Granular cell tumor of the breast: a series of 17 cases and review of the literature

Seventeen cases of granular cell tumor (GCT) of the breast are reviewed. The demographics and clinical features are reviewed and the radiologic and pathologic features as well as the immunohistochemistry are discussed. To our knowledge, our series of 17 breast GCT cases represent the largest series published to date.     

Granular cell tumor of the breast: Molecular pathology and clinical management

Granular cell tumor is a rare condition that occasionally affects breast parenchyma: approximately, 5%‐15% of all granular cell tumors represent 1:1000 of breast tumors. In this study, we reported a consecutive series of 12 patients with primary granular cell tumor of the breast observed at our institute, focusing attention on preoperative management, surgical approach, and long‐term follow‐up. Eight cases (8/12; 66.78%) presented with left‐breast tumors; in the majority of patients (11/12; 91.7%), the lesion was identified in one of the upper quadrants. Specifically, upper intern quadrants (10 cases) were more affected. Surgical excision was performed in all patients. Mean diameter at pathologic section was 11.4 mm (range: 5‐22). Tumor relapse was reported only in one case (8.3%). Mean follow‐up was 98.1 months (range: 1‐192). We proposed a model to explain the molecular mechanism of granular cell tumorigenesis associating to the high level of S100 protein. Management of primary granular cell tumor of the breast requires a correct initial diagnosis using breast imaging associated with core biopsy. Surgical procedure with wide resection or quadrantectomy requires a careful evaluation of breast margins.     

Primary squamous cell carcinoma of the breast in a pregnant woman: Report of a case

Although reports on primary squamous cell carcinoma of the breast have been increasing in number, the morbidity rate of the disease is comparatively low. Its onset in pregnant women, especially, is quite rare. We herein report a case of primary squamous cell carcinoma of the breast in a pregnant woman. A 33-year-old woman was admitted with a lump in the right breast and an abnormal bloody nipple discharge. The breast mass was 5.6×5.4 cm in size, and both ultrasonogram and CT scanning showed that it consisted of a cystic tumor for the most part. A large amount of bloody cystic fluid was aspirated by fine-needle aspiration; squamous cell carcinoma of the breast was suspected by a cytological study on the fluid. Twelve days after an induced abortion was performed, a modified radical mastectomy was carried out. Histological findings of the resected specimen demonstrated that the tumor was squamous cell carcinoma which had been well differentiated with partial keratinization and cancer pearls. Noninvasive ductal carcinoma was also observed in a very small region of the specimen, which indicated that the tumor was probably originally adenocarcinoma which later transformed into squamous cell carcinoma.     

Clinical Examination, Mammography, and Fine-Needle Aspiration Cytology in the Management of Palpable Breast Masses

Abstract: The combination of examination, mammography, and fine-needle aspiration cytology is increasingly being used to identify palpable breast masses that can be followed rather than excised. Since all three modalities are highly dependent on training and experience, causing the accuracy of the triple test to be highly variable, we examined the results of our own experience, expecting to find at least one triply false-negative cancer.
Consecutive patients (198) with breast masses subjected to clinical examination, mammography, fine-needle aspiration cytology, and confirmatory excisional biopsy were studied. Sensitivity and specificity were calculated for all combinations of the three diagnostic methods and the significance of concordant and discordant findings was evaluated.
The sensitivities of examination, mammography, and cytology were 96%, 82%, and 85% respectively and the specificities were 75%, 90%, and 82%. No cancers were missed when all three diagnostic modalities were used together. Benign concordance of examination, mammography, and cytology was invariably associated with benign pathology.
These results validate the use of the triple test in our hands. However, the accuracy of the triple test will vary from physician to physician and its validity in following benign lesions must be evaluated with confirmatory excisional biopsies.     

A prospective study of the use of fine-needle aspiration cytology and core biopsy in the diagnosis of breast cancer

A prospective study was carried out on 143 consecutive patients with palpable lumps larger than 2 cm in size which were clinically suspicious of carcinoma. One hundred and five lumps proved to be malignant and 38 were benign. Of the 105 patients with malignancy, confirmation was made in 95 by fine-needle aspiration cytology (FNAC) with a sensitivity of 90.4% and 100 by core biopsy with a sensitivity of 95.2%. The sensitivity of core biopsies increased with the number of cores taken (one core, 76.2%; two cores, 80.9%, three cores, 89.2%; four cores, 95.2%). The combined sensitivity of FNAC and core biopsies was 100%, and so are complementary in the accurate diagnosis of breast cancer. Patients presenting to the breast clinic with a solid suspicious breast lump larger than 2 cm can benefit from FNAC and a minimum of four core biopsies to improve diagnosis.     

Mucocele-like lesions of the breast: a benign cause for indeterminate or suspicious mammographic microcalcifications

Most earlier reports of mucocele-like lesions (MLL) of the breast have dealt with symptomatic cases in premenopausal women or lesions found incidentally in breast biopsies performed for other reasons. The diagnosis of this lesion has special challenges in the setting of mammographic screening for breast cancer because the imaging characteristics of MLL may mimic those of ductal carcinoma in situ (DCIS), while mucinous carcinoma enters the differential diagnosis on cytologic grounds. This report focuses on our experience with MLLs detected during screening mammography. Cases with MLL as the final histologic diagnosis in our database during January 1992-June 2000 are included. The results of clinical, imaging, cytologic, core biopsy, and histologic examination of these lesions are recorded. The relevant literature is reviewed. Twenty-six cases were found, with a mean patient age of 57.5 years. Microcalcifications were the dominant radiologic abnormality in 22 cases (84.6%). Imaging was considered suspicious or almost certainly malignant in 17 cases (65.4%). Cytology was classified as atypical or suspicious in 17 cases (70.9%). However, open biopsy showed mostly benign changes, including atypical ductal hyperplasia (ADH) in five cases (19.2%). In one case, ADH merged with a 3-4 mm focus of low-grade DCIS. This, the largest series focusing purely on screen-detected MLL, suggests that the combination of clinical, imaging, and cytologic features of screen-detected MLL are different from those of mucinous carcinoma, symptomatic MLL, or incidental MLL. Correlating the cytomorphology of mucinous lesions of the breast with their mammographic appearance may permit more precise preoperative diagnosis.     

The negative predicative value of breast fine-needle aspiration biopsy: the Massachusetts General Hospital experience

Breast fine-needle aspiration biopsy (FNAB) has been increasingly accepted as an important triage tool for the evaluation of breast lumps. We examined the clinical utility and diagnostic accuracy of a negative breast FNAB result by studying 450 breast aspirates in 413 patients (average age 45 years) with a "negative" or benign cytologic interpretation performed at Massachusetts General Hospital over a 4-year period. Of these patients, 121 (29%) underwent subsequent biopsy and 17 (4%) were found to have malignancy (3% of total negative FNABs; 14% with histology). None of these 17 patients had a triple negative test. A cohort of 115 patients had documentation of negative physical, radiologic, and cytologic examinations (the triple negative), none of whom were found to have malignancy on histologic or at least 2-year clinical follow-up (negative predictive value [NPV] = 100% with a triple-negative test). Outside of the triple-negative test, the NPV of a negative breast FNAB is reduced with a false-negative rate of 7%. However, in the setting of a triple-negative test, the NPV in our patient population was 100%, reassuring the patient and clinician that clinical follow-up and not surgical intervention was sufficient for proper patient care.     

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

Abstract: Granular cell tumors (GCTs) are rare lesions in the breast of putative schwannian origin. These tumors are found in multiple sites throughout the body and have a characteristic histologic appearance. Recognition of these usually benign tumors is important since clinically, radiologically, and grossly GCTs of the breast often mimic carcinoma. The literature on these lesions in the breast is confined to isolated case reports. We describe the epidemiologic, cytologic, pathologic, and radiologic findings in 19 GCTs of the breast in 16 patients diagnosed at the University of Texas Southwestern Medical Center between 1991 and 1997.     

Lymphoma of the breast: clinical and radiologic features with pathologic correlation in 28 patients

The objective of this study was to determine the clinical and radiologic findings of lymphoma involving the breast, separately evaluating primary and secondary forms. We retrospectively reviewed the medical reports of 28 patients with lymphoma of the breast: 12 patients with primary lymphoma and 16 with secondary lymphoma. In primary lymphoma, mammography revealed a solitary mass (58.3%), multiple unilateral masses (8.3%), unilateral diffuse involvement (25%), and bilateral diffuse involvement (8.3%). The margins of masses were irregular (50%), partially defined (37.5%), and well defined (12.5%). The mean diameter of the masses was 4.6 cm. In secondary lymphoma, mammography revealed multiple masses (56.2%), solitary masses (12.5%), and diffuse unilateral breast involvement (31.2%). Their margins were irregular (18.1%), partially defined (27.2%), and well-defined (54.5%). The mean diameter of the masses was 2.8 cm. Cytologic examination ( n = 13) was demonstrative of lymphomatous involvement in all cases. We observed an association between high-grade types of malignancy and a diffuse pattern of radiologic breast involvement. Masses in primary disease tended to have less-defined margins and greater diameters than those observed in secondary cases. Cytologic examination proved to be a useful diagnostic procedure in the evaluation of secondary disease. The involvement of the breast in extranodal lymphomas does not seem to affect the prognosis of the disease.     

Granular cell tumor of the urethra

A 38-year-old woman was referred for urethral tumor treatment. Needle biopsy of the tumor was performed. Histologically, the tumor was composed of large polygonal cells with eosinophilic and periodic acid-Schiff (PAS)-positive granular cytoplasm, indistinct cell margins and small round central nuclei. Immunohistochemical staining for S100 protein, vimentin, and neuron-specific enolase (NSE) was positive, indicating that it was a granular cell tumor. Excision of the tumor including the urethra and appendicovesicostomy using the Mitrofanoff principle were performed. There has been no tumor recurrence in the 8 months after the operation.     

Granular Cell Tumor of the Breast Preoperatively Diagnosed by Fine-Needle Aspiration Cytology: Report of a Case

Granular cell tumors (GCTs) have a characteristic cytological appearance, and fine-needle aspiration cytology (FNAC) has been suggested to be the diagnostic modality of choice. However, the differential diagnosis has not yet been well described. We herein describe a rare case of GCT of the breast and discuss the differential diagnosis. A 53-year-old woman presented to our hospital with a left breast mass. In clinical and radiological examinations, the mass was suspected to be malignant. Cytologically, the tumor was composed of cohesive groups of cells with a syncytial appearance, and the cells contained abundant, finely eosinophilic cytoplasmic granules and small round-to-slightly-oval nuclei, thus suggesting the presence of benign GCT. The results of immunohistochemical staining supported the proposed deviation from Schwann cells. This case emphasizes the fact that GCTs are a rare but important possibility in the differential diagnosis of breast tumors, and that FNAC may provide clinically useful information on the management of such lesions.     

An unusual presentation of locally recurrent breast cancer: a case report

Recurrent breast carcinoma is usually detected by imaging studies and biopsy. We present a case with unusual clinical presentation and discuss the diagnosis and treatment. While core needle biopsy and fine-needle aspiration are important in the diagnosis of early-stage breast cancer, physical examination and close follow-up are important in the absence of a diagnosis.     

Diagnostic Potential and Pitfalls of Ultrasound-guided Fine-Needle Aspiration Cytology for Breast Lesions

(Received for publication on July 29, 1996; accepted on May 12, 1997)     

锥光束乳腺CT引导下穿刺活检诊断乳腺浸润性导管癌1例

正患者女,45岁,以"左乳腺肿物性质待查"入院。实验室检查无异常。专科检查:左乳腺外上象限触及约3.0cm×3.5cm肿物,表面欠光滑,质硬,边界欠清,活动度欠佳,无压痛。乳腺X线摄影:左乳腺外上象限见分叶状稍高密度影,边界不清,可见毛刺影。乳腺MRI:左乳腺外上象限见约2.1cm×1.6cm×3.8cm不规则信号,边界不清,T1WI呈等信号,T2WI压脂呈高及稍高混杂信号,DWI呈明显高信号,ADC低信号,动态后肿物明显不均匀强化,考虑左乳腺外上象限乳腺癌[乳腺影像报告和数据系统     

Granular cell tumor of the esophagus —report of a case and review of the literature—

We report herein a case of a 46 year old man presenting with a gastric ulcer in whom an endoscopy happened to detect an elevated lesion in the lower esophagus. Endoscopic biopsy proved sufficient for determining the diagnosis of a granular cell tumor (GCT). Electron and microscopic studies suggest that GCT are derived from Schwann cells. Although commonly found in the tongue and skin, GCT are rarely seen in the gastrointestinal tract, especially in the esophagus. However, advances in endoscopic techniques will increase the opportunity of detecting GCT of the esophagus.     

Breast Fine-Needle Aspiration in the Socialist Republic of Vietnam: First-Year Experience in the Ho Chi Minh City Cancer Center

Abstract: In the Socialist Republic of Vietnam, breast cancer is the second leading cause of cancer death in women. Prior to 1994, in certain regions of Vietnam, such as the South, the only diagnostic modalities for breast lesions were clinical examination and open surgical biopsy, a procedure prohibitively expensive for many women. In January 1994, two American cytopathologists conducted a 3-day breast fine needle aspiration (FNA) seminar at the Ho Chi Minh City Cancer Center, Ho Chi Minh City. After the seminar, 754 breast FNAs were performed from January 1994 to January 1995. The sensitivity and specificity of breast FNA were 96% and 83%, respectively, and there were nine false positive and seven false negative diagnoses. The overall diagnostic accuracy of breast FNA is within the range of previously reported accuracies, indicating that breast FNA can be learned quickly and practiced proficiently. A main role of breast FNA in Vietnam is in the diagnosis of high-stage, inoperable breast tumors. The relative af-fordability of breast FNA enables many women with breast lesions to undergo a diagnostic procedure. The introduction of inexpensive, diagnostically accurate procedures, such as breast FNA, may prove to be of great benefit in countries with scant medical resources.     

Granular cell myoblastoma of the bronchus in a child: A case report

Granular cell myoblastoma of the right main bronchus in a 5-year-old girl is reported. The tumor extended to the lower trachea from the right main bronchus which was occluded completely by the tumor. The diagnosis was established histologically by a obtaining bronchoscopic biopsy specimen. Right pneumonectomy was carried out to control pulmonary suppuration caused by the tumor obstruction of the bronchus. External radiotherapy and interstitial brachytherapy were successfull to control the growth of the residual tumor. She has been free from symptoms for about 12 years after the treatment.     

Granular cell tumor of the urinary bladder

A case of granular cell tumor of the urinary bladder is reported. A 48-year-old Japanese man with a bladder tumor underwent transurethral resection of the tumor and microscopic examination showed a granular cell tumor. Immunohistochemical staining for neuron specific enolase and S100 protein was positive, and it was suggested that the granular cell tumor was derived from Schwann cells.     

Phyllodes tumor in epileptics: A report of two cases

Phyllodes tumor is an uncommon breast neoplasm characterized by a proliferation of both stromal and epithelial elements. In 1989, two young patients with phyllodes tumors were referred to our surgical department because of the detection of breast lumps. Interestingly, both patients also had epilepsy and had been taking anticonvulsants. An analytical case control study revealed that no significant difference between the control group and phyllodes group was found for various categories. In addition, no anticonvulsant medication had been prescribed in either the control group or the phyllodes group except for these two cases. We herein report two cases of phyllodes tumors occurring in two young epileptic patients.