Fine Needle Aspiration Cytology and Histologic Findings of Granular Cell Tumor of the Breast: Review of 19 Cases with Clinical/Radiologic Correlation

Granular Cell Tumor of the Breast: Radiologic-Pathologic Correlation

Granular cell tumor (GCT) is an uncommon neoplasm arising from perineural Schwann cells that can arise anywhere in the body and is particularly rare in the breast. Imaging typically shows an irregular, noncalcified mass with high density on mammography and intense posterior shadowing on US that mimics malignancy. Benign GCTs can be locally aggressive and invade the skin or chest wall. Core biopsy is necessary for diagnosis. Polygonal- to spindle-shaped cells with prominent cytoplasmic eosinophilic granules show S-100 and CD68 staining on immunohistochemistry and lack cytokeratin, estrogen, or progesterone expression. The vast majority of GCTs are benign, albeit locally infiltrative, tumors cured by wide local excision.

Granular cell tumor of the breast: a multidisciplinary challenge

Granular cell tumors are rare soft tissue tumors; they are almost never malignant, but can mimic a carcinoma clinically, radiologically and microscopically. The finding of a suspicious lump often entails subsequent diagnostic procedures that can pose significant anxiety on patients before reaching a challenging differential diagnosis. The physical and psychological burden is even more significant when such findings occur during the follow up of a previous oncologic condition. Sometimes the fear for a potential local or distant recurrence can be responsible for a misdiagnosis and lead to patient overtreatment.

Peripheral nerve sheath tumors of the breast

Benign and malignant peripheral nerve sheath tumors can involve the breast, presenting as masses in the dermis, deep breast parenchyma or axillary soft tissue. Although the histologic features are frequently characteristic, diagnosis can be challenging on core needle biopsy, and the differential diagnosis includes a variety of other benign and malignant spindle cell lesions of the breast. Here, we review the key clinical and pathological features of breast schwannoma, neurofibroma, granular cell tumor, and malignant peripheral nerve sheath tumor.

[Rare benign breast tumors including Abrikossoff tumor (granular cell tumor), erosive adenomatosis of the nipple, cytosteatonecrosis, fibromatosis (desmoid tumor), galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma: Guidelines for clinical practice]

OBJECTIVES

To provide guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF), based on the best evidence available, concerning rare benign breast tumors: Abrikossoff (granular cell tumor), erosive adenomatosis of the nipple, cytosteatonecrosis, fibromatosis (desmoid tumor), galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma.

METHODS

Bibliographical search in French and English languages by consultation of Pubmed, Cochrane and international databases.

RESULTS

For erosive adenomatosis of the nipple, surgical excision is recommended to exclude Paget's disease or cancer (grade C). When surgery is performed for breast desmoid tumor or syringomatous adenoma, free margins are recommended (grade C). Without clinico-radio-histologic discordance, surgical abstention may be proposed for Abrikossoff tumor (granular cell tumor), cytosteatonecrosis, galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma (grade C).

Granular Cell Tumor of Breast: a Case Report and Review of Literature

This is an article reporting a case of granular cell tumor in the left breast in a 58 year old lady. Patient presented with a 3 × 3 cm mass in the left breast. Mammography reported a BIRADS 5 lesion in the left breast. With a clinical and radiological diagnosis of malignancy, patient was sent for FNAC (Fine needle aspiration Cytology). The cytology report was granular cell tumor. Following this patient underwent wide excision of the mass. Histopathology confirmed the cytological diagnosis of granular cell tumor of the breast. Patient is on regular follow up and is presently free of disease. The case report is followed up by a brief review of literature of granular cell tumor of the breast.

Granular cell tumor of the breast during lactation: A case report and review of the literature

Granular cell tumor of the breast (GCTB) is a rare tumor, particularly in lactating women. This tumor can clinically and radiologically mimic breast carcinoma, which poses particular problems. The association between GCTB and sex hormones should receive particular attention. The present study reports a case of GCTB in a lactating patient. In this tsudy, the case of a 29-year old female who presented with a mass in the right breast is decribed. Immunohistochemical and cytological analysis revealed a GCT and subsequently wide local excision was performed. At 15 months following surgery, the patient is well and no tumor recurrence has been identified. A comprehensive review of the literature was also performed to assess and compare all cases of GCTB, with particular attention to hyperestrogenic and hyperprolactinemic states. Further studies are required to explore the association between granular cell tumors and hyperestrogenic and hyperprolactinemic states.

[Granular cell tumor of the male breast]

The granular cell tumor of the breast (TCGS) is a rare benign tumor, which grows from Schwann cells. It can be confused with a cancerous tumor clinically and radiologically. Only the histological appearance can make the diagnosis. We report a case of TCGS in a man, discovered as a result of self-examination of a breast lump. The authors emphasize the problem of differential diagnosis with breast cancer: clinically, a hard lump with an occasional skin retraction or a fixity to the deep plane; radiologically a stellar opaque appearance with irregular contours, sonographically unspecific, and even macroscopically during surgery, this lesion having morphological characteristics which need histologic examination and even immunohistochemistry in order to exclude a malignant tumor. They are cured by wide local excision and have generally a good prognosis.

[Granular cell tumour of the breast. A diagnosis to consider]

The granular cell tumour is a very rare tumour which originates in the Schwann cells, and is generally benign. It is usually located in the head and neck, and its appearance in the breast is uncommon. Although it is rare tumour, granular cell tumours of the breast have a higher prevalence than previously recognised. This tumour usually imitates breast cancer due to its clinical and imaging data, with its diagnosis being by histopathology. The treatment is a wide local excision, and its prognosis is good with a low recurrence rate. We present two cases of granular tumours of the breast in post-menopausal women that simulated a breast carcinoma in the ultrasound and mammography. The first was detected in the breast cancer screening program, and the second during follow up of an invasive ductal carcinoma.

A therapeutic and diagnostic dilemma: granular cell tumor of the breast

Six to eight percent of granular cell tumors are seen in the breast. Although mostly benign, they rarely have malignant features clinically and radiologically reminding of breast cancer. This may lead to a potential misdiagnosis of breast carcinoma and overtreatment of patients. The final diagnosis is made by immunohistochemical examination. We performed excisional biopsy on a patient who was diagnosed to have a breast mass. The histopathological examination of the mass revealed granular cell tumor.

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.

Granular cell tumor of the breast: a case report and review of literature

A 22-year-old female patient presented with a breast mass lesion with a clinical suspicion of a fibroadenoma. Histological evaluation revealed a rare benign neoplasm - granular cell tumor.

Granular cell tumor is rare neoplasm that may arise in virtually any body site, and in 5% it occurs in the breast. The histogenesis of this tumor is still rather controversial and currently the most acceptable theory is a Schwann cell origin. The main histological feature is granular cytoplasm of the tumor cells.

From a clinical point of view there is a similarity between granular cell tumor and mammary carcinoma on mammography and ultrasound. Pathohistologically, sometimes, differential diagnostic difficulties exist concerning apocrine carcinoma, histiocytic lesions and metastatic neoplasms.

Granular cell tumor of the neurohypophysis: report of a case with intraoperative cytologic diagnosis

Cytological techniques including touch and smear preparations are very useful diagnostic modality in the evaluation of central nervous system (CNS) lesions and, in many instances, may be effectively used as the sole modality of tissue preparation for intraoperative consultation. Cytologic preparations offer many advantages over frozen sections for CNS specimens. These include selective examination of multiple areas from small biopsy specimens, superior preservation and details of cellular morphology, fewer artifacts, faster results, and improved cost-effectiveness. We describe the cytologic diagnosis of a granular cell tumor (GCT) of the neurohypophysis in a 33-year-old male who presented with headache and blurred vision. CT scan revealed an enlarged sella with a 2.15 x 2.0 cm pituitary lesion. Transsphenoidal resection of the mass was performed and submitted for intraoperative consultation. Smears and touch preparations were made on a portion of the mass that showed uniform polygonal cells with round to ovoid nuclei and abundant eosinophilic granular cytoplasm. An intraoperative cytological diagnosis of "favor GCT" was rendered. The histologic sections of the remaining material confirmed the diagnosis. Although GCT of the neurohypophysis is very rare, a specific intraoperative cytological diagnosis is possible. We report the clinical, cytological, and pathological findings of a GCT affecting the neurohypophysis.

Unusual benign breast lesions

The purpose of this article is to show examples of the radiological (mammography and/or ultrasound) and pathological appearances of unusual benign breast lesions. The conditions covered are granular cell tumours, fibromatosis, nodular fasciitis, myofibroblastomas, haemangiomas, neurofibromas, and leiomyomas. The article includes the first published description of the ultrasound appearance of a myofibroblastoma. Knowledge of these appearances may help confirm or refute radiological-pathological concordance of percutaneous biopsy results during multidisciplinary assessment of these lesions and aid patient management.

Cytomorphology of Benign Breast Disease

Fine needle aspiration biopsy is a widely used technique for the initial diagnosis of mammary lesions. The majority of patients undergoing fine needle aspiration biopsy of a breast lesion will have a benign disease of the breast. This article provides a review of the cytomorphologic features in a variety of benign breast lesions,and discusses the commonly encountered differential diagnoses on aspiration biopsy. Topics discussed include inflammatory and reactive conditions, treatment-induced changes, pregnancy-related changes, benign proliferative lesions, and benign neoplasms of the breast.

Granular cell tumour: a pitfall in FNA cytology of breast lesions

Granular cell tumours of the breast are rare lesions that may mimic an invasive carcinoma. The fine needle aspiration cytology (FNAC) findings in five cases are presented with specific attention to the pitfalls in the cytological diagnosis of these lesions.

Granular Cell Tumor of the Breast

Granular cell tumors (GCT) are uncommon, usually benign, neoplasms that are thought to derive from Schwann cells of the peripheral nerves. They can originate anywhere in the body but are most frequently found in the head and neck, particularly in the oral cavity. When they are located in the breast, as may occur in 5–8 per cent of cases, the clinical and pathologic appearance is similar to that of a malignant tumor. Immunohistochemical analysis, including reactivity for periodic acid–Schiff, CD68, and S100 and negative reactivity for cytokeratin, is required for definitive diagnosis. Awareness of this tumor's unique characteristics might aid in differentiating it from the more common malignant tumors of the breast.

Pitfalls in fine needle aspiration cytology

A review of pitfalls encountered in fine needle aspiration cytology (FNAC) of all organs and tissues and based mainly on the author's 35-year experience of diagnostic FNAC in clinical practice is presented. Diagnostic difficulties are usually related to deviations from common cytological criteria that may occur in some lesions. Others are due to the effects of the sampling procedure or of the preparation of samples. A few basic rules are proposed, which may help to avoid some of the diagnostic pitfalls.