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CORRESPONDENCE
Year : 2018  |  Volume : 14  |  Issue : 2  |  Page : 459-461

Cytological and histological correlation of granular cell tumor in a series of three cases


1 Department of Pathology, IPGME and R, Kolkata, West Bengal, India
2 Department of Pathology, N.R.S. Medical College, Kolkata, West Bengal, India

Date of Web Publication8-Mar-2018

Correspondence Address:
Dr. Ram Narayan Das
265, Purba Sinthee Bye Lane, Kolkata - 700 030, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrt.JCRT_876_14

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 > Abstract 


Granular cell tumor (GCT) is an uncommon soft tissue tumor characterized by proliferation of cells with granular eosinophilic cytoplasm. We came across three such tumors, one in the tongue, one in the chest wall, and one in the right deltoid region, which were referred for fine-needle aspiration cytology. On cytological examination, the first two cases were diagnosed as GCT, and the mass in deltoid region was suggestive of proliferative myositis. The cytological details of these cases are discussed. The excision biopsies of the first two cases and Tru-cut biopsy of the deltoid mass confirmed the diagnosis of GCT.

Keywords: Cytology, granular cell tumor, histology, periodic acid-Schiff stain


How to cite this article:
Das S, Das RN, Sen A, Chatterjee U, Datta C, Choudhuri M. Cytological and histological correlation of granular cell tumor in a series of three cases. J Can Res Ther 2018;14:459-61

How to cite this URL:
Das S, Das RN, Sen A, Chatterjee U, Datta C, Choudhuri M. Cytological and histological correlation of granular cell tumor in a series of three cases. J Can Res Ther [serial online] 2018 [cited 2019 Nov 18];14:459-61. Available from: http://www.cancerjournal.net/text.asp?2018/14/2/459/208758




 > Introduction Top


Granular cell tumor (GCT) is an uncommon benign tumor of soft tissues which most often arises in head and neck region, especially the tongue. It is also common in skin and subcutis of breast and proximal extremities. It is thought to be of Schwann cell origin.[1],[2] It is characterized by proliferation of large cells with granular-appearing eosinophilic cytoplasm. As a simple, inexpensive, first-line investigative modality, fine-needle aspiration cytology (FNAC) plays a major role.[3] We came across three such cases, the details of which are described below.


 > Case Reports Top


Case 1

A 19-year-old girl presented to surgical outpatient department with a smooth swelling over dorsum of tongue, measuring 3 cm × 2 cm × 2 cm. The overlying mucosa was normal in color [Figure 1]. The patient was referred for FNAC.
Figure 1: Photograph of granular cell tumor showing a firm, sessile swelling over dorsum of tongue

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The smears showed moderate cellularity with cells arranged singly and in small groups. Many bare nuclei were present. The cells were polygonal with indistinct margins and abundant granular cytoplasm. The nuclei were small, round to oval, with bland chromatin, and small, prominent nucleoli. Some cells showed anisonucleosis, but no mitosis or pleomorphism was seen. The cytoplasmic granules were periodic acid-Schiff (PAS) stain positive. The lesion was suggested to be a GCT of tongue. Histopathological examination of the excised specimen showed a tumor consisting of lobules of polygonal cells with eosinophilc granular cytoplasm and centrally placed small, round to oval hyperchromatic nuclei. The diagnosis of GCT was confirmed.

Case 2

A 26-year-old male presented to surgical outpatient department with a smooth, firm swelling over anterior chest wall, measuring 2 cm × 1.5 cm × 1.5 cm. FNAC smears were cellular with cells arranged in small clusters and features similar to the first case, suggesting of GCT [Figure 2]a and [Figure 2]b. Later, the mass was excised, and histopathological examination confirmed the diagnosis of GCT [Figure 3]a and [Figure 3]b.
Figure 2: (a) Cytology of granular cell tumor shows clusters of cells with ill-defined margins, eosinophilic cytoplasm, and round to oval nuclei; few bare nuclei also seen (LG stain, ×100). (b) The smear showing cluster of cells with large nuclei and eosinophilic granular cytoplasm (LG stain, ×400). (c) Cytology showing round to triangular cells with basophilic cytoplasm and eccentrically placed nuclei (LG stain, ×100). (d) High power view of Figure 2c showing round to triangular cells with basophilic cytoplasm and eccentrically placed nuclei (LG stain, ×100)

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Figure 3: (a) This photomicrograph shows a tumor composed of lobules of cells with eosinophilic cytoplasm (H and E, ×100). (b) High power view of Figure 3a shows tumor cells having abundant eosinophilic granular cytoplasm and centrally placed hyperchromatic nuclei (H and E, ×400). (c) The section from the Tru-cut biopsy showing loosely cohesive sheets of polygonal cells with abundant granular cytoplasm and fibrovascular stroma (H and E, ×100). (d) This photomicrograph of granular cell tumor shows tumor cells with abundant granular cytoplasm and round to oval hyperchromatic nuclei. Bi- and multinucleated cells are also seen (H and E, ×400)

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Case 3

A 35-year-old female presented to surgical outpatient department with a smooth, firm swelling, measuring 4 cm × 3 cm × 3 cm, over deltoid region of the right arm. The overlying skin was normal. FNAC smears showed ganglion cell-like cells in clusters and singly. The cells were triangular to polygonal having abundant basophilic cytoplasm and eccentrically placed nuclei with prominent nucleoli resembling ganglion cells. Many cells were bi- or multinucleated [Figure 2]c and [Figure 2]d. The diagnosis of proliferative myositis was suggested on cytology. Subsequent histological examination of Tru-cut biopsy specimen revealed large polygonal cells with granular cytoplasm and oval to round nucleus with loose chromatin [Figure 3]c and [Figure 3]d PAS-positive granules were detected in the cytoplasm [Figure 4]. The histological diagnosis was GCT.
Figure 4: This photomicrograph shows periodic acid-Schiff-positive granules in cytoplasm of the tumor cells (PAS stain, ×100)

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 > Discussion Top


GCT is an uncommon benign neoplasm of soft tissues, first described by Abrikossoff.[4] It is thought to be of Schwann cell origin.[1],[2] The tumor was initially called “granular cell myoblastoma” due to its possible origin from skeletal muscle, as proposed by Abrikossoff. Its association with nerve sheath differentiation was proposed by Feyrter. The diagnosis of GCT on histology is straightforward; however, its cytological features are not well documented.

GCT can occur at any age, but it is more common in adults. The male-to-female ratio is about 1:2. The tumor is mostly solitary but may be multiple in 10%–20% patients. About 70% of the tumors are located in the head and neck region, mostly in the tongue. Other common locations are the skin and subcutis of the breast and proximal extremities. Visceral involvement can also occur, mainly in respiratory and gastrointestinal tracts.[5] The lesion typically presents as a smooth, sessile, firm mucosal swelling. A correct preoperative cytological diagnosis obviates the need for biopsy.

FNAC smears show granular cells in syncytial clusters and singly. The cytoplasm of intact cells is abundant and relatively dense, eosinophilic in hematoxylin and eosin, and dark blue in MGG with prominent fine, eosinophilic granulation. GCT expresses markers associated with both neural (S-100 protein, PGP9.5, neuron-specific enolase, peripheral myelin proteins, and CD57) and histiocytic (CD68, α-1-antitrypsin) differentiation.[6],[7],[8]

The differential diagnosis of GCT on FNAC includes malignant GCT, rhabdomyoma, proliferative myositis, histiocyte-rich lesions, metastatic carcinoma, epithelioid sarcoma, and melanoma. Another important lesion that needs to be differentiated from GCT on cytology is alveolar soft part sarcoma (ASPS) that shows cells with granular cytoplasm which are PAS-positive, diastase resistant with abundant cytoplasmic needle-like pink-colored crystals.[9] Malignant GCT differs from benign GCT in that it exhibits necrosis, mitotic activity, and nuclear atypia. Rhabdomyoma cells exhibit abundant eosinophilic cytoplasm, where special stains for skeletal muscle are diagnostic. Granular cells include many cytologically similar, yet diverse entities. The granularity of the cells may be a senescent change associated with accumulation of lysosomes.

Histiocytes are distinguished from GCT cells in that they show bean-shaped nuclei. GCT cells are negative for antibodies to AE1, AE3, desmin, MyoD1, myogenin, HMB-45, melan-A, and MART-1, which help to exclude metastatic carcinoma, epithelioid sarcoma, ASPS, and melanoma.[10],[11] Although GCT is an uncommon benign neoplasm, there are reported cases of malignant GCT in the literature.[12],[13] The malignant variants are aggressive tumors and usually recur for multiple times before distant spread. Even benign variants recur commonly due to incomplete removal complicated by perineural spread.

Although the etiology of GCT is still controversial, the currently most accepted hypothesis is that the tumor arises from Schwann cells or their precursors.[1],[2] Surgical excision with a safety margin is the treatment of choice for GCT. Radiotherapy and chemotherapy have no place in the treatment.


 > Conclusion Top


GCTs occur in a wide variety of sites with a wide spectrum of differential diagnoses that vary according to the site of occurrence. Besides cytomorphological features, a simple PAS stain is helpful in most cases. In difficult situations, judicious use of relevant markers on a cell block will be contributory to its diagnosis on cytology to avoid mutilating surgery.

Acknowledgment

I particularly thankful to our technical staffs – Janababu, Ashimda, and Dayal also actively helped in our work. So they also owe special appreciation for their cooperation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

1.
Becelli R, Perugini M, Gasparini G, Cassoni A, Fabiani F. Abrikossoff's tumor. J Craniofac Surg 2001;12:78-81.  Back to cited text no. 1
    
2.
Le BH, Boyer PJ, Lewis JE, Kapadia SB. Granular cell tumor: Immunohistochemical assessment of inhibin-alpha, protein gene product 9.5, S100 protein, CD68, and Ki-67 proliferative index with clinical correlation. Arch Pathol Lab Med 2004;128:771-5.  Back to cited text no. 2
    
3.
Rekhi B, Gorad BD, Kakade AC, Chinoy R. Scope of FNAC in the diagnosis of soft tissue tumors – A study from a tertiary cancer referral center in India. Cytojournal 2007;4:20.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Abrikossoff A. Über myome, ausgehend von der quergestreiften willkürlichen muskulatur. Virchow Arch 1926;260:215-33.  Back to cited text no. 4
    
5.
Billeret Lebranchu V. Granular cell tumor. Epidemiology of 263 cases. Arch Anat Cytol Pathol 1999;47:26-30.  Back to cited text no. 5
    
6.
Fine SW, Li M. Expression of calretinin and the alpha-subunit of inhibin in granular cell tumors. Am J Clin Pathol 2003;119:259-64.  Back to cited text no. 6
    
7.
Mahalingam M, LoPiccolo D, Byers HR. Expression of PGP 9.5 in granular cell nerve sheath tumors: An immunohistochemical study of six cases. J Cutan Pathol 2001;28:282-6.  Back to cited text no. 7
    
8.
Mazur MT, Shultz JJ, Myers JL. Granular cell tumor. Immunohistochemical analysis of 21 benign tumors and one malignant tumor. Arch Pathol Lab Med 1990;114:692-6.  Back to cited text no. 8
    
9.
Shabb N, Sneige N, Fanning CV, Dekmezian R. Fine-needle aspiration cytology of alveolar soft-part sarcoma. Diagn Cytopathol 1991;7:293-8.  Back to cited text no. 9
    
10.
Liu Z, Mira JL, Vu H. Diagnosis of malignant granular cell tumor by fine needle aspiration cytology. Acta Cytol 2001;45:1011-21.  Back to cited text no. 10
    
11.
Hassan AM, Khamis NN, Hammam MM. Role of fine needle aspiration cytology in diagnosis of soft tissue tumors. J Am Sci 2011;7:188-99.  Back to cited text no. 11
    
12.
Budiño-Carbonero S, Navarro-Vergara P, Rodríguez-Ruiz JA, Modelo-Sánchez A, Torres-Garzón L, Rendón-Infante JI, et al. Granular cell tumors: Review of the parameters determining possible malignancy. Med Oral 2003;8:294-8.  Back to cited text no. 12
    
13.
Chiang MJ, Fang TJ, Li HY, Chen IH, Lee KF. Malignant granular cell tumor in larynx mimicking laryngeal carcinoma. Am J Otolaryngol 2004;25:270-3.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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