Journal of Cutaneous and Aesthetic Surgery
Print this page
Email this page
Small font size
Default font size
Increase font size
Home About us Current issue Archives Instructions Submission Subscribe Editorial Board Partners Contact e-Alerts Login 


 
   Table of Contents     
CORRESPONDENCE  
Year : 2015  |  Volume : 8  |  Issue : 3  |  Page : 181-183
Granular cell tumour


1 Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
2 Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Click here for correspondence address and email

Date of Web Publication14-Oct-2015
 

How to cite this article:
Singh HK, Anantharaju A, Sistla SC. Granular cell tumour. J Cutan Aesthet Surg 2015;8:181-3

How to cite this URL:
Singh HK, Anantharaju A, Sistla SC. Granular cell tumour. J Cutan Aesthet Surg [serial online] 2015 [cited 2020 Nov 30];8:181-3. Available from: https://www.jcasonline.com/text.asp?2015/8/3/181/167288


Dear Editor,

Granular cell tumour is a benign tumour of Schwann cell origin. It can occur in skin, subcutaneous tissue, submucosa, and deep soft tissue and internal organs but is most common in head and neck region particularly tongue. Rarely, has it been documented to present as an inguinal swelling. [1],[2],[3],[4]

A 13-year-old boy presented with a gradually increasing swelling in the left inguinal region for two years. This was associated with a dull aching pain. He had no significant illnesses in the past or any familial diseases.

His general examination was unremarkable. Local examination revealed a swelling of 3 × 2 cm in the left inguinal region near the root of penis [Figure 1]a]. It was non-tender, firm and mobile. There was no impulse on cough. The cord structures, testes and external genitalia were normal. Ultrasonography of the abdomen was normal. Ultrasound of the swelling showed a hypoechoic lesion of 1.2 cm with loss of fatty hilum. Both the testes and epididymis were normal. A provisional diagnosis of an enlarged inguinal lymph node was made. Fine needle aspiration cytology showed uniform appearing large polyhedral cells arranged in sheets. These cells had small round nuclei and abundant dense granular cytoplasm. These features suggested a possibility of a granular cell tumour.
Figure 1: (a) Clinical photograph showing a swelling in the left inguinal region near the root of the penis (b) Intraoperative appearance of the tumour (c) Tumour after en bloc excision (d) Cut section of the tumour showing solid areas with interspersed fatty tissue

Click here to view


Since the patient was symptomatic, a decision to excise the swelling was made. Intra-operatively, the swelling (3 × 3cm) was in the subcutaneous plane in the inguinal region [Figure 1]b]. It was adherent to the external oblique aponeurosis. Enbloc excision of the swelling was done. On cut section, the tumour showed solid areas with interspersed fatty tissue [Figure 1]c and d]. Histopathology confirmed the findings of cytology. All margins were free of the tumour. Immunohistochemistry was positive for S100 protein [Figure 2]. Post-operatively, the wound healed well with no complications. The patient was advised a regular yearly follow-up.
Figure 2: (a) (400X) Haematoxylin and Eosin staining of the tumour showing large polyhedral cells arranged in sheets with abundant granular cytoplasm and small hyperchromatic nuclei (b) (400X) Immunohistochemistry showing positivity for S100 protein suggestive of a granular cell tumour

Click here to view


The common causes of inguinal swelling in adolescents include lipoma, fibroma, fibrolipoma, dermatofibroma, hamartoma, lymphatic or venous malformations. Rarely, as seen in present case, granular cell tumour has been documented to present as inguinal swelling. It commonly affects third to fourth decades of life. However, the present patient was much younger. Familial associations are infrequent. These neoplasms are usually small ranging in size from 5 mm to 2 cm and slow growing. They are well-circumcised and firm.

These tumours are non-encapsulated and composed of irregularly arranged sheets of large polyhedral cells with small central hyperchromatic nuclei and abundant eosinophilic, PAS-positive granular cytoplasm. The overlying epithelium often shows prominent pseudo-epitheliomatous hyperplasia, which may be misdiagnosed as squamous cell carcinoma if a superficial biopsy is taken for examination. Recent studies on ultrastructure and immunohistochemistry have proven it to be of Schwann cell differentiation. The cells are positive for S-100, CD68, protein gene product 9.5, and inhibin-alpha. [5]

The malignant counterparts of these tumours are exceedingly rare. The treatment of choice for benign tumours is observation or wide local excision. Recurrent granular cell tumours may benefit from adjuvant radiotherapy. [6] Chemotherapy has shown promise in metastatic granular cell tumour. [7] In this patient, the tumour was excised enbloc and histopathology was suggestive of a benign tumour with tumour-free margins. So, the patient was asked to follow-up annually.

Granular cell tumour being rare in the inguinal region, is usually not suspected clinically and the diagnosis is usually made on histopathology/cytology.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Qureshi NA, Tahir M, Carmichael AR. Granular cell tumour of the soft tissues: A case report and literature review. Int Semin Surg Oncol 2006;3:21.  Back to cited text no. 1
    
2.
Loncar B, Marjanović K, Pauzar B, Staklenac B. Granular cell tumor - clinically presented as lymphadenopathy. Coll Antropol 2010;34:261-3.   Back to cited text no. 2
    
3.
Leyva AM, Husein-Elahmed H, Aneiros-Fernandez J, Almodovar-Real A, Ruiz-Carrascosa JC. Case for diagnosis. An Bras Dermatol 2014;89:523-4.  Back to cited text no. 3
    
4.
Rao S, Rajendiran S, Surendran P, Venkata SP, Prathiba D. Granular cell tumor in inguinal region: A case of mistaken identity on cytology. J Cytol 2012;29:60-2.   Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.
Weber-Cappuis K, Wildmann JJ, Kapanci Y. Histologic and immunohistochemical profiles of benign granular cell tumors. Report of 41 cases. Ann Pathol 1995;15:198-202.  Back to cited text no. 5
    
6.
Rosenthal SA, Livolsi VA. Turrisi AT 3 rd . Adjuvant radiotherapy for recurrent granular cell tumor. Cancer 1990;65:897-900.  Back to cited text no. 6
    
7.
Kanat O, Yalcinkaya U, Akbunar T, Kurt E, Evrensel T, Manavoglu O. Gemcitabine plus paclitaxel may be a promising chemotherapy regimen for metastatic granular cell tumour. Clin Oncol (R Coll Radiol) 2008;20:93-6.  Back to cited text no. 7
    

Top
Correspondence Address:
Hemant Kumar Singh
Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry - 605 006
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2077.167288

Rights and Permissions


    Figures

  [Figure 1], [Figure 2]



 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures

 Article Access Statistics
    Viewed1668    
    Printed12    
    Emailed0    
    PDF Downloaded77    
    Comments [Add]    

Recommend this journal