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E-IJD-CASE REPORT
Year : 2015  |  Volume : 60  |  Issue : 3  |  Page : 322
Granular cell tumor: An uncommon benign neoplasm


Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India

Date of Web Publication6-May-2015

Correspondence Address:
Anupam Das
"Prerana", 19 Phoolbagan, Kolkata 700 086, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.156453

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   Abstract 

Granular cell tumor is a distinctly rare neoplasm of neural sheath origin. It mainly presents as a solitary asymptomatic swelling in the oral cavity, skin, and rarely internal organs in the middle age. Histopathology is characteristic, showing polyhedral cells containing numerous fine eosinophilic granules with indistinct cell margins. We present a case of granular cell tumor on the back of a 48-year-old woman which was painful, mimicking an adnexal tumor.


Keywords: Back, granular cell tumor, painful


How to cite this article:
Gayen T, Das A, Shome K, Bandyopadhyay D, Das D, Saha A. Granular cell tumor: An uncommon benign neoplasm. Indian J Dermatol 2015;60:322

How to cite this URL:
Gayen T, Das A, Shome K, Bandyopadhyay D, Das D, Saha A. Granular cell tumor: An uncommon benign neoplasm. Indian J Dermatol [serial online] 2015 [cited 2021 Jul 29];60:322. Available from: https://www.e-ijd.org/text.asp?2015/60/3/322/156453

What was known?
Granular cell tumor usually presents as an asymptomatic lesion



   Introduction Top


Granular cell tumor (GCT) is an uncommon benign tumor, affecting the skin and internal organs. The condition was first described by Abrikossoff, and the name 'granular cell myoblastoma' was suggested by Horn and Stout. [1] The name was given on the erroneous notion regarding its origin from muscle. These neoplasms are now considered to be of neural origin. The tumor is usually asymptomatic although some patients may experience mild pruritus or pain. A case of a large solitary painful GCT is reported here for its rarity.


   Case Report Top


A 48-year-old housewife presented to us with a painful solid mass over her upper back present for the preceding 2 years. Starting as a pea-size swelling, it increased gradually in size and became more painful. There was no history of prior trauma or any discharge from the lesion [Figure 1].
Figure 1: Well-defined, yellowish hard nodular lesion with smooth irregular surface over midline in the upper back

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On examination, there was a well-defined, very tender, yellowish, hard lesion of about 3 cm diameter, having a smooth irregular surface located over the midline in the upper back. It was not fixed to underlying tissue. There was no regional lymphadenopathy and no other mucocutaneous findings. Systemic review was non-contributory.

Fine-needle aspiration cytology (FNAC) showed large round to oval cells with vesicular nuclei. Few binucleated cells were embedded in abundant proteinaceous material. Histology showed sheets of large polygonal cells infiltrating the dermis. The cells were characterized by abundant, coarsely granular and amphophilic cytoplasm; with eccentrically located small vesiculated nuclei and prominent nucleoli. There was neither any mitotic figure nor spindling of the lesional cells [Figure 2] and [Figure 3].
Figure 2: Photomicrograph showing sheets of large polygonal cells infiltrating into the dermis (H and E, ×10)

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Figure 3: Photomicrograph showing sheets of large polygonal cells with centrally placed small round to oval vesiculated nuclei with abundant granular eosinophilic cytoplasm without any mitotic figures (H and E, ×40)

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Routine laboratory tests, blood biochemistry panel and imaging studies were within normal limits. Immunohistochemistry was not done due to local unavailability and financial constraints. Based on the clinical and histological findings, a diagnosis of GCT was made.


   Discussion Top


GCT, also known as Abrikossoff's tumor, is an uncommon benign neoplasm. It was long debated whether the tumor originates from muscle, fibroblast, histiocyte, neural crest or nerve sheath. However, it is now accepted to be of neural sheath origin, indicated by S-100 protein, peripheral nerve myelin protein, such as P2 and PO protein positivity. [2],[3]

Although common during the third and fourth decades of life, GCT can occur at any age. Two thirds of the cases had been reported in women. [2],[4] Around 40% of cases are found in the tongue while skin and subcutaneous tissue share one third of the cases. Other sites such as esophagus, stomach, larynx, bronchus, uvea, muscle and pituitary stalk may be involved. GCT had been reported to occur in vaccination scar. [5] In 10% cases multiple tumors may be found at a time. [6] GCT usually presents with a well-circumscribed, solitary, raised, firm nodule of 0.5 to 3.0 cm diameter with a smooth, rough or verrucous surface. It usually remains asymptomatic, but sometimes may be associated with mild pruritus or tenderness. Our case was painful and very tender, an uncommon finding.

Histopathological examination is necessary for a conclusive diagnosis. FNAC may sometimes be helpful in this regard. The characteristic cytologic findings are large, pale oval, round, bipolar or polygonal cells with abundant fine or coarsely granular, eosinophilic cytoplasm, inconspicuous cell border, eccentrically located nuclei, fine nuclear chromatin and indistinct nucleoli. [7] Histopathology shows the same cellular architecture, pseudoepitheliomatous hyperplasia and cords of cells infiltrating into the dermis. Electron microscopy indicates that the characteristic granularity is owing to the accumulation of lysosomes. [8] On immunohistochemistry, the tumor cells are positively stained with vimentin, neuron-specific enolase, S-100, myelin protein, p75 nerve growth factor, calretinin, NKI/C3 and PGP9.5. [9]

Malignant GCT is found in only 1 to 2% of cases, indicated by large size, rapid growth, lymph node involvement, necrosis and cytologic features of malignancy. As mitoses are normally found in GCT, they are not considered to be the marker for malignant transformation. [10] An important feature of malignancy in a granular cell tumor is spindling of lesional cells.

Complete excision is the best mode of intervention. Rarely the tumor can recur, usually following inadequate removal.

Our case presented with a well-defined very painful nodular lesion with a smooth, but bosselated surface. We considered different painful dermal adnexal tumors as differential diagnoses. However, typical FNAC and histopathological findings indicated a diagnosis of GCT. We referred the patient to plastic and reconstructive surgeon for complete excision and follow up.

 
   References Top

1.
Funan HU. Granular cell myoblastoma. In: Demis DJ, McGuire J, editors. Clinical Dermatology. 12 th revision. Vol. 4. London: Harper and Row Publishers; 1982. p. 1-5.  Back to cited text no. 1
    
2.
Loncar B, Marjanoviæ K, Pauzar B, Staklenac B. Granular cell tumor-clinically presented as lymphadenopathy. Coll Antropol 2010;34:261-3.  Back to cited text no. 2
    
3.
Agarwal A, Sinha A, Rijal A, Karki S, Nizamani SM. Cytology diagnosis of granular cell tumor of umbilicus mimicking metastatic skin nodule and review of literature. Med Channel 2010;16:103-5.  Back to cited text no. 3
    
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.
Bandyopadhyay D, Sen S, Bandyopadhyay JP. Granular cell tumour on vaccination scar in a young girl. Indian J Dermatol 2006;51:196-7.  Back to cited text no. 5
  Medknow Journal  
6.
Aparicio SR, Lumsden CE. Light- and electron-microscope studies on the granular cell myoblastoma of the tongue. J Pathol 1969;97:339-55.  Back to cited text no. 6
[PUBMED]    
7.
Nasit JG, Chauhan S, Dhruva G. Granular cell tumor of hand presenting as subcutaneous nodule mimicking dermal adnexal tumor: A diagnosis by cytology. Indian Dermatol Online J 2013;4:33-6.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.
Ordóñez NG. Granular cell tumor: A review and update. Adv Anat Pathol 1999;6:186-203.  Back to cited text no. 8
    
9.
Vered M, Carpenter WM, Buchner A. Granular cell tumor of the oral cavity: Updated immunohistochemical profile. J Oral Pathol Med 2009;38:150-9.  Back to cited text no. 9
    
10.
Miracco C, Andreassi A, Laurini L, De Santi MM, Taddeucci P, Tosi P. Granular cell tumour with histological signs of malignancy: Report of a case and comparison with 10 benign and 4 atypical cases. Br J Dermatol 1999;141:573-5.  Back to cited text no. 10
[PUBMED]    

What is new?
Our case presented with an extremely painful and very tender swelling, an uncommon finding.


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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