Indian Journal of Dermatology
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Year : 2015  |  Volume : 60  |  Issue : 2  |  Page : 206-208
Multiple painless cutaneous nodules

1 Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
2 Department of Dermatology, School of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA

Date of Web Publication3-Mar-2015

Correspondence Address:
Morteza Khodaee
Department of Family Medicine, AFW Clinic, 3055 Roslyn Street, Denver, 80238 Colorado
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-5154.152541

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How to cite this article:
Khodaee M, Amir M, Spittler J, Abdollahi M. Multiple painless cutaneous nodules. Indian J Dermatol 2015;60:206-8

How to cite this URL:
Khodaee M, Amir M, Spittler J, Abdollahi M. Multiple painless cutaneous nodules. Indian J Dermatol [serial online] 2015 [cited 2021 Jul 26];60:206-8. Available from: https://www.e-ijd.org/text.asp?2015/60/2/206/152541

A 34-year-old gentleman presents with three asymptomatic skin nodules on his lower abdomen, right flank, and lower back that have been enlarging for 4 months. He denies any weight change, fatigue, or other symptoms. Past medical history is significant for a "similar" lesion on his buttock which was removed and diagnosed as a trichilemmal (pilar) cyst 4 years ago. The patient is otherwise healthy with unremarkable past medical and family histories. Physical examination revealed a 2 × 2 cm and a 1 × 1 cm firm, non-tender, and well-circumscribed nodules on the lower abdomen [Figure 1] and [Figure 2] left lower back, respectively. The skin around both nodules was firm and indurated. There was also a 1 × 1 cm relatively soft and non-tender lesion on his right flank. Excisional biopsies of the lesions on the lower abdomen and right flank were performed.

Histological examination of the right flank tumor revealed a trichilemmal cyst. The hematoxylin-eosin-stained sections of the tumor on the lower abdomen [Figure 1] showed a non-encapsulated dermal tumor composed of irregularly arranged sheets of large polyhedral cells with small central hyperchromatic nuclei and abundant granular eosinophilic cytoplasm [Figure 3]. There was no evidence of necrosis, cytologic atypia, or mitotic figures. The overlying epidermis was relatively unremarkable with an intact basal layer, granular layer, and stratum corneum. Pseudoepitheliomatous hyperplasia was not seen. The tumor cells showed diffuse, strong nuclear and cytoplasmic staining with S100 protein [Figure 4] and strong cytoplasmic staining with CD68 [Figure 5]. The periodic acid-Schiff (PAS) stain was not performed .
Figure 1: A 2 × 2 cm non-tender firm cutaneous nodule of the lower abdomen

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Figure 2: A 1 1 cm non-tender relatively soft cutaneous lesion of the right flank

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Figure 3: Large cytoplasmic granules surrounded by a clear halo (arrow) were present in some sections (hematoxylin and eosin stain ×60)

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Figure 4: Immunohistochemistry depicting diffuse and strong positive nuclear and cytoplasmic response with S100 protein (original magnification ×4)

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Figure 5: Immunohistochemistry showing strong positive cytoplasmic staining with CD68 (original magnification ×10)

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   References Top

An JS, Han SH, Hwang SB, Lee JH, Min BW, Um JW, et al. Granular cell tumors of the abdominal wall. Yonsei Med J 2007;48:727‑30.  Back to cited text no. 1
Hatta J, Yanagihara M, Hasei M, Abe S, Tanabe H, Mochizuki T. Case of multiple cutaneous granular cell tumors. J Dermatol 2009;36:504‑7.  Back to cited text no. 2
Park JY, Hwang JJ, Lee SA, Lee WS, Kim YH, Chee HK, et al. Granular cell tumor occurring in the chest wall: A case report. Korean J Thorac Cardiovasc Surg 2012;45:196‑8.  Back to cited text no. 3
Hazan C, Fangman W. Multiple cutaneous granular‑cell tumors. Dermatol Online J 2007;13:4.  Back to cited text no. 4
Gross VL, Lynfield Y. Multiple cutaneous granular cell tumors: A case report and review of the literature. Cutis 2002;69:343‑6.  Back to cited text no. 5
Torrijos‑Aguilar A, Alegre‑de Miquel V, Pitarch‑Bort G, Mercader‑Garcia P, Fortea‑Baixauli JM. Cutaneous granular cell tumor: A clinical and pathologic analysis of 34 cases. Actas Dermosifiliogr 2009;100:126‑32.  Back to cited text no. 6
Singh A, Sawhney M, Das S. Granular cell tumor of skin diagnosed on fine needle aspiration cytology. Indian J Dermatol 2012;57:330‑1.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
Neural and neuroendocrine tumors. In: Weedon D, editor. Weedon's skin pathology. 3rd ed. London: Churchill Livingstone Elsevier; 2010. p. 878‑9.  Back to cited text no. 8
Epstein DS, Pashaei S, Hunt E Jr, Fitzpatrick JE, Golitz LE. Pustulo‑ovoid bodies of Milian in granular cell tumors. J Cutan Pathol 2007;34:405‑9.  Back to cited text no. 9
Le BH, Boyer PJ, Lewis JE, Kapadia SB. Granular cell tumor: Immunohistochemical assessment of inhibin‑alpha, protein gene product 9.5, S100 protein, CD68, and Ki‑67 proliferative index with clinical correlation. Arch Pathol Lab Med2004;128:771‑5.  Back to cited text no. 10
Sehgal VN, Verma P, Sharma S. An asymptomatic, progressive, ulcerative nodule over the anterolateral surface of the left upper arm. Clin Exp Dermatol 2012;37:695‑7.  Back to cited text no. 11
Stefansson K, Wollmann RL. S‑100 protein in granular cell tumors (granular cell myoblastomas). Cancer 1982;49:1834‑8.  Back to cited text no. 12


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


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