14. Granular cell tumor( GCTs)
Uncommon tumor thought to be derived from
schwann cells.
Abrikossoff first described this tumour in 1926 as
‘‘granular cell myoblastoma’’, assuming it was of
myogenic origin; some even refer to the lesion as
‘‘Abrikossoffoma’’.
Considered benign, only rare reports of malignant
variants
Incidence
Occur in any age but are most common in
fourth, fifth and sixth decades of life, rare in
children.
It is about twice as common in women as in men.
15. Site
Arise in any organ as solitary painless nodule
Most frequently in oral cavity typically the tongue
Internal organs, particularly larynx, bronchus, stomach
and bile duct.
Clinically
Approximately 10–15% of patients have lesions at
multiple sites.
Multiple lesions may appear synchronously or over a
period of many years.
Gross picture
Poorly circumscribed nodule less than 3 cm
Cut section pale yellow-tan or gray.
17.
Pseudoepitheliomatous
hyperplasia of the overlying
squamous epithelium, should
not be mistaken for squamous
cell carcinoma.
In close proximity to peripheral
nerve bundles
18. Special Stains and
Immunohistochemistry
S-100 protein: highlights cytoplasmic
granularity with strong cytoplasmic and
nuclear staining
Carcinoembryonic antigen (CEA): diffuse
immunoreactivity
Cytokeratin and (EMA) are negative
Myoglobin negative
(ER) and (PR) are negative
PAS positive diastease resistant cytoplasmic
granules
19.
20. GCTs in breast
Incidence
5%- 6% in breast.
Premenopausal women in 40’s, reported in
adolescents, elderly women and men
May be more common in African-American women
Site
Superior medial quadrant (course of supraclavicular nerve)
Clinical features
Usually solitary unilateral, rarely multiple
Painless firm mass, may be associated with skin
retraction and nipple inversion
21. Gross
Cut surface is fairly
defined white - gray to
yellow
Less than 3 cm but
reported up to 9 cm.
26. Apocrine carcinoma
Older age
Usually in outer
quadrant
large cells with
pleomorphic nuclei,
prominent nucleoli,
mitosis
Typically associated with
intra-ductal component
IHC: Positive for
cytokeratin, GCDFP-15
27. Myoblastomatoid invasive lobular
carcinoma, histocytic variant
Older age
Associated with
infiltrative
component
Loosely cohesive
tumor cells
IHC: Positive for
cytokeratin
28. Alveolar soft part sarcoma
•
•
•
•
•
•
Deep soft tissue
Pleomorphic cells
Cells are divided into
packets by thin walled
vessels
Alveolar pattern if cells
discohesive
Vascular invasion
common
IHC: Positive for
Myoglobin
29. Metastatic malignant melanoma
Old age
History of primary
elsewhere
Nuclei usually show
nucleoli
Cytoplasmic pseudoinclusions
Melanin pigments
IHC: Positive HMB- 45
30. Metastatic renal cell tumor
History of primary
elsewhere
Nests, separeted by
sinasoids
Well defined cell
membrane
Nuclear
pleomorphism
Prominent nucleoli in
high grades
Clearing of
cytoplasm
IHC: positive for
EMA
31.
32.
33.
34. Take home message
GCTs is an uncommon tumor occur in any age.
5%-6% incidence in breast, inner upper quadrant.
Pose a real diagnostic challenge for physicians.
Clinically and radiologically misdiagnosed as carcinoma
Preoperative diagnosis with core needle biopsy is
important because treatment is with wide excision , rather
than mastectomy.
Less than 1% of all GCTs, including mammary
lesions, are malignant.
The prognosis for benign GCT of the breast is excellent.
Recurrence occurs in 2-8% of individuals after excision
with wide margins
