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Zylis D, Kokkali S, Sofopoulos M, Zografaki E, Vourlakou C, Skafida E. Metastatic Granular Cell Tumor: A Rare Entity. Int J Surg Pathol 2024:10668969241229347. [PMID: 38321950 DOI: 10.1177/10668969241229347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Granular cell tumor, which is thought to recapitulate a Schwann cell phenotype, is a very rare neoplasm that belongs to soft tissue tumors. It can be classified as benign, atypical or malignant, based on specific histological criteria, with the majority of cases exhibiting an indolent behavior. Its biology and clinical course are poorly understood and its optimal management is yet to be defined, given the rarity of cases. Here we describe an atypical granular cell tumor in the upper middle back skin that evolved after a thirty-year indolent period. Despite complete surgical removal, the patient experienced a recurrence, both local and in the lungs, following an aggressive clinical course. Data on management of metastatic disease are extremely scarce, comprised exclusively of case reports. Therefore, we administered to the patient systemic therapy according to soft tissue sarcoma guidelines, which led to disease progression, with fatal outcome. In conclusion, recurrent and/or metastatic granular cell tumor is a rare disease that can be life-threatening, for which response to different therapies is unknown. The biologic behavior of atypical and malignant granular cell tumor is quite different from its benign counterpart, evoking soft tissue sarcomas, and its diagnosis should alert clinicians. The role of adjuvant chemotherapy and radiation therapy in this setting should be explored, to limit disease recurrence.
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Affiliation(s)
- Dimosthenis Zylis
- First Medical Oncology Clinic, Saint-Savvas Cancer Hospital, Athens, Greece
| | - Stefania Kokkali
- First Medical Oncology Clinic, Saint-Savvas Cancer Hospital, Athens, Greece
- Oncology Unit, 2nd Department of Medicine, National and Kapodistrian University of Athens, Medical School, Hippocratio General Hospital of Athens, Athens, Greece
| | | | - Eirini Zografaki
- Department of Plastic Surgery, Saint-Savvas Cancer Hospital, Athens, Greece
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2
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Yan J. Granular cell tumor of the breast: A case report and review of literature. World J Clin Cases 2023; 11:8044-8049. [DOI: 10.12998/wjcc.v11.i33.8044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/26/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Granular cell tumor (GCT) of the breast (GCTB) is a rare neoplasm that can exhibit malignant characteristics both clinically and radiologically. This tumor can also coexist and colocalize with breast carcinoma.
CASE SUMMARY We present a patient with this uncommon tumor and discuss the diagnostic and therapeutic approaches in order to further the knowledge of GCTB and prevent misdiagnosis and overtreatment. The characteristics of the tumor, methods of diagnosis, therapy and postoperative pathological outcomes were analyzed, and relevant literatures of GCTs were reviewed. The patient underwent surgery after core needle biopsy, and the excised neoplasm was sent for pathological examination. Histological analysis revealed nests of cells with abundant pink granular cytoplasm, confirming the diagnosis of GCTB.
CONCLUSION As manifestations of GCT and malignancy can mimic each other, a careful histological examination is essential before major surgery. Treatment consisting of complete excision with close clinical follow-up is recommended.
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Affiliation(s)
- Jun Yan
- Department of Breast Surgery, The University of Hong Kong - Shenzhen Hospital, Shenzhen 518000, Guangdong Province, China
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3
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Revia RA, Shah R, Mandalia A, Parikh J, Zayat V. Esophageal Granular Cell Tumor: An Uncommon Cause of Dysphagia. Cureus 2023; 15:e41846. [PMID: 37575771 PMCID: PMC10423093 DOI: 10.7759/cureus.41846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Granular cell tumors (GCTs) are rare, typically benign, solitary neoplasms that can arise throughout the body, with reports of cases in the tongue, esophagus, colon, skin, vulva, and skeletal muscle, among others. Although GCTs are usually asymptomatic, esophageal GCTs can grow large enough to cause dysphagia. When developing the differential diagnosis for dysphagia, a broad consideration includes routine etiologies such as esophageal strictures, eosinophilic esophagitis, carcinoma, webs and rings, achalasia, and motility disorders, but GCTs may not readily come to mind. Due to their scarcity, this case report is presented to raise awareness of esophageal GCTs and emphasize key goals for diagnosing and managing this uncommon yet treatable cause of dysphagia. This case report details the clinical course of a patient presenting with a chief complaint of difficulty swallowing that was found to be caused by a subepithelial esophageal tumor discovered with esophagogastroduodenoscopy (EGD) and endoscopic ultrasound (EUS). Histopathological studies paired with immunohistochemical investigations of a tissue biopsy confirmed the etiology of the offending esophageal mass to be a GCT. The patient's dysphagia resolved after endoscopic mucosal resection of the GCT, and follow-up evaluations have remained negative for recurrence. This case highlights the esophageal GCT as an uncommon source of dysphagia and the need for EGD and EUS evaluations of subepithelial esophageal lesions accompanied by histopathological analysis for a definitive diagnosis of GCT.
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Affiliation(s)
- Richard A Revia
- Pathology, University of Central Florida College of Medicine, Orlando, USA
| | - Raj Shah
- Internal Medicine, University of Central Florida Hospital Corporation of America (HCA) Healthcare Graduate Medical Education, Orlando, USA
- Internal Medicine, Orlando Veterans Affairs Medical Center, Orlando, USA
| | - Amar Mandalia
- Gastroenterology, Orlando Veterans Affairs Medical Center, Orlando, USA
| | - Jignesh Parikh
- Pathology, Orlando Veterans Affairs Medical Center, Orlando, USA
| | - Vania Zayat
- Pathology, Orlando Veterans Affairs Medical Center, Orlando, USA
- Pathology, University of Central Florida College of Medicine, Orlando, USA
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Raveendran C, Elias R, Parameswaran S, Yadev IP. Recurrent primary cutaneous granular cell tumor of the neck in an Asian women: A case report. Int J Surg Case Rep 2023; 106:108213. [PMID: 37080152 DOI: 10.1016/j.ijscr.2023.108213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Granular cell tumors are uncommon neoplasms. They appear in the skin, subcutaneous tissues, and many internal organs. It is essential to diagnose this disease because it mimics other tumors clinically. We report this case because of the rarity of tumors in Asians and the necessity of excision with clear margins. CASE PRESENTATION A 55-year-old Indian woman reported swelling in the right side of the neck for six months and gradually increasing in size. Two years ago, she had a similar swelling excised from her neck. She had wide local excision of the tumor with wider margins in the plastic surgery department, and histopathology revealed a granular cell tumor with clear margins. She is undergoing close follow-up with history and physical examination with no evidence of disease recurrence. CLINICAL DISCUSSION Granular cell tumors can have recurrences. These slow-growing tumors appear benign. Histopathological examination with careful assessment of high-risk features is vital in evaluating Granular cell tumors. Wide local excision with clear margins is the mainstay of treatment. CONCLUSION Achieving clear margins in the head and neck area is sometimes tricky for granular cell tumors. Margin positivity is associated with a high risk of local recurrence and needs re-excision of the tumor for adequate local control.
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Affiliation(s)
- Ciniraj Raveendran
- Department of Radiation Oncology, Medical College Thiruvananthapuram, Kerala State, 695011, India.
| | - Ruby Elias
- Department of Pathology, Medical College Thiruvananthapuram, Kerala State, 695011, India
| | - Sabu Parameswaran
- Department of Plastic Surgery, Medical College Thiruvananthapuram, Kerala State, 695011, India
| | - I P Yadev
- Department of General Surgery, Medical College Thiruvananthapuram, Kerala State, 695011, India
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Evmorfopoulos K, Tzortzis V, Vlachostergios PJ. Granular cell tumors of the urethra. Cancer Treat Res Commun 2023; 35:100695. [PMID: 36940531 DOI: 10.1016/j.ctarc.2023.100695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 05/15/2023]
Abstract
Granular cell tumors (GCTs) are a rare type of mesenchymal tumors that are histologically derived by Schwann cells and rise within soft tissues such as skin and mucosal surfaces. Differentiation between benign and malignant GCTs is often difficult and relies on their biological behavior and metastatic potential. While there are no standard guidelines for management, upfront surgical resection, whenever feasible, is key as a definitive measure. Systemic therapy is often limited by poor chemosensitivity of these tumors; however, accumulating knowledge of their underlying genomic landscape has opened some opportunities for targeted approaches, for example, the vascular endothelial growth factor tyrosine kinase inhibitor pazopanib, which is already in clinical use for the treatment of many types of advanced soft tissue sarcomas.
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Affiliation(s)
- Konstantinos Evmorfopoulos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41100 Larissa, Greece
| | - Vassilios Tzortzis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41100 Larissa, Greece
| | - Panagiotis J Vlachostergios
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, 41100 Larissa, Greece; Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY 10065, USA.
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Gao S, Xing B, Lichao S, Luo J, Tang J, Wang Y, Zhang X. Malignant granular cell tumor in the thoracic wall: A case report. Front Oncol 2022; 12:895924. [PMID: 36203431 PMCID: PMC9531233 DOI: 10.3389/fonc.2022.895924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022] Open
Abstract
Granulosa cell tumor (GCT) is a rare tumor that originates from neural/Schwann cells. GCTs can occur at any age and at any site in the body. The most common site is the tongue, followed by the mammary gland, upper respiratory tract ( throat and bronchus), and gastrointestinal tract (esophagus, large intestine and perianal area, stomach, small intestine, and bile duct). Malignant GCTs account for less than 1%–2% of all GCTs. Fewer than five GCTs in the thoracic wall have been reported, almost all of these benign. Here, we report a new case of malignant GCT of the thoracic wall, with rib invasion and pleural metastasis, in an Asian male. Microscopic examination revealed round, granular cells with eosinophilic cytoplasm and without prominent atypia. Despite these findings the disease showed rapid clinical progression. In summary, the tumor, although histologically ‘benign’, was clinically ‘malignant’.
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Affiliation(s)
- Shengnan Gao
- Department of Clinical Laboratory, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center/National Clinical Research Center for Cancer/State Key Laboratory of Molecular Oncology, Beijing, China
| | - Bin Xing
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Sun Lichao
- National Center for Respiratory Medicine, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Emergency department, China Japan Friendship Hospital, Beijing, China
| | - Jie Luo
- National Center for Respiratory Medicine, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Department of Pathology, China-Japan Friendship Hospital, Beijing, China
| | - Jiao Tang
- Department of internal medicine, China Nuclear Industry Beijing 401 Hospital, Beijing, China
| | - Ye Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoyan Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- National Center for Respiratory Medicine, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- *Correspondence: Xiaoyan Zhang,
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Amphlett A. An Update on Cutaneous Granular Cell tumours for Dermatologists and Dermatopathologists. Clin Exp Dermatol 2022; 47:1916-1922. [PMID: 35727729 DOI: 10.1111/ced.15309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
Abstract
Granular cell tumours are rare soft tissue neoplasms which occur at a wide variety of sites and commonly involve the skin. Distinction between benign and malignant granular cell tumours is important because benign tumours are commonly cured by complete excision and malignant tumours commonly recur and cause fatal metastatic disease. Communication between the dermatologist and pathologist is also important, as the pathologist may provide false reassurance by evaluating a benign appearing part of a clinically malignant tumour. The following review summarises the current literature on the epidemiology, clinical presentation, pathology, radiology, treatment and prognosis of cutaneous granular cell tumours, with a focus on improving diagnosis and management for dermatologists and dermatopathologists.
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Wei MZ, Yan ZJ, Jiang JH, Jia XL. Atypical granular cell tumor of the urinary bladder: A case report. World J Clin Cases 2021; 9:8453-8460. [PMID: 34754853 PMCID: PMC8554444 DOI: 10.12998/wjcc.v9.i28.8453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/14/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Granular cell tumor (GCT) is a neurogenic tumor mainly occurring in the head and neck. GCT in the genitourinary system is extremely rare and only sporadic cases of urinary bladder GCT have been reported. Most urinary bladder GCT cases are benign and only two malignant cases have been reported. Due to its rarity, no consensus criteria for the treatment of urinary bladder GCT are available at present.
CASE SUMMARY A 62-year-old Chinese woman was found to have a urinary bladder tumor without any clinical manifestations on physical examination. Cystoscopy revealed a semispherical shaped lesion measuring approximately 4.0 cm in diameter at the junction of the left wall and roof of the bladder, which was covered with normal bladder mucosa. Computed tomography scan demonstrated a high-density lesion on the left wall of the bladder, measuring approximately 2.9 cm × 2.4 cm with clear boundaries. Contrast-enhanced pelvic magnetic resonance imaging revealed a space-occupying lesion on the left wall of the bladder (non-mucosal origin/ external pressure), which was preliminarily suspected to be a desmoplastic fibroma or leiomyoma. In the context of the above findings, a pre-operative diagnosis of bladder leiomyoma was made. The patient consequently underwent a laparoscopic partial cystectomy. The resected bladder mass looked yellowish and well-demarcated, measuring 4.0 cm × 3.5 cm and infiltrated the muscular layer. The diagnosis of urinary bladder GCT was finally made by postoperative pathology, with positive immunohistochemical S-100 staining and negative pancytokeratin. The patient has been followed for 6 mo so far, with no tumor recurrence detected.
CONCLUSION This case highlights the biological feature and differential diagnosis of urinary bladder GCT at the pathological and molecular levels. Transurethral resection of the bladder tumor and partial cystectomy are recommended in most urinary bladder GCT cases, while radical cystectomy is recommended in malignant cases.
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Affiliation(s)
- Ming-Ze Wei
- Department of Urology, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315000, Zhejiang Province, China
| | - Ze-Jun Yan
- Department of Urology, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315000, Zhejiang Province, China
| | - Jun-Hui Jiang
- Department of Urology, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315000, Zhejiang Province, China
| | - Xiao-Long Jia
- Department of Urology, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315000, Zhejiang Province, China
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Rehan S, Paracha H, Masood R, Wang R. Granular cell tumor of the abdominal wall, a case report and review of literature. AME Case Rep 2021; 5:28. [PMID: 34312607 DOI: 10.21037/acr-20-160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/02/2021] [Indexed: 11/06/2022]
Abstract
Granular cell tumors (GCTs) on the abdominal wall are rare and present as a painless superficial abdominal mass. We report the case of a 73-year-old female, who presented to the family medicine practice with a painless subcutaneous anterior abdominal wall mass. Ultrasound showed a 0.9×0.5×1.3 cm3 hyperechoic solid lesion with distal shadowing within the subcutaneous tissue of the anterior abdominal wall. The X-ray did not show any calcification within the subcutaneous tissue which ruled out metastatic calcified lesions. The patient was referred to general surgery for further evaluation. A previous computed tomography (CT) revealed a nonspecific 12 mm lesion involving the skin and subcutaneous fat in the right upper quadrant of the anterior abdominal wall. The lesion was excised under local anesthesia and sent for histopathological analysis. CD68 highlighted the multitude of macrophages microscopically. Histopathology demonstrated CKAE1/AE3 was negative for any epithelial components and S100 was diffusely positive. A final diagnosis of GCT was made. On follow-up, the patient underwent excision of the scar tissue with no evidence of atypia or GCT. This case is unique due to its benign presentation and limited reported literature. Further evaluation of a painless subcutaneous lesion is imperative to rule out rare conditions and the possibility of recurrent or metastatic malignancy.
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Affiliation(s)
- Sarwat Rehan
- University of the Punjab, Lahore, Punjab, Pakistan
| | - Hamza Paracha
- International American University College of Medicine, Vieux Fort, Saint Lucia
| | - Rehan Masood
- Department of General Surgery, University of Calgary, Calgary, Canada
| | - Robby Wang
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada
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Malignant Granular Cell Tumor of the Lower Extremity in an Adolescent Male. J Pediatr Hematol Oncol 2021; 43:e529-e531. [PMID: 32769557 DOI: 10.1097/mph.0000000000001886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/13/2020] [Indexed: 11/26/2022]
Abstract
Granular cell tumors (GCTs) are extremely rare soft tissue tumors, with only 2% of tumors being malignant. Malignant GCTs are more often seen in women between the ages 40 and 60. There has been no case reported of a malignant GCT in a pediatric patient. We present a case of a 14-year-old male who presented with a large mass in his left lower extremity. After being biopsied, the mass was diagnosed as a malignant GCT. The tumor was completely excised with wide margins and close follow-up with the patient continued.
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Multifocal intraoral nodules. J Am Dent Assoc 2021; 153:74-78. [PMID: 33494934 DOI: 10.1016/j.adaj.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/15/2020] [Accepted: 11/07/2020] [Indexed: 11/23/2022]
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Benign and Malignant Granular Cell Tumor of the Hypopharynx: Two Faces of a Rare Entity. Head Neck Pathol 2020; 15:281-287. [PMID: 32240515 PMCID: PMC8010051 DOI: 10.1007/s12105-020-01157-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
Granular cell tumors (GCT) are rare soft tissue tumors that involve the head and neck in 50% of patients. Two distinct variants of GCT, one benign (bGCT) and the other malignant (mGCT), involving the hypopharynx, a subsite of the larynx, are presented here. The clinical presentations, radiographic features, pathologic diagnosis in these two variants of GCT are discussed. The mGCT was diagnosed only after complete tumor excision. This report highlights the importance of complete excision of the tumor mass, as diagnosis of mGCT can be exceedingly difficult to make on a small biopsy specimen. Therefore, complete excision is recommended for definitive diagnosis and treatment of GCTs.
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Metastasizing Malignant Granular Cell Tumor (Abrikossoff Tumor) of the Anterior Abdominal Wall, with Prolonged Survival. Case Rep Pathol 2019; 2019:9576487. [PMID: 31080684 PMCID: PMC6475540 DOI: 10.1155/2019/9576487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/11/2019] [Indexed: 11/18/2022] Open
Abstract
Malignant granular cell tumor (MGCT) is a rare high-grade mesenchymal tumor of Schwann cell origin. MGCTs commonly affect thigh, extremity, and trunk; however, involvement of the abdominal wall is quite rare. It has poor prognosis with 39% mortality rate in 3-year interval. We report a 50-year-old female who had MGCT arising in the anterior abdominal wall and developed massive metastatic deposits in both lungs and in the right inguinal lymph nodes, with prolonged survival for 11 years. A brief review of the literature is presented.
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