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Year : 2013  |  Volume : 58  |  Issue : 3  |  Page : 246
Management of a solitary tongue nodule

1 Dermatology Unit, Nesmos Department, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
2 Histopathology Unit, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
3 Otolaryngology Unit, NESMOS Department, Sant'Andrea Hospital, Matera, Italy
4 Plastic Surgery Unit, Madonna Delle Grazie Hospital, Matera, Italy

Date of Web Publication20-Apr-2013

Correspondence Address:
Abruzzese Claudia
Dermatology Unit, Nesmos Department, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University, Rome
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-5154.110889

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How to cite this article:
Guglielmo PC, Marta M, Giorgia C, Claudia A, Giulia P, Eugenio P, Luigi V, Miriam G. Management of a solitary tongue nodule. Indian J Dermatol 2013;58:246

How to cite this URL:
Guglielmo PC, Marta M, Giorgia C, Claudia A, Giulia P, Eugenio P, Luigi V, Miriam G. Management of a solitary tongue nodule. Indian J Dermatol [serial online] 2013 [cited 2020 Jun 3];58:246. Available from:


A 49-year-old man presented with a solitary nodule on the tongue, which had developed over a month, gradually increasing in size. Physical examination showed a hard and painless nodule measuring about 1 cm in diameter on the right lateral margin of the tongue [Figure 1]; the patient's medical history was unremarkable.
Figure 1: Nodular lesion localized on the right lateral margin of the tongue

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The lesion was excised completely, sparing the rest of the tongue, and the histopathological examination, associated with positive immunohistochemical staining for neuron-specific enolase (NSE), revealed a granular cell tumor [[Figure 2]a-b].
Figure 2: (a) Granular cell tumor composed of polygonal cells, with fine eosinophilic granular cytoplasm. Neoplastic cells characteristically dissect the collagen fibers (H and E, original magnification ×315) (b) Positive NSE stain (original magnification ×25)

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After 1-year follow-up, the patient is in good condition with no recurrence of the disease [Figure 3].
Figure 3: Complete resolution and no recurrence after 1 year of follow-up

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Granular cell tumor or Abrikossoff's tumor, first described by Abrikossoff in 1926, is a soft tissue neoplasm, benign in most of the cases, usually presenting as a solitary lesion and developing between the second and sixth decade of life, more frequently among women and blacks. Although it can arise in any organ of the body, the head and neck area is affected in the majority of cases, whose 70% are located on the tongue, oral mucosa, and hard palate. Oral cavity lesions mostly present as non-tender papules or nodules of less than 3 cm in diameter. They are asymptomatic and generally covered by normal or verrucous mucous membranes. [1] The histological features of the benign type consist of characteristic granular cells of large size, polygonal or fusiform, separated by collagen and not encapsulated, with a small nucleus, abundant cytoplasm and fine eosinophilic granulations. [2] The malignant type is diagnosed by the presence of histological criteria like necrosis, distribution of the cells in fusiform strings, large nucleus with vesicular core, increased mitotic activity, increased nucleus radius in relations to cytoplasm and nuclear pleomorphism; [3] rarely, it can present metastasis. Since Abrikossoff's tumor is one of the most common granular cell lesion of the head and neck, it is important to differentiate it from other tumors of the oral cavity containing granular cells like odontogenic granular cell fibroma, granular cell ameloblastoma, fibroxanthoma, angiosarcoma, and carcinoma of the basaloid cells. [4]

The origin of Abrikossoff's tumor is uncertain. Some authors thought it to arise from skeletal muscle, others have postulated a fibroblastic, histiocytic, or indifferentiated mesenchymal cell origin. More recent hypothesis suggests a derivation from Schwann cell. [5] In this regard, immunohistochemistry can be an important diagnostic tool: granular cell tumors are usually positive for S-100, vimentin and are strongly positive for NSE. Recently, a positive reaction for CD68 staining in granular cell tumors has also been described. [6]

In the reported case of a typical granular cell tumor, a complete excision of the single lesion is resolving, although the onset of relapses is possible. We recommend physicians to carry out a thorough differential diagnosis, pointing out the typical clinical features of this lesion. Conservative management without a radical surgery intervention could be adopted when Abrikossoff's tumor is suspected, thus not to reduce organ function and patient quality of life.

   References Top

1.Albrecht S. Neoplasias and hyperplasias of neural and muscular origin. In: Fitzspatrick TB, Freedberg IM, Wolff K, Eisen AZ, Austen KS, editors. Fitzspatrick's Dermatology in General Medicine. 1v. 50 th ed. New York: McGraw-Hill; 1999. p. 1210-20.  Back to cited text no. 1
2.Giuliani M, Lajolo C, Pagnoni M, Boari A, Zannoni GF. Granular cell tumor of the tongue (Abrikossoff's tumor). A case report and review of the literature. Minerva Stomatol 2004;53:465-9.  Back to cited text no. 2
3.Fanburg-Smith JC, Meis-Kindblom JM, Fante R, Kindblon LG. Malignant granular cell tumor of soft tissue: Diagnostic criteria and clinicopathologic correlation. Am J Surg Pathol 1998;22:779-94. Erratum in: Am J Surg Pathol 1999;23:136.  Back to cited text no. 3
4.Barr RJ, Grahan JH. Granular cell basal cell carcinoma. A distinct histopathologic entity. Arch Dermatol 1979;115:1064-7.  Back to cited text no. 4
5.Haukal F, Maceira JP, Dias EP, Ramos-e-Silva M. Histogenesis of Abrikosoff tumour of the oral cavity. Int J Dent Hyg 2010;8:53-62.  Back to cited text no. 5
6.Kurtin PJ, Bonin DM. Immunohistochemical demonstration of the lysosome-associated glycoprotein CD68 (KP-1) in granular cell tumors and schwannomas. Hum Pathol 1994;25:1172-8.  Back to cited text no. 6


  [Figure 1], [Figure 2], [Figure 3]


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