Granular cell tumors

Granular Cell Tumors of the Larynx: A Systematic Review

OBJECTIVE

Granular cell tumor of the larynx is an uncommon, typically benign lesion that may be confused for a malignant neoplasm based on histopathology. This review examines cases of granular cell tumor of the larynx in adults to highlight key distinctions in diagnosis/management and demonstrate how misclassification may lead to unnecessary escalations in therapy.

DATA SOURCES AND METHODS

A systematic search of PubMed, Ovid, and EBSCO Search Hosts was completed in December 2021. The search yielded 501 articles with 87 full-text articles included in the review. Primary search terms included granular cell, tumor, larynx, and adult. Primary endpoints were patient presentation, primary management, pathological features, and disease course.

RESULTS

A systematic review of 87 articles identified 200 patients with granular cell tumors (GCTs) of the larynx. Of the 200 patients, 50.3% were males and 49.7% were females. Of these, 54.0% were reported as white patients, and 46.0% were reported as black patients. The most common presenting symptoms were dysphonia (85.9%) and stridor/dyspnea (14.1%). On examination, the lesions were most commonly polypoid/nodular and firm. Pseudoepitheliomatous hyperplasia (PEH) was identified in 33.5% of cases, and 2% of cases were malignant. GCTs were misdiagnosed as other malignant lesions in 11% of cases. In benign cases, 13.5% of patients underwent additional surgeries beyond simple excision/laryngofissure, including laryngectomy and neck dissection. Less than 2% of lesions reoccurred.

CONCLUSION

Granular cell tumors of the larynx are typically benign lesions that may be misdiagnosed with unnecessary escalation of treatment. However, most lesions resolve via primary surgical excision. Laryngoscope, 134:1523-1530, 2024.

Recurrent granular cell tumor of the thyroid: a case report and literature review

BACKGROUND

Granular cell tumor (GCT) of the thyroid is a rare benign tumor of Schwann cell origin with a favorable prognosis and only 10 cases have been reported so far in scientific literature. The present case study describes the first case of recurrent thyroid GCT.

CASE PRESENTATION

Our case describes a 20-year-old woman who had undergone lobectomy for GCT of the thyroid 4 years ago. Hematoxylin-eosin (HE) staining revealed that the lesion was composed of epithelioid cells with an abundance of eosinophilic granular cytoplasm. Immunohistochemical analysis showed that tumor cells tested positive for S-100 protein and negative for desmin. Both histological and immunohistochemical analyses supported the diagnosis of recurrent GCT of the thyroid.

CONCLUSIONS

Our case suggested that a tumor-free margin excision and post-operative follow-up are necessary for the treatment of GCT of the thyroid.

Laryngeal granular cell tumour: a very rare diagnosis for a child presenting with hoarse voice in the UK

We present a rare case of a paediatric laryngeal granular cell tumour (GCT) of the vocal cord. GCTs are rare clinical entities, thought to arise from Schwann cells. There are only a handful of paediatric laryngeal GCTs in the literature, and therefore, little is known regarding their natural history or preferred management strategies. In this case report, we discuss the incidence, aetiopathogenesis, presentation and management of a laryngeal GCT in an 11-year-old girl, who presented with dysphonia. We believe that this case will aid otolaryngologists in the management of paediatric patients with the common dysphonia.

Perianal Granular Cell Tumor: Report of a Case and Review of the Literature

Introduction

Granular cell tumor was first described by Abrikossoff in 1926. Over the years several cases of this neoplasm have been reported, with a variety of localizations. We here report a case of perianal granular cell tumor and discuss its histogenesis and its relevance to clinical practice.

Methods

The clinical course and histopathology of the case are reviewed, and a literature search for other reported cases has been performed.

Results

A 46-year-old woman presented with a perianal nodular lesion. Pathological examination revealed a granular cell tumor. A literature search produced only 25 other cases of anal and perianal granular cell tumors.

Conclusions

Granular cell tumors are rarely observed in the perianal region. Their existence must always be borne in mind in the differential diagnosis of perianal neoplasms. In most cases surgical excision is curative, but potential malignant transformation must be considered during therapeutic procedures and follow-up.

Laryngeal Granular Cell Tumor

Granular cell tumor (GCT) of the larynx is an uncommon, benign laryngeal neoplasm. Abrikossoff first described the tumor in 1926 as myoblastoma. The origin of this tumor has been debated in the literature. Most of the authors believe that the tumor is of neural origin due to the characteristic immunohistochemical-staining pattern. The authors describe two cases of laryngeal GCTs located in different sites with a review of the histological and clinical features, the differential diagnosis, and the treatment and the prognosis of the tumor.

Granular Cell Tumour Affecting the Left Vocal Cord in a Dog

Granular cell tumours (GCTs) have been described in human vocal cords, but not in those of the dog. A single polyp in the left vocal cord, associated with laryngeal oedema and monolateral hyperplasia of the tonsil, was observed endoscopically in a 6-year-old male dog. Cytologically, the mass was characterized by well-defined polygonal cells, with granular cytoplasm and an eccentric nucleus. Histologically, the mass showed sheets of globoid to polygonal cells, filled with numerous diastase-resistant, periodic acid-Schiff-positive granules, and scanty stroma. Ultrastructurally, the granules were represented by heterogeneous lysosomes of variable size, suggesting a diagnosis of GCT. As reported in man, hyperplasia of the laryngeal and tonsillar epithelium and the presence of foci of pearl-like epithelial cells, mimicking invasive squamous cell carcinoma, were observed. Immunohistochemical examination revealed labelling of neoplastic cells for S-100 protein, CD68, collagen IV, and, focally, for glial fibrillary acidic protein, neuron-specific enolase and vimentin. These findings suggested a Schwann cell origin of the GCT.

[Endobronchial granular cell tumor - what approach to take]

Granular cell tumor is a mesenchymal neoplasm almost always benign, with tendency to recurrence. Although it is more frequent in in the head and neck it has been described in almost all areas of the body. Its occurrence in the lung is extremely rare. The authors describe two cases of endobronchial granular cell tumours, discuss the particularities of this pathology as well as the treatment options, with particular attention to the use of endobronchial excision and criotherapy.

Granular cell tumor: immunohistochemical assessment of inhibin-alpha, protein gene product 9.5, S100 protein, CD68, and Ki-67 proliferative index with clinical correlation

CONTEXT

Granular cell tumor (GCT) is a rare tumor of nerve sheath origin with a predilection for upper aerodigestive tract, skin, and soft tissue. The neoplastic cells typically express S100 and CD68 (KP-1), the latter due to cytoplasmic lysosome content. However, the histogenesis of this tumor is unknown. Additionally, distinction between benign and malignant GCT is difficult because of histologic similarity and lack of reliable criteria that can predict clinical behavior.

OBJECTIVE

To perform a comparative, side-by-side immunohistochemical assessment of the traditional immunohistochemical markers for GCTs (S100, CD68), along with the newer markers (inhibin-alpha, protein gene product 9.5) for these tumors.

DESIGN

To address diagnostic and prognostic issues, we studied 30 specimens of GCT (27 primary and 3 recurrent tumors, 2 of which occurred consecutively in the same patient) for (1) nuclear pleomorphism, prominent nucleoli, necrosis, spindling, high nuclear-cytoplasmic ratio, and mitoses; (2) immunohistochemical expression of inhibin-alpha, protein gene product 9.5, S100, CD68 (KP-1), and Ki-67 using the avidin-biotin complex method on formalin-fixed, paraffin-embedded sections; and (3) correlation between tumor grade, proliferative fraction, and clinical data.

RESULTS

Twenty-seven of 27 primary GCTs and 1 of 3 recurrent GCTs had typical histologic features, while the 2 consecutive recurrent GCT specimens from the same patient were atypical (moderate nuclear atypia and prominent nucleoli alone). The mean age for primary GCT was 37.3 years (range, 5-67 years), and mean size was 1.89 cm. None of the cases metastasized. All 30 specimens showed diffuse (2+ to 3+) staining for S100, CD68, and inhibin-alpha, and 3+ staining for protein gene product 9.5; pseudoepitheliomatous hyperplasia was nonreactive. The Ki-67 proliferative index was less than 1% to 20% in typical nonrecurrent cases, 1% in the typical recurrent case, and 1% and 10% in 2 sequential recurrences of the atypical case.

CONCLUSION

Our study expands the immunophenotype of GCT (S100, CD68, protein gene product 9.5, and inhibin-alpha) regardless of location and supports a neural origin. Intensity of immunohistochemical staining had no prognostic significance. Although 1 of the 2 recurrent GCTs had atypical features, the Ki-67 proliferative index did not distinguish reliably between typical (nonrecurrent) and atypical or recurrent GCTs. The significance of inhibin expression with regard to cell differentiation and pathogenesis is unclear and warrants further investigation.

Malignant granular cell tumor in larynx mimicking laryngeal carcinoma

A 72-year-old man presented to our clinic with progressed husky voice, dysphagia and globus pharyngeus. Fiberoptic laryngoscopy showed a large subglottic mass with an irregular surface. A chest roentgenogram revealed multiple nodules over the right upper and lower lobes. Under the impression of malignant laryngeal tumor with lung metastasis, he underwent direct laryngeal biopsy and excision. Pathologic findings showed malignant granular cell tumor. Postoperative palliative chemotherapy was done for his lung metastasis. The multiple pulmonary nodules were decreased in size and number but not complete remission. The laryngeal tumor has not recurred after a 14-month follow-up.

Mohs micrographic surgery for granular cell tumor using S-100 immunostain

BACKGROUND

Granular cell tumor (GCT) is an uncommon tumor of neural origin. Most commonly it is found in the head and neck region and rarely on the foot. The pathologic diagnosis is often confirmed by immunohistochemical staining for S-100 protein. The standard treatment is complete excision. Two previous cases of GCTs treated by Mohs micrographic surgery (MMS) have been reported in the English literature. The immunohistochemical stain S-100 was not used in these cases.

OBJECTIVE

Describe the use of S-100 immunohistochemical stain on MMS frozen sections in clearing a GCT of the foot with extension along nerves without involvement of perineurium.

METHODS

Tissue was embedded and cut using standard Mohs surgical methodology. Frozen sections were stained with hematoxylin and eosin and with an immunoperoxidase method for S-100 protein using a Ventana automated stainer.

RESULTS

MMS in combination with S-100 was successfully performed on a GCT on the plantar surface of our patient's foot. The S-100 immunohistochemical stain was helpful in tracking the extension along nerves of the GCT which was not evident with hematoxylin and eosin alone.

CONCLUSION

Using S-100 immunohistochemical stain on the MMS frozen sections can increase the diagnostic accuracy for complete removal of GCT.

Granular cell tumor of the pituitary fossa

Although granular cell tumors are relatively common in the head and neck, symptomatic granular cell tumors of the neurohypophysis are extremely rare. Ophthalmologic symptoms are most common, followed by endocrinologic manifestations. We report a case of a granular cell tumor of the pituitary fossa that was surgically treated. The clinical manifestations, radiographic appearance, and surgical management of granular cell tumors of the pituitary fossa are reviewed, as well as the unique histopathology and electron microscopy of this uncommon neoplasm.

Granular cell tumor of the trachea in a child

Granular cell tumors are benign neoplasms found most commonly in the head and neck, particularly the tongue. They have, however, been described in all areas of the body. Their presentation in the trachea is exceedingly rare, with their presence in the pediatric trachea being an even rarer occurrence. We describe a case of a granular cell tumor of the trachea in a 10-year-old boy with a dramatic, almost lethal, presentation. This is followed by a review of the literature, including pathology and treatment options.

Abrikossoff's tumor

Abrikossoff's tumor is a disease that more commonly affects the oral cavity but can also occur at other sites. It develops between the second and sixth decades of life, more frequently among women and blacks. The neoplasm can affect all parts of the body. The head and neck areas are affected in 45% to 65% of cases and of these, 70% are located interorally (tongue, oral mucosa, hard palate). The benign form shows polygonal cells with granular, eosinophilic cytoplasm and small nuclei. The malignant form, however, is associated with a high mitotic index and pleomorphic cellular tissue. The clinical aspect of the neoformation is a swelling covered by mucus of normal appearance. Studies of the neoformation show that in addition to the objective examination, further instrumental research is necessary, i.e., with nuclear magnetic resonance or computed tomography with contrast CT scan. However, the only examination that can confirm the clinical diagnosis is the histological examination. The only treatment for Abrikossoff tumor is surgery. The surgical treatment provides for an extirpation of the neoformation with the overhanging mucus and the underlying periosteum. In this work, the authors discuss a case of Abrikossoff tumor affecting the mucus of the right side of the hemipalate in a 53-year-old patient and present a review of the literature.

Granular cell tumor of the hypopharynx treated by endoscopic CO(2) laser excision: report of two cases

BACKGROUND

Granular cell tumor (GCT), or Abrikossoff's tumor, is an unusual lesion probably arising from Schwann cells. It is frequently found in the head and neck region, where the tongue is the most commonly affected site. Involvement of the hypopharynx is exceedingly rare because, to the best of our knowledge, only four cases have been reported in the literature.

METHODS

We describe hypopharyngeal GCT in two women aged 29 and 52 years, respectively.

RESULTS

In the first patient, preoperative diagnostic examination, including endoscopy, CT, and MRI scan, was suggestive of a benign lesion arising from the posterior wall of the hypopharynx. In the second patient, a previous biopsy of the postcricoid area performed elsewhere suggested a diagnosis of well-differentiated squamous cell carcinoma, and CT scan staged the lesion as T1 N0. In both cases, treatment included surgical excision under microlaryngoscopy with CO(2) laser. The histopathologic study of the specimens, supported by immunohistochemical techniques, determined the lesions to be a GCT. The postoperative course was uneventful, and the patients were discharged 12 and 2 days after surgery, respectively. Both patients were asymptomatic without evidence of recurrence when last seen 2 years and 4 months after surgery, respectively.

CONCLUSIONS

GCT should be included in the differential diagnosis of submucosal hypopharyngeal lesions. Endoscopy and radiologic imaging do not display any typical finding suggestive of the diagnosis, which can be based only on histologic findings. Resection of the tumor, when technically feasible, should be performed under microlaryngoscopy with the CO(2) laser, which makes it possible to work in a bloodless field with minimal thermal damage and reduction of scarring and postoperative edema.

Granular cell tumors of the larynx

Granular cell tumor is a rare neoplasm that may involve the larynx. It is almost always benign. Laryngologists should be familiar with this unusual tumor, its implications and appropriate treatment.

Immunoreactivity in granular cell tumours of the larynx

OBJECTIVE

To elucidate histogenesis and behaviour of laryngeal granular cell tumours (GCT) and to determine the role of p53 protein expression in these lesions.

METHODS

The clinical, pathological and immunohistochemical findings of three cases of laryngeal GCTs are described.

RESULTS

All tumours were surgically excised and appeared histologically benign. Pseudoepitheliomatous hyperplasia, mitosis and nuclear pleomorphism were not found in any of the three cases. All lesions were negative for keratin 8, desmin and actin. Only one case stained for collagen IV. Positive staining was found for S-100 protein and CD68 in all tumours. Ki-67 and Bcl-2 staining was confined to occasional cells. p53 reactivity was seen in all tumours; positivity ranged from 35 to 42%. The three patients have remained free of disease without complications up to 10 years after treatment.

CONCLUSION

Immunohistochemical findings support benign behaviour and a Schwann cell origin for laryngeal GCT. The expression of p53 by granular cells is unclear but appears to be unrelated to behaviour.

Granular cell tumour of the larynx

Granular cell tumour (GCT) of the larynx is an uncommon laryngeal tumour. It is always benign and commonly located in the posterior part of the larynx. Care must be taken to differentiate this lesion from others due to the presence of pseudo-epitheliomatous hyperplasia which overlies the GCT and may occasionally mimic squamous cell carcinoma. Therefore, histological differentiation is important because these tumours are normally managed conservatively. The origin of this tumour is a matter of debate, but most authors believe it to be neural in origin. The rarity of this tumour in the male population prompted reporting this case in the literature.

Multiple granular cell tumor: a case report and review of the literature

BACKGROUND

Granular cell tumor was first described by Abrikossoff in 1926. It is rare and usually presents as a benign solitary lesion. Multifocal and malignant forms are known to occur.

METHODS

This presentation illustrates an additional case of granular cell tumor. Clinical and histological features to distinguish malignant and benign forms are presented.

RESULTS

Tumor can develop years after therapy for the primary lesion. Treatment recommendations are presented.

CONCLUSIONS

Patients diagnosed with granular cell tumor require close follow-up. Radiographic evaluation for the presence of metastatic disease is necessary if a malignant variant is suspected.

Immunohistochemical study on histogenesis of congenital epulis and review of the literature

Congenital epulis is a very rare lesion found only in newborn infants. This tumor is multiple in about 10% of reported cases, rarely with the simultaneous involvement of the maxilla and mandibula, as in this article. In the presented case, light microscopy demonstrated large eosinophilic granular cells arranged in solid nests that are separated by thin fibrovascular areas. The tumors in the maxilla and mandibula were investigated with a panel of polyclonal and monoclonal antibodies, and using immunoperoxidase methods on formalin-fixed, paraffin-embedded sections. Immunohistochemical studies revealed strong and diffuse cytoplasmic staining for neuron specific enolase and vimentin. However, all other reactions were negative. These results suggest that the congenital epulis may be derived from uncommitted nerve-related mesenchymal cells.