Granular cell tumor of the breast

Rare Mesenchymal Breast Entities that Mimic Malignancy: A Single-institution Experience of a Challenging Diagnosis

Background

Benign mesenchymal tumors of the breast are rare and may mimic invasive carcinoma on imaging and morphology, thus becoming clinically challenging for clinicians, radiologists, and pathologists. To improve the understanding of these lesions and to avoid erroneous diagnosis and inappropriate treatment, we report our institution’s experience with seven cases of granular cell tumor (GCT) and myofibroblastoma (MFB) in the past 10 years.

Materials and methods

Seven cases of benign mesenchymal tumors of the breast were identified at the University of Texas Medical Branch from 2008 to 2018. Breast biopsies were collected from all patients after mammography and ultrasound imaging classified their results as suspicious or highly suggestive of malignancy by the Breast Imaging Reporting and Data System (BI-RADS ≥ 4A). All cases were reviewed to study the morphologic features and their immunoprofiles. The demographic characteristics, methods of treatment, postoperative pathological results, and follow-up results of the cases were then analyzed and compared to peer-reviewed literature.

Results

The study consisted of five females and two males with a mean age of 50 years in the GCT patients and 62 years in MFB patients. We identified four cases of GCT and three cases of MFB. The mean tumor size was 1.9 cm. Clinically, five patients presented with a palpable nontender mass, one with breast asymmetry, and one was asymptomatic. All patients underwent imaging studies prior to core needle biopsy. BI-RADS was ≥4B in patients with GCT and 4A-C in MFB. Definitive diagnosis was made by histopathology and confirmed by immunohistochemistry in accordance with the features described in the literature. Six patients underwent wide excision. The mean follow-up duration was 44.5 months. All patients remained well, without recurrence.

Conclusions

MFB and GCT can mimic malignant neoplasms and the clinical significance of these entities lies primarily in their recognition as distinctive benign neoplasms. The gold standard for the diagnosis of GCT and MFB is histopathology. All the cases in our series were clinically or radiologically mistaken for carcinoma, which has been largely reported in the literature. Pathologists should bear this in mind to avoid misdiagnosis and unnecessary treatment.

Granular cell tumor of the pancreas diagnosed by endoscopic ultrasound-guided fine-needle aspiration

A 68-year-old woman was referred to our hospital for the treatment of bile duct stone, pancreatic tumor, and pancreatic cysts. First, bile duct stone was removed using endoscopic retrograde cholangiopancreatography. By abdominal contrast-enhanced computed tomography, a 12-mm diameter tumor was found in the pancreatic body. The tumor was isodense compared with the surrounding pancreatic parenchyma in the non-contrast phase and poorly enhanced in the arterial phase; it exhibited gradual enhancement from the portal vein phase to the late phase. Numerous pancreatic cysts were also observed by contrast-enhanced computed tomography. By magnetic resonance imaging, the tumor was hypointense in T1-weighted images, isointense in T2-weighted images, and hyperintense in diffusion-weighted images. By magnetic resonance cholangiopancreatography, the main pancreatic duct was not dilated, and pancreatic cysts communicated with the main pancreatic duct. The pancreatic cysts were diagnosed as branch-type intraductal papillary mucinous neoplasm. Histopathologic assessment of the specimens obtained by endoscopic ultrasound-guided fine-needle aspiration revealed the tumor as benign pancreatic granular cell tumor. The patient was followed up without surgical resection. On contrast-enhanced computed tomography at 6 months after admission, the tumor did not show any changes in diameter or characteristics.

Myoblastoma of the breast: Our experience and review of literature

INTRODUCTION

Breast myoblastoma or granular cell tumor involving the breast parenchyma has been described in detail for the first time since Abrikossoff in 1931. The location of this injury to the breast is very rare, accounting for between 5% and 15% of all cases of cancer of the granular cells. We present our experience regarding the identification of two cases because of the relative rarity of this tumor. It is often confused with breast cancer on clinical and radiological, and its diagnosis can then be difficult for physicians, radiologists and pathologists.

PRESENTATION OF CASES

We report the cases of two young women who came to our attention because of the presence of mass shoveled breast, mobile and accompanied by pain cycle independent. In both cases, mammography and ultrasound revealed the presence of heterogeneous mass and irregular, but in one of two such mass located at the Union of external quadrants of the left breast and was in contact with his serratus anterior and suspicion for malignancy. In both cases the 'histology combined with immunohistochemical study proved to be a granular cell tumor.

CONCLUSION

Although a granular cell tumor of the breast is a rare tumor breast, should be considered in the differential diagnosis of benign and malignant lesions. Surgeons and pathologists should keep in mind when considering a granular cell tumor cells with abundant granular cytoplasm containing materials to avoid misdiagnosing breast cancer, which could lead to unnecessary surgery.

Myofibroblastoma of the mandible in a 3-year-old child

Myofibroblastoma is a rare benign tumor of the head and neck region, which is characterized by a large, rapidly growing, and destructive mass. A 3-year-old boy presented with an 8-week history of a rapidly growing swelling of the right mandible. Examination revealed a firm 13-cm mass occupying the entire right body and ramus of the mandible. The clinical and radiological features were suggestive of a sarcoma. An initial biopsy taken in the referring hospital was inconclusive, and the second biopsy showed a myofibroblastic neoplasm consistent with a desmoplastic fibroma. Progressive tumor growth necessitated a tracheostomy. Right hemimandibulectomy was performed, and the defect was reconstructed with free microvascular fibula flap. Histopathology and immunocytochemistry revealed a myofibroblastoma. This entity differs from other myofibroblasts and fibroblast tumors such as inflammatory myofibroblastic tumor (IMT), myofibroma, and desmoplastic fibroma. The child has been followed up for 2 years.

CONCLUSION

Differentiation between myofibroblasts and fibroblastic tumors as well as some malignancies can be challenging. Myofibroblastoma can behave as a malignant neoplasm, and the clinical distinction of this entity lies primarily in its recognition as a benign neoplasm.

Diagnosis of a granular cell tumour at the abdominal wall using fine needle aspiration cytology and histology: Case report

This case report describes the use of fine needle aspiration cytology to diagnose a granular cell tumour (GCT) that presented as a painless, palpable mass at the abdominal wall in a 50-year-old woman who had had the mass for ≥1 year prior to presentation. Routine haematoxylin and eosin staining of the cytological smears demonstrated that the specimen was predominantly cellular; it contained both cell clusters and single cells with abundant granular cytoplasm and indistinct cell borders. Cells were fragile and had fairly uniform naked nuclei that were scattered with vacuolated and prominent nucleoli. Background material on the smears included eosinophilic, granular cytoplasmic material and some adipose tissue. Neither mitoses nor necrosis were observed. A cytological diagnosis of a GCT was confirmed by histological examination of a surgical specimen stained with haematoxylin and eosin. This case report found that the GCT had a characteristic cytological appearance and that cells with prominent nucleoli can be present in benign GCTs.

Granular cell tumor of the breast: a case report

Introduction

A granular cell tumor involving the breast parenchyma was first described by Abrikossoff in 1931. Localization of this lesion to the breast is very rare, accounting for between 5% and 15% of all granular cell tumor cases. We present this case because of the rarity of this tumor. It is frequently confused with breast carcinoma on clinical and radiological examination, and its diagnosis can therefore be challenging for clinicians, radiologists and pathologists.

Case presentation

We report the case of a 32-year-old Moroccan woman who presented with a palpable mass in her right breast. Mammography and ultrasound examination revealed a heterogeneous, irregular and poorly limited mass, located at the union of the outer quadrants of her right breast. The mass was in contact with her latissimus dorsi and suspicious for malignancy. A histological examination combined with immunohistochemical study revealed it to be a granular cell tumor.

Conclusion

Although a granular cell tumor of the breast is a rare breast neoplasm, it should be considered in the differential diagnosis of benign and malignant lesions. Pathologists should bear in mind a granular cell tumor when examining material containing cells with abundant granular cytoplasm to avoid misdiagnosing breast carcinoma, which could lead to unnecessary surgery.

Is fine needle aspiration cytology a useful diagnostic tool for granular cell tumors? A cytohistological review with emphasis on pitfalls

Background:

Granular cell tumors (GCT) formerly known as Abrikossoff tumor or granular cell myoblastoma, are rare neoplasms encountered in the fine needle aspiration (FNA) service. Named because of their highly granular cytoplasm which is invariably positive for the S-100 antibody, the classic GCT is thought to be of neural origin. The cytomorphological features range from highly cellular to scanty cellular smears with dispersed polygonal tumor cells. The cells have abundant eosinophilic granular cytoplasm, eccentric round to oval vesicular nuclei with small inconspicuous nucleoli. The fragility of the cells can result in many stripped nuclei in a granular background. The differential diagnosis occasionally can range from a benign or reactive process to features that are suspicious for malignancy. Some of the concerning cytologic features include necrosis, mitoses and nuclear pleomorphism.

Methods:

We identified 6 cases of suspected GCT on cytology within the last 10 years and compared them to their final histologic diagnoses.

Results:

Four had histologic correlation of GCT including one case that was suspicious for GCT on cytology and called atypical with features concerning for a malignant neoplasm. Of the other two cases where GCT was suspected, one showed breast tissue with fibrocystic changes, and the other was a Hurthle cell adenoma of the thyroid.

Conclusions:

These results imply that FNA has utility in the diagnosis of GCT, and should be included in the differential diagnoses when cells with abundant granular cytoplasm are seen on cytology. Careful attention to cytologic atypia, signs of reactive changes, use of immunohistochemistry, and clinical correlation are helpful in arriving at a definite diagnosis on FNA cytology.

Myofibroblastoma of the breast: Case report and literature review

Myofibroblastoma of the breast is a rare benign mesenchymal tumor. The literature describes relatively few cases of this type of tumor. We report on a new case of myofibroblastoma in a 65-year old man successfully managed at our institution. The purpose of this case report is to highlight characteristics and differential diagnosis of this rare neoplasm.

Granular cell tumor of the pancreas: A case report and review of literature

Granular cell tumors, also called Abrikossof’s tumors, were originally described by Abrikossof A in 1926. The first case of a pancreatic granular cell tumor was described in 1975 and only 6 cases have been reported. We describe a case of granular cell tumor in the pancreas showing pancreatic duct obstruction. Because imaging studies showed findings compatible with those of pancreatic carcinoma, the patient underwent distal pancreatectomy. Histological examination showed that the tumor consisted of a nested growth of large tumor cells with ample granular cytoplasm and small round nuclei. The tumor cells expressed S-100 protein and were stained with neuron-specific enolase and periodic acid-Schiff, but were negative for desmin, vimentin, and cytokeratin. The resected tumor was diagnosed as a granular cell tumor. To our knowledge, this is the seventh case of Granular cell tumor of the pancreas to be reported.

Granular cell tumour of the breast

Granular cell tumour of the breast (GCTB) is a rare tumour which arises from Schwann cells. It is a largely benign tumour but in extremely rare cases can exhibit malignant characteristics. It poses a particular problem as it's characteristics can mimic breast carcinoma clinically, radiologically and macroscopically. This results in the potential misdiagnosis of breast carcinoma and over treatment of patients. Typically GCTBs are benign, solitary lesions but variations include malignant GCTBs, colocalisation with breast malignancies and multicentricity. These tumours can be investigated using mammography, ultrasound and magnetic resonance imaging. However none of these modalities have yet identified any GCTB specific characteristics. On pathological examination they can be identified using both microscopic and immunohistochemical features. The cells have a distinctive granular eosinophilic cytoplasm associated with typical nuclei and abundant lysosomes. Immunohistochemically they are positive for S100 protein, CD68 and neuron specific endolase (NSE). They are treated with wide local excision and while they may reoccur, are associated with a good prognosis.