Malignant granular cell tumor of the median nerve: a case report with a literature review of 157 cases

Antiangiogenics in Malignant Granular Cell Tumors: Review of the Literature

Granular cell tumors (GCT) represent 0.5% of all soft tissue sarcomas (STS), and when metastatic, they exhibit aggressive behavior and determine limited survival. Metastatic GCTs are relatively chemo-resistant; however, there is growing evidence of the benefit of using pazopanib and other targeted therapies in this histology. This is a review of the role of pazopanib and other targeted therapies in the treatment of GCTs, along with some insights on pathology and molecular biology described in GCTs. From 256 articles found in our search, 10 case-report articles met the inclusion criteria. Pazopanib was the most employed systemic therapy. The median reported time on therapy with pazopanib was seven months. Eight out of ten patients (80%) experienced disease control with pazopanib, while four out of ten (40%) patients achieved an objective RECIST response. Molecular studies suggested that antitumoral effects of pazopanib in GCT might be due to a loss-of-function of ATP6AP1/2 genes which consequently enhance signaling through several molecular pathways, such as SFKs, STAT5a/b, and PDGFR-β. Other reported targeted therapies for malignant GCTs included pazopanib in combination with crizotinib, which showed disease control for four months in one patient, and a PI3K inhibitor which achieved disease control for nine months in another patient. Dasatinib and megestrol were ineffective in two other different patients. Pazopanib has been demonstrated to be active in advanced GCTs and may be considered as a preferable treatment option.

Case report: Giant atypical granular cell tumor of the median nerve

Granular cell tumors are extremely uncommon soft tissue neoplasms that mostly occur in the head and neck regions. Granular cell tumors are generally benign, asymptomatic, and rarely involve the median nerve. Due to the lack of awareness about granular cell tumors, they are easily misdiagnosed and mistreated in primary hospitals. Here, we report a giant atypical granular cell tumor located on the median nerve, approximately 12 cm in size, with unusual symptoms of median nerve damage. Magnetic resonance imaging revealed a fusiform mass that was hyperintense on T2-weighted images and iso-hypointense on T1-weighted images. The mass was subsequently biopsied and found to be a granular cell tumor. The tumor was resected, and a pathological examination was performed. Pathological examination revealed necrotic foci, abundant eosinophilic granules, pustular ovoid bodies, and multiple mitoses. Immunohistochemical staining revealed that the tumor cells were positive for S-100, CD68, SMA, SOX-10, Calretinin, and TFE3. The integrated diagnosis was an atypical granular cell tumor. To the best of our knowledge, this is the first report of an atypical granular cell tumor involving the median nerve. Furthermore, we comprehensively reviewed the existing literature to provide a concise summary of the diagnostic criteria, imaging findings, and pathological features of granular cell tumors. Given the high recurrence and metastasis rates of this disease, granular cell tumors of the median nerve should be considered when a patient presents with symptoms of median nerve impairment. The diagnosis of atypical granular cell tumors relies on pathological examination. In addition, extensive resection and long-term follow-up are necessary to improve prognosis.

Benign mesenchymal tumours of the tongue: A report of adult-type rhabdomyoma and granular cell tumour with a review of the literature

The cytomorphological features of benign mesenchymal tumours of the tongue have rarely been reported. Herein, we present the cytomorphological features of adult-type rhabdomyoma, which occurred in the tongue of a female patient, and granular cell tumour (GCT), which occurred in the tongue of a male patient; both patients were in their mid-50s. The cytological features of the adult-type rhabdomyoma case included large polygonal to ovoid cells with abundant and granular cytoplasm with predominantly peripherally located, uniform, round to oval nuclei and small nucleoli. Cross-striation and crystalline intracytoplasmic structures were not seen. The cytological features of the GCT case included large cells with abundant granular pale cytoplasm, small round nuclei and small distinct nucleoli. The cytological differential diagnoses of these tumours overlap; thus, the cytological findings of the different entities included in their differential diagnoses are discussed.

Granular cell tumors of the urethra

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.

Malignant granular cell tumour at the interventricular septum

Granular cell tumours are usually benign with a 1–2% incidence of malignancy. They are less sensitive to radiotherapy and chemotherapy and are treated by surgical excision. We report a case of a malignant granular cell tumour located at the interventricular septum.

Effect of High-Quality Nursing Intervention on the Quality of Life and Psychological State of Tumor Patients Undergoing First Chemotherapy

This study aimed to investigate the effect of high-quality nursing intervention on the quality of life (QOL) and psychological state of patients undergoing chemotherapy for the first time. A total of 100 malignant tumor patients admitted to Jiangyin Hospital of Traditional Chinese Medicine to receive chemotherapy for the first time from October 2018 to July 2020 were selected and randomized either to the control group or to the study group (50 cases in each group) via the random number table method. The control group received routine nursing, while the study group received high-quality nursing intervention. There was no striking difference in self-rating anxiety scale (SAS), self-rating depression scale (SDS), Karnofsky score (KPS), Eastern Cooperative Oncology Group (ECOG), and QOL between the two groups before nursing intervention (all P > 0.05). After nursing intervention, the SAS, SDS, KPS, ECOG, and QOL in the study group were better than those in the control group (all P < 0.05). The adverse reaction scores of the patients in the study group were lower than those in the control group (P < 0.05). High-quality nursing intervention can effectively reduce the psychological pressure of the first chemotherapy for patients with malignant tumor, ameliorate the psychological burden of patients, relieve patients' anxiety and fear, thus improve the chemotherapy effect, and contribute to improve their QOL.

Malignant granular cell tumors: Combining cytological and pathological findings for a definitive diagnosis

Malignant granular cell tumors (GCTs) account for less than 2% of all GCTs and mainly occur in the deep soft tissue of the thigh or trunk. Malignant GCTs are highly aggressive tumors with high rates of recurrence and metastasis. In this brief report, we describe a rare case of malignant GCT in a 64-year-old Japanese man who presented with a 14 × 20 cm mass in the left inguinal region. The cytologic findings of fine-needle aspiration (FNA) revealed atypical epithelial-like granular cells with granular substance in the background, which was difficult to differentiate from apocrine carcinoma or melanoma. The immunohistochemistry (IHC) findings of the needle biopsy revealed that the tumor cells were positive for S-100 and lysosomal marker CD68 which was suggestive of a GCT. However, the presence of crush artifacts made it challenging to identify cellular atypia, which is a characteristic of malignant tumor. Taken together, the FNA and needle biopsy results were suggestive of malignant GCT. The importance of preoperative diagnosis of malignant GCT is well known, but few reports have described its cytological findings. In our brief report, we show that combining cytological FNA and biopsy findings with IHC findings achieves an accurate diagnosis of malignant GCT.

Granular Cell Tumor of the Hand: Unusual Malignancy of a Previous Benign Lesion: A Case Report

CASE

Malignant granular cell tumors are uncommon soft-tissue tumors. We describe a granular cell tumor that presented as a benign hand nodule diagnosed by biopsy and image. The patient refused local excision. After 15 years, the patient came back because of symptomatic growth, and a malignant granular cell tumor was diagnosed, with metastatic disease. Despite surgical disarticulation and adjuvant treatment, she died after 8 months. The pathological examination revealed the tumor had progressed to malignant behavior.

CONCLUSIONS

Our findings highlight the importance of a closer follow-up. Although unusual, we must be aware of the possibility of a change of behavior from benign to malignant granular cell tumor.

[Granular cells tumour (Abrikossof) of the ulnar nerve at the arm. A case report and literature review]

INTRODUCTION

Granular cell tumours are extremely rare on peripheral nerves, with an incidence of 0.029% of pathologic samples. In a literature review, we found only 5 cases involving the ulnar nerve, although considered the most frequently involvement nerve.

CASE REPORT

A 32 year-old female from the French West Indies presented a severe arm pain with deficit of interosseous hand muscles. Imaging studies were in favour of a Schwanoma, but during surgery, we found an unremovable intra-neural tumour. Nerve biopsy revealed a granular cell tumour. Initial decision was observation only. However, within two years, tumour increased in size, along with pain aggravation and functional deficit. We performed a nerve resection (with adequate margins) with reconstruction using sural nerve graft associated with a neurotisation of the motor branch with the anterior interosseus nerve. At two years follow-up, no recurrence was observed. The scar is hypersensitive with moderate neuropathic pain. There is a sensory reinnervation of the fourth finger, with no motor recovery of the hand. We observed a slight recovery of flexor profundus tendons, which, in turn increased the claw hand.

DISCUSSION

The five cases described in the literature were managed differently (biopsy only, excision, excision with reconstruction), with modest results. There is no recommended treatment. Our case is the first at arm level. We were able to perform complete resection, but functional result is poor.

CONCLUSION

Granular cell tumours require treatment if symptomatic (pain, function loss), but, at the moment, there is no recommended treatment.

Metastasizing Malignant Granular Cell Tumor (Abrikossoff Tumor) of the Anterior Abdominal Wall, with Prolonged Survival

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.