Granular cell tumour of the breast

Summary Eight cases of benign granular cell tumour of the breast are reported. Seven patients were women and one was male. The age at the time of the excision ranged from 17 to 73 (average 40.1) years. All tumours were positive for S-100 protein and negative for keratin, myoglobin and gross cystic disease fluid protein. In two cases ultrastructural studies revealed findings identical to those in the previously reported cases of granular cell tumours. None of these cases were diagnosed preoperatively. In six cases the clinical and mammographic findings, and in one case the frozen section, led to an erroneous diagnosis of malignancy. The clinico-pathological features of the cases are delineated in order to draw attention to a benign condition which closely simulates malignancy.     

Granular cell astrocytoma

Granular cell astrocytoma (GCA) is a rare morphologic variant of astrocytomas, characterized by a prominent component of plump granular tumor cells. It has an aggressive clinical course as compared with conventional astrocytoma of the same grade. As its cytologic feature resembles that of a foamy histiocyte and, histologically, the tumor is rich in arborizing capillaries, it can be difficult to distinguish GCA from non-neoplastic diseases such as infarct or demyelinating disease. In this paper, a case of a GCA in a 28-year-old full-term pregnant woman suffering from a sudden episode of seizure during delivery is described, focusing on histopathological, immunohistochemical, and ultrastructural features. Histopathology and immunohistochemical phenotype of this tumor were identical to the previous reports. Ultrastructurally, secondary lysosome (so-called lipofuscin bodies) granules were present but not numerous; instead, many mitochondria and unusual paracrystalline inclusions were found in each tumor cell. In our case, the light microscopic granular appearance might be produced not only by phagolysomes but also by numerous mitochondria and paracrystalline inclusions.     

Experimental investigation of the mammary gland tumour phantom for multifrequency microwave radio-thermometers

Microwave radiometry is a spectral measurement technique for resolving the electromagnetic radiation of matter when its temperature is above absolute zero. The radio-thermometer utilises this technique and consequently can provide temperature distributions in subcutaneous biological tissues. A new phantom was proposed that imitates a mammary gland tumour, and the brightness temperature was observed using radio-thermometers operated at different frequencies, 1.75 GHz and 3 GHz. The proposed phantom, simulating heat diffusion propagated by tissues around real tumours, revealed that the thermal characteristics of the tumour imitator were well matched to the heat transfer properties of a real tumour and a proportional linear relationship between the location of the tumour imitator and the brightness temperature in a homogenous medium was established. From experiments using the proposed mammary gland tumour phantom and a clinical trial on patients with breast cancer, it could be concluded that a radio-thermometer with a short wavelength (λ=10 cm, i.e., f=3 GHz) is useful to resolve a thermal anomaly at a shallow depth in an homogenous medium such as a breast.     

Granular cell tumour of the appendix in a patient irradiated for a rectal carcinoma

Summary We report on a 47-year-old man with a granular cell tumour of the appendix, discovered incidentally during surgery for a rectal adenocarcinoma that had been irradiated preoperatively. A detailed immunocytochemical analysis revealed positivity for S-100 and neuron-specific enolase (NSE). Electron microscopically, the cytoplasm of the tumour cells contained numerous pleomorphic lysosomes. In the appendix tissue adjacent to the tumour a neuroma and the histological features of radiation injury were present. Our findings suggest that this granular cell tumour may have originated from a pre-existing appendix neuroma which underwent granular degeneration, possibly as a result of radiation.     

Extranodal follicular dendritic cell tumour of the nasopharynx

 We report the first case of an extranodal follicular dendritic cell (FDC) tumour localized in the nasopharynx of a 44-year-old male patient. The tumour cells were characterized immunohistochemically by strong expression of CD21, HLA-DR and vimentin and focal expression of CD68 and cytokeratin. Electron microscopic examination revealed desmosomal cell junctions between adjacent cell processes. Molecular genetic analysis using polymerase chain reaction (PCR) showed germline configuration of immunoglobulin and T-cell receptor genes. Epstein-Barr virus (EBV) genomes were detectable by PCR. After complete surgical tumour removal and radiotherapy the patient is disease-free 20 months after the initial diagnosis. Received: 21 July 1997 / Accepted: 12 September 1997     

Granular cell tumor (Abrikossoff tumor) of the thyroid gland

Only 4 cases of granular cell tumor of the thyroid have been previously reported in the English literature. We report herein the fifth case of this uncommon neoplasm and the first one affecting a male patient. The tumor was well circumscribed and located to the left thyroid lobe, near the isthmus. Histologically, the tumor was composed of large, rounded, granular eosinophilic cells that were immunohistochemically positive for S-100, calretinin, and PGP9.5 and negative for cytokeratin AE1-3, TTF-1, and thyroglobulin.     

A basaloid tumour of the parotid gland

Basal cell adenocarcinoma is a malignant basaloid tumour most seen in the parotid gland. This case report and subsequent discussion highlights the key diagnostic findings seen in this rare tumour.     

Solitary fibrous tumour of the thyroid: Clinicopathological,immunohistochemical and ultrastructural study of three cases

We describe three cases of solitary fibrous tumour (SFT) arising from thyroid stroma. Grossly, the tumours were clearly delimited but only partly encapsulated. The following histomorphological growth patterns were observed: bundles of cells in storiform configuration; non-structured bundles; prevalence of fibrous matrix; highly cellular, non-structured; prevalence of loose, non-structured extracellular substance; cellular proliferation and vascular spaces in a haemangiopericytic configuration and a lipomatous component. Immunohistochemical investigation demonstrated intense, diffuse vimentin positivity and focal, less intense actin positivity in all three cases. At electron microscopy we observed a primitive cell of mesenchymal type, with cytoplasm poor in organelles and rich in filaments; this cell sometimes presented differentiation characteristics. SFT is at present the most correct term for the lesions presented here despite some morphological characteristics which differ from cases reported in the literature.     

Merkel cell carcinoma of the parotid gland associated with Warthin tumour: report of two cases

AIMS: Two cases of Merkel cell carcinoma occurring simultaneously and in close association with a Warthin tumour of the parotid gland are reported. METHODS AND RESULTS: The patients were a 65-year-old man and a 70-year-old man, respectively. The Merkel cell carcinoma component was immunoreactive for chromogranin and keratin 20 and contained neuroendocrine-type granules at the ultrastructural level. CONCLUSIONS: The histogenesis of this heretofore undescribed combination is discussed.     

Granular cell tumor of the penis: clinicopathologic evaluation of 9 cases

The occurrence of granular cell tumor (GCT) in penile tissue is very rare, with only 9 examples reported to date in the English-language literature. Herein, we describe the clinicopathologic and immunohistochemical findings in 9 additional cases. The patients ranged in age from 20 to 60 years (mean, 42 years; median, 40 years) at time of diagnosis. All penile tumors were solitary and arose in the dermis of the penile shaft (n=4), prepuce (n=3), and corona (n=2). A patient had a history of multiple cutaneous GCTs. Duration of symptoms before surgery ranged from 5 days to 2 years with the presence of an asymptomatic nodule representing the most common tumor-related complaint (n=8). The lesions ranged in size from 0.6 to 2.5 cm (mean, 1.5 cm; median, 1.5 cm). Microscopically, the tumors were moderate to highly cellular and were composed of oval to polygonal-shaped cells with abundant coarsely granular eosinophilic cytoplasm. Tumor cells grew in infiltrating nests, cords, and trabeculae and showed neural (n=2) and vessel wall (n=1) invasion or formed a relatively well-marginated solid nodule. Bland cytological features with only rare cells showing nucleomegaly (n=7) or spindling (n=3) were exhibited by 8 tumors. A tumor demonstrated diffuse nuclear atypia and was classified as "atypical." Mitotic activity ranged from 0 to 8 mitoses (mean, 1.4 mitoses) per 50 high-powered fields with no atypical division figures identified. All tumors tested showed moderate to strong immunohistochemical expression of S100 protein (n=6) and low-affinity nerve growth factor receptor (n=5), which was useful for detecting small deposits of tumor and helpful in evaluating surgical margins. Focal tumor cell immunoreactivity was observed for calretinin (4/6 cases) and glial fibrillary acidic protein (1/6 cases). All patients underwent simple (local) excision of their tumor. Complete follow-up data (mean, 21 years; interval range, 0.5-28 years) were available for 6 patients. No patient experienced recurrence or metastatic spread of tumor although surgical margins were microscopically involved by tumor in 5 cases. Benign GCT involving superficial soft tissue of the penis can be adequately managed by a simple excision. Patients with microscopically involved surgical margins can be clinically followed without immediate additional surgery.     

Solitary fibrous tumour of the adrenal gland associated with pregnancy

Solitary fibrous tumour (SFT), first described as a pleural lesion, has been reported in several extrathoracic sites over the past 10 years. We describe a SFT of the left adrenal gland incidentally discovered in a 23-year-old, 22-week pregnant woman and characterised by a rapid growth during the third trimester of pregnancy. Elevated serum and urinary levels of cortisol and elevated blood levels of delta 4 androstendione and 17-OH progesterone were observed. After spontaneous delivery, the patient underwent laparoscopic resectioning of the mass and of the left adrenal gland from which the tumour was apparently originating. The kidney was not involved, and no other abdominal tumours were found. Histological and immunohistochemical features were typical of SFT of pleura and other locations. Only one case of adrenal SFT is on record, and the adrenal gland is to be added to the long list of extrathoracic locations of SFT. The association with pregnancy was a previously unrecognised event in SFT. The focal expression of progesterone receptors in the tumour cells may be related to pregnancy. This observation prompted an analysis of steroid hormone receptors in SFT of classical sites (pleura). Two of five cases had focal progesterone receptors too, a finding which deserves further investigations in a much larger series of SFTs. Received: 22 December 1999 / Accepted: 22 May 2000     

Granular cell dermatofibroma

 

Aims:

To describe a series of five granular cell dermatofibromas as an unusual and rare manifestation of fibrohistiocytic tissue response.  

Methods and results:

Five granular cell dermatofibromas were collected out of 136 tumours filed as granular cell tumours. Clinically, all lesions occurred on the shoulder or back of middle-aged adults (two women, three men), mostly with the clinical diagnosis of a fibrohistiocytic lesion. Histology revealed well-circumscribed, dermal to subcutaneous lesions dominated by periodic acid–Schiff (PAS) positive, granular cells. Acanthosis above, as well as storiform arrangement of spindle cells, sclerotic collagen and some interspersed lymphohistiocytic infiltrate at the periphery of the lesion, indicated the fibrohistiocytic origin. Lesions showed prominent reactivity with NK1C3 (CD57), as well as for macrophage markers KiM1p and KP1 (CD68). In contrast to classic Schwannian/neurogenic granular cell tumours, granular cell dermatofibromas were S100 protein negative, but showed variable reactivity for factor XIIIa (10–50%) in 4/5, for smooth muscle specific actin (10–50%) in 2/5 and with E9 (10–30%) in 3/5 lesions. Electron microscopy in one case revealed large pools of phago-lysosomes and variably sized glycogen granules in granular cells.  

Conclusion:

Our series delineates granular cell dermatofibroma as a distinct clinicopathological variant of fibrohistiocytic tissue response which needs to be distinguished from other tumours with granular cell features.     

Granular cell tumour of the colon with extensive sclerosis

Granular cell tumour (GCT) is a rare, usually benign, mesenchymal lesion that can occur in nearly any organ, but has a proclivity for the oral cavity, skin and subcutaneous tissue. They occasionally arise in the gastrointestinal tract (GIT) where the oesophagus is most commonly involved. Occurrence in the colorectum is unusual. We report a case of a 73 year-old man with an incidentally discovered GCT with extensive sclerosis in the caecum. Microscopically, a well-circumscribed, paucicellular nodule was identified in the submucosa with prominent hyalinisation and focal myxoid change. Scattered, finely granular cells expressing S100, inhibin and calretinin were identified. CD117 and DOG-1 were negative. This case was made challenging by the prominent sclerosis with only focally visible granular cells, however, the overall features were those of a GCT of the colon. We highlight the morphological and immunohistochemical features of this rare entity in the colon, and discuss the differential diagnosis. In this era where incidental polyps and submucosal lesions are increasingly being detected by endoscopy, knowledge and recognition of GCT in the colon is important as they are generally benign with a good prognosis following complete excision.     

Cellular localization of aquaporins along the secretory pathway of the lactating bovine mammary gland: An immunohistochemical study

In this study we examined the cellular localization of aquaporins (AQPs) along the secretory pathway of actively lactating bovine mammary glands using immunohistochemistry. Mammary tissues examined included secretory ducts and acini, gland cisterns, teats, stromal and adipose tissues. Aquaporin 1 (AQP1) was localized in capillary endothelia throughout the mammary gland in addition to myoepithelial cells underlying teat duct epithelia. AQP2 and AQP6 were not detected and AQP9 was found only in leukocytes. AQP3 and AQP4 were observed in selected epithelial cells in the teat, cistern and secretory tubuloalveoli. AQP5 immunopositivity was prominent in the cistern. AQP3 and AQP7 were found in smooth muscle bundles in the teat, secretory epithelial cells and duct epithelial cells. These immunohistochemical findings support a functional role for aquaporins in the transport of water and small solutes across endothelial and epithelial barriers in the mammary gland and in the production and secretion of milk.     

Light and electron microscopic localization of the N-terminal fragment of human pro-opiomelanocortin in the human pituitary gland and in neoplasms

Summary Immunohistochemical localization of theN-terminal fragment (1–76) (NTF) of human pro-opiomelanocortin (POMC) was studied in human adult and fetal pituitary glands, as well as in pituitary adenomas associated with Cushing's syndrome and in ectopic ACTH-producing tumors. Comparison of localization between NTF and ACTH was performed using mirror sections. Our results indicated concomitant localization of NTF and ACTH in the same cells, not only in normal adult and fetal pituitaries but also in pituitary adenomas and ectopic ACTH producing tumours. Specificity of the NTF staining was confirmed by immunoabsorption. Negative staining of the bovine pituitary gland indicated the immunohistochemical localization ofN-terminal (1–45) of human POMC as there is a known species difference in the sequence 1–45 between human and the bovineN-terminal fragment. Presence of NTF in cisterna of rough endoplasmic reticulum indicates its production by small cell carcinoma. These findings, together with the previous studies, suggest that the complete form of POMC is produced in the tumours as well as in normal pituitaries.This work was supported in part by the Grant-in-Aid for Cancer Research (58-Z) from the Ministry of Health and Welfare.Supported by NIH # 16315-04 and by a program grant from the Medical Research Center of Canada     

Hybrid salivary gland tumour: interpreting conflicting morphologies in final needle aspiration cytology

Cytological assessment of salivary gland tumours can be a challenging endeavour that requires careful assessment and interpretation of cytomorphological features. We present a case of a hybrid salivary gland tumour with both elements detectable on fine needle aspiration cytology and consider the relevant differential diagnoses when faced with multiple contrasting morphologies on salivary gland sampling. We also discuss the proposed pathogenesis, relevant nomenclature and key clinical considerations for this rare neoplasm.     

Osteoclast-type giant cell tumour of the pancreas

Summary Two cases of osteoclast-type giant cell tumour of the pancreas (OGTP) are presented and compared with similar tumours of other locations and pancreatic carcinomas. One of the tumours was analyzed by immunohistochemical methods. The mononuclear stromal cells and osteoclast-like giant cells, which characterize this very rare neoplasm, reacted with an antibody against vimentin, but were not decorated by antibodies against lysozyme, alpha-1-ACHT, alpha-1-AT. Pleomorphic mononuclear cells in osteoid additionally contained osteonectin and could thus be identified as osteoblasts. Only the tumour glands stained positively with panepithelial keratin antibodies and antibodies against the keratin polypeptides 7, 18, 19. These results demonstrate for the first time the mesenchymal differentiation of the OGTP, which in some cases is also able to form epithelial structures. The immunohistochemical reactions and the characteristic morphology of the tumour show the OGTP to be an entity which must be differentiated from pancreatic carcinoma, especially from its giant cellular subtype.     

Islet cell tumour with vacuolated lipid-rich cytoplasm: a new histological variant of islet cell tumour

Aims: A previously unreported clear cell variant of islet cell tumour of the pancreas is described. Methods and results: By light microscopy, the cytoplasm of the clear cells was finely reticulated and vacuolated. Immunohistochemical and electron microscopy studies confirmed the endocrine nature of the tumour. Conclusions: The clear cell morphology was due to the accumulation of lipid in the cytoplasm.