Malignant granular cell tumor

A case of a granular cell tumor with a malignant behavior is described. Several repeated biopsy specimens, a resection specimen, and the metastatic lesions were compared with one another. Consecutive specimens showed increasing atypia. Electron microscopy of the metastatic lesions confirmed the granular cell nature of the tumor. The historic aspects of histogenesis are briefly discussed. The findings agree with a presently accepted origin from a primitive mesenchymal cell.     

Malignant granular cell tumor.

We report a case of malignant granular cell tumor of the chest wall that recurred in the right breast with axillary lymph node metastases. The recurrent tumor clinically and grossly mimicked a breast carcinoma. Electron microscopy and immunohistochemical techniques were used to confirm the cytologic and histologic diagnosis of granular cell tumor. The importance of true metastases in the diagnosis of malignant granular cell tumor and their differential diagnosis are discussed.     

膀胱恶性颗粒细胞瘤一例

患者女,46岁。2000年3月在外院行“子宫肌瘤”手术,术中发现膀胱与阴道之间有一个巨大肿块,未切除,活检病理诊断：颗料肌母细胞瘤,低度恶性。单纯介入治疗2次出院。     

Malignant granular cell tumor of the abdominal wall

The granular cell tumor is an uncommon tumor that usually appears as a solitary small nodular growth and runs a benign course. It occurs widely throughout the body, but is rarely described in the abdominal wall. The authors report a case of malignant granular cell tumor which was arising in anterior abdominal wall of a 67-year-old woman. Malignant variant is rare and the abdominal wall site is extremely uncommon. Regarding this clinical case and the literature the authors purpose to review the criteria of malignancy.     

Malignant granular cell tumor at the retrotracheal space

We report a case of an extremely rare neoplasm, malignant granular cell tumor (MGCT). The patient was a 21-year-old woman, who was 5 months pregnant. The tumor occurred in the retrotracheal space, extending from the level of the larynx to the thoracic inlet. In addition, there were multiple, variable-sized tumor nodules within both lung fields on chest CT scan. Histologically, tissue biopsied from the periphery of the tumor consisted of solid sheets of large ovoid cells with ample, eosinophilic cytoplasm, eccentric nuclei, and prominent nucleoli. Each cell showed slight atypism of the nuclei. There was a focal necrosis at the periphery of the lesion. These cells stained strongly for S-100 protein, neuron-specific enolase (NSE) and CD68. On electron microscopy, the tumor cells contained autophagic vacuoles. The patient refused further treatment and died 7 months later. The exact cause of death was not known. Until now, the diagnosis of MGCTs has been made only when metastasis and an aggressive clinical course are identified, although some observers advocate that some histologic features such as nuclear pleomorphism, necrosis, and the presence of any mitotic activity are indicative of malignancy. These histologic findings are not easily detectable in every case of MGCT, as in our case. So the diagnosis of a MGCT should be considered in cases with aggressive clinical findings and some histologic features, such as necrosis, nuclear atypism, and mitotic activities, which could suggest the malignant behavior of this neoplasm.     

Malignant granular cell tumor with unusual histological features

Malignant granular cell tumor, although uncommon, should be differentiated from a number of granular cell-containing tumors. Reported herein is a distinctive variant of malignant granular cell tumor, clinically presenting as a rapidly enlarging scrotal mass, in which some areas morphologically displayed features indistinguishable from Kaposi sarcoma. Cells in areas simulating Kaposi sarcoma were immunohistochemically the same as typical granular cells in other portions of the tumor. The recognition of this pattern is important because it may predominate and overshadow the original nature of tumor.     

Malignant granular cell tumor: a look into the diagnostic criteria

Fanburg-Smith et al. classified granular cell tumors (GCTs) using six criteria with high Ki-67 and p53 in malignant cases.We aim to refine their classification and reproduce their immunohistochemical findings. We, first, classified our 48 cases according to Fanburg-Smith criteria (37 benign, seven atypical, and four malignant), and performed Ki-67 and p53 on a sample of tumors. Then, we reclassified them into 44 benign and four with uncertain malignant potential (GCT-UMP) using only necrosis and/or mitoses.

(1)

According to Fanburg-Smith criteria: Malignant cases were significantly younger than benign and atypical ones; occurred predominantly in males; were significantly larger in size; and showed a higher Ki-67 expression but an insignificant difference in p53 staining.

(2)

Comparative findings: The four malignant cases according to Fanburg-Smith corresponded to our four cases with UMP. The seven atypical cases and our benign group shared similar means, except for age. None of these atypical cases recurred or metastasized.

Despite its small number, our preliminary study showed similar selectivity of two more reproducible criteria (vs six) in the classification of cases of GCT with potential aggressive behavior, preserving a role for Ki-67 in difficult cases. However, metastases remain the sole definite criterion for malignancy.     

Infiltrating granular cell tumor of the esophagus: a description of two cases

Granular cell tumor of the esophagus is an unusual tumor. It presents usually as a small and well limited lesion, localized in the mucosa or the submucosa. We report two cases of granular cell tumor of the esophagus, remarkable for their infiltrative growth. The tumor invaded the esophageal muscularis propria in one case and went through the adventitia in the other. There was no recurrence 1 year and 7 years after surgery, despite an incomplete resection in the second case. Thirteen cases of infiltrative granular cell tumors of the esophagus have been published. They are usually responsible for dysphagia. They can invade the muscularis propria and the adventitia as well as the periesophageal organs. There is no recurrence, even after an incomplete resection. The infiltrative feature of the granular cell tumors of the esophagus, by itself, cannot be considered as a malignant feature. The diagnosis of malignant granular cell tumor of the esophagus lies on the discover of metastases.     

Malignant granular cell myoblastoma

A case of granular cell myoblastoma which metastasized with fatal results is described. The literature relating to similar cases is reviewed and a total of 13 acceptable cases is listed.     

Malignant granular cell tumor of the esophagus. A case report with light and electron microscopic, histochemical, and immunohistochemical study

Malignant granular cell tumor of the esophagus found in a 70-year-old female was reported. Microscopically, the tumor showed a variety of the histology from compact proliferation of polygonal granular cells in pseudo-epitheliomatous pattern to plexiform proliferation of elongated granular and fibroblastic cells in neurofibromatous pattern, and the tumor cells frequently contained eosinophilic globules in the cytoplasm. Histochemically, argyrophilic neurofibrils in the stroma and argyrophilic cytoplasmic processes or grains were seen. Immunohistochemically, the tumor cells showed positive reaction with S-100 protein (S-100), but all reactions with myoglobin (MG), desmin (DM), fibronectin (FN), creatinine phosphokinase-mm (CPK), factor 8th-related antigen (F8RA), alpha-1-antitrypsin (A1AT), alpha-1-antichymotrypsin (A1ACT), keratin (KN), and carcinoembryonic antigen (CEA) were negative. Electron microscopy revealed that the tumor cells had typical lysosomal granules filled with proteinaceous electron dense materials and fine membrane-bound particles sized 15 to 45 nm resembling virus or neurosecretory granule.     

Malignant granular cell tumor. A clinico-pathologic and ultrastructural study of a case

The clinical and light- and electron-microscopic features of a malignant granular cell tumor in a 64-year-old man are reported. The ultrastructural appearance, with abundance of cytoplasmic "phagosomes", may help in the differential diagnosis. The light-microscopic findings and some ultrastructural observations support the suggestion that the tumor originated from peripheral nerves, and that a close relationship exists between malignant granular cell tumors and malignant Schwannoma.     

Malignant granular cell tumor of soft tissues: a study of two new cases

We describe 2 cases of malignant granular cell tumor. A marked discrepancy exists concerning the criteria of malignancy of this rare entity, which was diagnosed in male patients aged 41 and 52 years, respectively. They presented with tumors measuring more then 3.5 cm; one arose in the dermis and subcutaneous tissue in the region of the scapula, whereas the other was situated in deeper soft tissue in the pelvis. One case, with previous diagnosis of benign granular cell tumor, presented local recurrence 2 years after the initial diagnosis. The other case presented a fascicular pattern of growth invading adjacent muscular tissue. Both neoplasms were composed of polygonal and spindle cells, showing abundant cytoplasm, vesicular nuclei with large nucleoli, high nuclear-to-cytoplasmic ratio, and pleomorphism. Immunohistochemically, the neoplastic cells of both cases were positive for vimentin, S100 protein, neuron-specific enolase (NSE), and CD68. In addition, high expression of p53 and MiB1 (Ki67) was detected. Herein, we discuss the morphologic and immunohistochemical criteria of malignancy of granular cell tumors. Int J Surg Pathol 9(3):255-259, 2001     

Malignant granular cell tumour with intraperitoneal dissemination

An unusual case of a malignant granular cell tumour involving the peritoneal cavity and probably arising in the pelvis is reported. The light microscopic diagnosis was confirmed by electron microscopy and immunohisto-chemistry.     

恶性颗粒细胞瘤10例临床病理学观察及文献复习

目的 探讨恶性颗粒细胞瘤的临床病理学特征,评价组织学上诊断恶性的标准。方法 对10例恶性颗粒细胞瘤的临床资料和组织学形态进行回顾性分析,并采用免疫组织化学(LSAB法)和电镜检测研究其免疫表型和超微结构。结果男性4例,女性6例,年龄范围为27～73岁(平均46岁)。临床上,9例表现为皮下或深部软组织内无痛性生长的孤立性肿块,其中1例伴有周围神经症状。肿瘤位于下肢3例,乳腺2例,项部2例,胸壁、右颈部和盆腔者各1例。肿瘤直径2～11cm,平均4．8cm。镜下由成巢或成片的多边形细胞组成,胞质呈嗜伊红色颗粒状,与良性性颗粒细胞瘤极为相似,但仔细观察发现,9例显示至少下述形态中的3种：核增大呈空泡状并可见明显的核仁;多形性瘤细胞;核质比增大;瘤细胞趋向梭形;可见核分裂象;凝固性坏死。除经典性形态外,1例尚可见散在的多核性瘤细胞。余1例除局部区域显示核增大呈空泡状并可见明显的核仁外,其余形态均不明显,但临床上却呈恶性经过。9例均强阳性表达S-100蛋白和神经元特异性烯醇化酶(NSE),7例尚表达CD68。电镜观察显示瘤细胞胞质内充满大量退变的复合性溶酶体。随访7例,5例复发,4例转移,2例死于肿瘤。结论 (1)Fangburg-Smith等的组织学恶性标准具有较高的可重复性,但在少数情形下,最终诊断仍需结合肿瘤的生物学行为;(2)提议将核分裂象的标准修订为＞5／50HPF;(3)广泛性局部切除加上必要的区域淋巴结清扫仍是目前最主要的治疗手段,辅助性化疗和(或)放疗并不能明显改善患者的预后;(4)描述一种尚未见报道的多核性瘤细胞形态亚型。     

恶性颗粒细胞瘤临床病理、免疫组化和超微结构观察

目的：探讨恶性颗粒细胞瘤的病理学诊断和鉴别诊断要点及组织学起源。方法：对３例恶性颗粒细胞瘤进行临床病理、免疫组化及超微结构观察研究。结果：男性２例，女性１例，平均年龄为４９岁。部位分别为颈部１例，右大腿２例。其中２例分别于术后２年半及７年复发，并伴有区域淋巴结转移。组织学上３例与良性颗粒细胞瘤十分相似，局部区域出现梭形瘤细胞，空泡状核及明显的核仁，其中１例在肿瘤的周边部可见到瘤细胞与外周神经束支之间有直接移行关系。免疫酶标结果显示瘤细胞强阳性表达Ｓ－１００蛋白和神经特异性烯醇化酶（ＮＳＥ），１例电镜检测显示胞浆内充满膜包被复合性溶酶体。结论：对临床明显恶性而组织学上却极似良性的恶性颗粒细胞瘤，以下几点能提示恶性诊断：（１）肿瘤超过４ｃｍ；（２）核分裂象超过２个／１０ＨＰＦ；（３）核呈空泡状并有明显的核仁；（４）出现梭形瘤细胞；（５）有肿瘤性坏死。此外，免疫组化标记及超微结构观察有助于鉴别诊断及揭示组织学起源。     

FNA of thyroid granular cell tumor

Granular cell tumor rarely occurs in the thyroid. This case report describes the cytologic features of a granular cell tumor seen in a fine needle aspirate obtained from a 27‐year‐old woman with a gradually enlarging thyroid nodule. The aspirate showed single as well as syncytial clusters of cells with abundant granular cytoplasm. The differential diagnosis in this case included granular cell tumor, Hurthle cell lesion/neoplasm, and a histiocytic reparative process. Immunohistochemical studies, including S‐100 protein and CD68, performed on a cell block preparation were helpful in supporting the diagnosis. Diagn. Cytopathol. 2013;41:825–828. © 2012 Wiley Periodicals, Inc.     

Cytology of endobronchial granular cell tumor

Cytologic features of four cases of endobronchial granular cell tumor are presented. The diagnostic cells were found in bronchoscopically obtained material. They were arranged in smaller clusters and had finely granular cytoplasm with uniform oval or round nuclei. Frequently the cells are overlooked on regular cytologic examination owing to their benign nature. Nevertheless, there are enough cytomorphologic features that help to distinguish these cells from macrophages and bronchial epithelial cells. It is essential that the possibility of granular cell tumor is considered on cytologic examination. Final diagnosis, however, requires histologic verification.