Granular cell tumours of the orbit

Surgical Management of Granular Cell Tumor of the Orbit: Case Report and Literature Review

Introduction:

Granular Cell Tumors (GCTs) of the orbit are rare-entity soft-tissue tumors, and few reports have been published in the literature. The treatment of the choice is total excision. Early diagnosis prior to surgery is valuable for the distinction of malignant from benign tumor.

Case presentation:

We report a case of a 55-year-old woman with a solitary slow-growing mass in the right orbit with the involvement of the rectus inferior muscle, and present a review of the recent literature. The lesion had a diameter of 1 cm and was noticed 2 years before the examination. Excisional biopsy confirmed the diagnosis of GCT. The tumor was resected through a retroseptal transconjunctival approach. The final histological examination revealed findings characteristic of GCT, including positive reaction for protein S-100, SOX10, and calcitonin and negative reaction for desmin, myogenin, Smooth Muscle Antigen (SMA), Melan-A, and HMB-45. There were no signs of malignancy in this sample. Disturbance of motility was not noted by the patient after surgery.

Conclusion:

GCT should be included in the differential diagnosis of intraorbital lesions, particularly those that involve the orbit muscles. A biopsy is recommended before surgical resection, to exclude malignancy and prevent radical resection.

Case report: an intriguing sign in a patient with an inferior rectus muscle granular cell tumor

RATIONALE

Occurrence of granulosa cell tumors (GCTs) in the eye are rare and may be diagnosed by imaging examination and immune-histochemical studies. Two common signs of a rectus muscle tumor are the proptosis of the eye ball and the complaint of bi-ocular diploma.

PATIENT CONCERNS

A 45-year-old man visited our ophthalmology department with an about a 3-year history of vertical diplopia. His visual acuity when looking forward was normal but was severely low when gazing upward.

DIAGNOSIS

Histopathological analysis demonstrated that the encapsulated tumor contained large nested or cord-like cells with small nuclei and abundant eosinophilic cytoplasmic particles. Immunohistochemistry showed that tumor cells strongly expressed CD68, S100 and vimentin, were weakly positive for Ki67, and negative for CK. The tumor was diagnosed as a GCT.

INTERVENTIONS

The tumor was surgically removed via a transconjunctival approach along inferior rectus muscle.

OUTCOMES

The severe loss of acuity when gazing upward was ameliorated after surgery, but global mobility did not improve. Long-term follow-up was still needed.

LESSONS

Ophthalmologists should be aware that when a patient's visual acuity is normal when looking forward but severely low when gazing upward, it may be a sign of a GCT of the inferior rectus muscle.

Progressive orbital granular cell tumour associated with medial rectus

Granular cell tumour is a rare soft tissue tumour that can occur in any part of the body, but seldom in ocular adnexa. It usually behaves in a benign fashion. We report a case of a 54-year-old man with a well-demarcated, solitary, slow-growing orbital tumour which lead to significant ocular symptoms. The case was a diagnostic and therapeutic challenge due to its location and difficulty in obtaining tissue for a histological diagnosis. Surgical biopsy attempts were made but they all failed to uncover the true identity of the lesion. A definitive diagnosis was revealed with complete surgical excision of the tumour, which was challenging due to its size and close association with rectus muscle. This case has highlighted that orbital granular cell tumour may result in significant ocular symptoms. Adequate exposure to the anatomical site is the key to obtaining diagnosis and complete excision of a lesion.

Orbital granular cell tumours: clinical and pathologic characteristics of six cases and literature review

OBJECTIVE

To retrospectively assess the clinicopathological characteristics of orbital granular cell tumours (GCTs).

METHODS

A non-comparative review of the clinical characteristics, imaging, histopathological features, management, and prognosis of five cases of benign GCT and one case of malignant GCT (MGCT) was conducted, along with a review of the English language literature.

RESULTS

Among the six cases, four tumours were adherent to the extraocular muscle (EOM), and three tumours to the optic nerve (ON). Morphologic examinations revealed polygonal cells containing periodic-acid-Schiff-positive eosinophilic granules. All tumours (100%) were positive for VIM and NSE, five (83.3%) tumours were positive for S-100, and three (50%) tumours were positive for CD68. The follow-up examination of the MGCT witnessed recurrence and brain metastasis despite several thorough resections, but the patient remained alive; the follow-up examination of the four benign GCTs that had received incomplete excision revealed recurrence in one patient and dramatic shrinkage of the residual tumour in another; there was no recurrence in the other two patients.

CONCLUSIONS

GCT should be considered in the differential diagnosis of orbital tumours, which may affect EOMs and ON. The natural course of GCT can include tumour progression, stability, or spontaneous regression. To avoid recurrence, complete resection is recommended for orbital GCT. To the best of our knowledge, primary orbital MGCT is reported for the first time.

Surgical Excision of Orbital Progressive Granular Cell Tumour

Granular cell tumour (GCT) is mostly benign lesion first described by Abrikossoff and named after him. Most cases are reported in the head and neck area, where the tongue is the most common site. Here we review previous cases in the literature for GCT in the orbit and present a new case. A 49-year-old male presented with apparent exophthalmos. Examination of the patient revealed the presence of a mass in the bottom side of the orbit. A substantial progress was noted after two months from the initial examination using computed tomography (CT) scan. An orbital mass was extracted and histological analysis showed signs typical for GCT. Immunohistochemistry was positive for S-100; the biopsy showed no mitotic or necrotic areas. Proptosis was resolved after surgery and a six-year follow-up CT scan was performed. We conclude that rapid progress of the tumour does not necessarily suggest malignancy.

Granular cell tumor masquerading as a chalazion: a case report

Granular cell tumors were first described in the 1920s and since then have been commonly found throughout the body. They are rarely found in periorbital, orbital, and ocular structures. The authors present a patient with a 2-year history of a lesion that had been previously excised as a presumed chalazion without pathologic analysis. The lesion recurred, and histopathological analysis following complete resection revealed a granular cell tumor. This case is an example of a rare periocular tumor. Although only an isolated case, it provides support for the recommendation that excised lesions be sent to pathologic study, particularly those with an atypical clinical course.

Oculomotor disturbances due to granular cell tumor

Primary granular cell tumor of the orbit is a rare type of neoplasm. The tumor is frequently associated with extraocular muscles, and eye motility limitation is an unavoidable complication after its surgical removal. The objective of the present article is to review the literature on primary granular cell tumors of the orbit and to report a case of this uncommon neoplasia. Granular cell tumor is a benign lesion encountered in most cases (58.3%) in the inferior aspect of the orbit. Extraocular muscle involvement occurs in 72.2% of the patients, and diplopia is present in 77.1% of the cases. The inferior and medial recti are the most affected muscles (38.5% and 26.9%, respectively). Surgical excision is the only modality of treatment, but diplopia persists in 73.3% of the cases. In conclusion, granular cell tumor is a benign lesion but involves a high rate of extraocular muscle morbidity.

Granular cell astrocytoma of the cerebellum: report of the first case

Granular cell astrocytomas are an uncommon morphologic variant of infiltrating gliomas characterized by relatively large tumor cells with granular cytoplasm occupying variable proportions of the tumor. These tumors are thought to be more aggressive than similar tumors with no granular cell component. The tumor occurred in a 9-year-old girl who was immunocompromised owing to liver transplantation. Histologically, the tumor corresponded to World Health Organization grade II. It extensively infiltrated the cerebellum and was composed, predominantly, of large cells with eosinophilic granular cytoplasm. These cells coexpressed glial fibrillary acidic protein and CD68. Of the 49 cases of granular cell astrocytomas reported to date, none have involved the cerebellum. The tumor described herein represents the first case of cerebellar granular cell astrocytoma. Pathologic features and diagnostic pitfalls are explored.

Granular cell change in astrocytic tumors

Intracerebral granular cell neoplasms are uncommon. We report five hemispheric astrocytomas, all of which showed the distinctive features of granular cell change, being composed exclusively or predominantly of rounded cells with coarse granular eosinophilic cytoplasm and eccentrically placed nuclei. Four showed clear foci of transition from an anaplastic astrocytoma and contained lipidized as well as granular cells. In all tumors, the cytoplasmic granules were positive for periodic acid Schiff and resistant to diastase digestion, and there was focal glial fibrillary acidic protein expression. In addition, diffuse cytoplasmic positivity with epithelial membrane antigen antiserum was present, but in no case was there true membrane staining. Ultrastructural appearances were similar in four cases, showing the cytoplasm of tumor cells to be filled with membrane-bound autophagic vacuoles; bundles of intermediate filaments were also seen in some cells. Despite earlier controversy over the histogenesis of granular cell tumors, it is now clear that granular change is a degenerative phenomenon that, like lipidization, can occur in tumors of different cell types, including--rarely--astrocytic neoplasms. It is important that this histologic variant be recognized, as on a small biopsy sample diagnostic confusion with an infarct, demyelinating disease or a secondary carcinoma is a real possibility.