspondence Address:
Debabrata Bandyopadhyay
203, M. N. K. Road (South), Kolkata - 700 036
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.27985

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   Abstract 

Granular cell tumors originate from neural elements. These distinctly rare tumors usually appear as solitary nodular growths and run a benign course. Although internal organs are rarely involved, skin and oral cavity are the commonest sites of affection. Their peak occurrence is in middle age. We present a case of a large solitary granular cell tumor occurring on the upper arm of a young girl at the site of a vaccination scar. Histopathology showed sheets of polyhedral cells with indistinct cell boundaries containing abundant eosinophilic fine granules. Excision of the lesion appeared to have cured the condition.


Keywords: Granular cell tumor, childhood, vaccination scar


How to cite this article:
Bandyopadhyay D, Sen S, Bandyopadhyay JP. Granular cell tumour on vaccination scar in a young girl. Indian J Dermatol 2006;51:196-7

How to cite this URL:
Bandyopadhyay D, Sen S, Bandyopadhyay JP. Granular cell tumour on vaccination scar in a young girl. Indian J Dermatol [serial online] 2006 [cited 2019 Aug 23];51:196-7. Available from: http://www.e-ijd.org/text.asp?2006/51/3/196/27985



   Introduction Top


Granular cell tumor (GCT), also known as Abrikosoff's tumor, was previously known as granular cell myoblastoma on the mistaken notion of muscular origin. The origin of the tumor was disputed in the past. Now they are regarded as benign neoplasms of neural origin. GCT may arise from almost any organ, most commonly the tongue and the skin. GCT very rarely involves children. These tumors are usually solitary but can be multiple and have a very small but definite chance of turning malignant. A case of a solitary large granular cell tumor occurring during childhood on the site of a vaccination scar is described here for its rarity.


   Case Report Top


A fourteen-year-old girl presented to the skin outdoor of our hospital with a nodular painless swelling over a scar on BCG vaccination site on her left upper arm [Figure - 1]. It had started as a small swelling about eight years previously, and had slowly increased in size. The tumor was about 4 cm in diameter, solitary, well circumscribed, firm in feel, globular, non-tender but pruritic. The surface was irregular with scaly margins and a depressed center. The central part was hyperpigmented. A thorough clinical assessment of the patient was done and no associated abnormality was recorded. There was no accompanying lymphadenopathy, neither was there any involvement of the tongue. Endoscopy of the GI tract did not reveal any abnormality and the X-ray of the skull did not show any suspicious shadow in the pituitary region. The chest X-ray was normal.

A skin biopsy was taken from the lesion which revealed sheets of large polyhedral cells with indistinct cytoplasmic boundaries between the collagen bundles beneath a hyperkeratotic and mildly acanthotic epidermis. The cytoplasm of the cells was seen to contain uniformly fine eosinophilic granules [Figure - 2]. The nuclei were centrally located, roundish as well as elongated, and occasionally vesicular. There was no cellular atypia or mitotic figures. The subcutis was involved at places. There was no inflammatory infiltrate. Immunohistochemistry was not done owing to lack of facility.


   Discussion Top


GCT is an uncommon tumor that may involve almost any organ. The cell of origin is still disputed, and although distinct neural features suggest a Schwann cell origin, the noncommittal term granular cell tumor continues to be appropriate.[1] A few atypical varieties have been described like the 'gingival type' found in newborns which are likely to be reactive rather than neoplastic and the 'primitive polypoid granular cell tumor' which is non-neural and shows no obvious line of differentiation.[2]

GCT occurs more in women and blacks are affected slightly more than whites.[3],[4] Though any age may be affected, the peak age of incidence has been found to be in the fourth through sixth decades of life. Our patient had the onset of the tumor in her first decade of life. Very few cases of childhood onset of the disease have been reported in the past.[5],[6],[7] The tumor can affect any organ of the body.[3] However, a study of 263 cases showed that the most preferred sites were the skin, oesophagus and the tongue.[8] As in the present case, most GCT are solitary, but multiple tumors do occur in 5 to 10 per cent of cases.[6].[8],[9] Our case had a single lesion over her left shoulder and no lesions in the oral cavity, pharynx, larynx or stomach..

Malignant variants occur only in 1-2% cases and may cause local symptoms from pressure, obstruction, hemorrhage, ulceration or secondary infection. These cases also show cytological features of malignancy or metastasize to regional lymph nodes or distant sites.[10] Indicators of malignancy are large size, vascular invasion, necrosis, and rapid growth.[10] They are however mostly found in the elderly. Thus granular cell tumors need proper histopathological evaluation and follow up. Cutaneous lesions may occur in association with visceral affection,[11] thus necessitating proper evaluation to exclude internal association. We could find only one instance in the literature of GCT occurring on a scar:[12] a GCT of vulva occurring on an episiotomy scar. The occurrence of the tumor on an old vaccination scar in the present case may suggest an aetiological implication, or simply an incidental co-localization.

Histopathologically, a granular cell tumor is diagnosed by the characteristic granular cell, which is a large, pale, polygonal, oval or bipolar cell with abundant fine or coarsely granular, eosinophilic cytoplasm, and a pale staining nucleus situated centrally.[10] The cells form cords that infiltrate dermal collagen bundles. The main morphologic feature is the granularity of the cytoplasm which is caused by a massive accumulation of lysosomes.[13] The present case showed the presence of typical granular cells without any cellular atypia. Immunohistochemical features of the tumors are characterized by S 100 protein and neuron-specific enolase positivity among others,[10] which help differentiation of GCT from other lesions with a granular cell phenotype.

Granular cell tumors are best treated with surgical removal which is rarely followed by recurrence. The present case showed excellent healing after surgical excision and had no sign of recurrence during a short follow-up period of one year.



 
   References Top

1.Ordonez NG, Mackay B. Granular cell tumor: A review of the pathology and histogenesis. Ultrastruct Pathol 1999;23:207-22.  Back to cited text no. 1  [PUBMED]    
2.Chaudhry IH, Calonje E. Dermal non-neural granular cell tumour (so-called primitive polypoid granular cell tumour): A distinctive entity further delineated in a clinicopathological study of 11 cases. Histopathology 2005;47:179-85.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Morrison JG, Gray GF Jr, Dao AH, Adkins RB Jr. Granular cell tumors. Am Surg 1987;53:156-60.  Back to cited text no. 3  [PUBMED]    
4.Apisarnthanarax P. Granular cell tumor. An analysis of 16 cases and review of the literature. J Am Acad Dermatol 1981;5:171-82.  Back to cited text no. 4  [PUBMED]    
5.De Raeve L, Roseeuw D, Otten J. Multiple cutaneous granular cell tumors in a child in remission for Hodgkin's disease. J Am Acad Dermatol 2002;47:S180-2.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]  
6.Sahn EE, Dunlavey ES, Parsons JL. Multiple cutaneous granular cell tumors in a child with possible neurofibromatosis. J Am Acad Dermatol 1997;36:327-30.  Back to cited text no. 6      
7.Dheepa R, Janaki C, Sentamilselvi G, Janaki VR. Granular cell schwannoma. Indian J Dermatol 2004;49:198-9.  Back to cited text no. 7    Medknow Journal  
8.Billeret Lebranchu V. Granular cell tumor. Epidemiology of 263 cases. Arch Anat Cytol Pathol 1999;47:26-30.  Back to cited text no. 8      
9.Price ML, MacDonald DM. Multiple granular cell tumors. Clin Exp Dermatol 1984;9:375-8.  Back to cited text no. 9      
10.Weedon D. Skin Pathology. 2nd ed. Churchill Livingstone: Edinburg; 2002. p. 986-7.  Back to cited text no. 10      
11.Seo IS, Azzarelli B, Warner TF, Goheen MP, Senteney GE. Multiple visceral and cutaneous granular cell tumors. Ultrastructural and immunocytochemical evidence of Schwann cell origin. Cancer 1984;53:2104-10.  Back to cited text no. 11      
12.Murcia JM, Idoate M, Laparte C, Baldonado C. Granular cell tumor of vulva on episiotomy scar. Gynecol Oncol 1994;53:248-50.  Back to cited text no. 12      
13.Ordonez NG. Granular cell tumor: A review and update. Adv Anat Pathol 1999;6:186-203.  Back to cited text no. 13      


    Figures

  [Figure - 1], [Figure - 2]

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1 Tumeur cellules granuleuses
L. Ayadi,A. Khabir,I. Fakhfakh,M.H. Abdelmoula,S. Makni,T. Sellami Boudawara
Revue de Stomatologie et de Chirurgie Maxillo-faciale. 2008; 109(3): 158
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2 Granular cell tumor | [Tumeur à cellules granuleuses]
Ayadi, L., Khabir, A., Fakhfakh, I., Abdelmoula, M.H., Makni, S., Sellami Boudawara, T.
Revue de Stomatologie et de Chirurgie Maxillo-Faciale. 2008; 109(3): 158-162
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    Abstract
    Introduction
    Case Report
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    References
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