Although colorectal granular cell tumors (GCTs) are rare, their incidental finding has increased as the use of diagnostic colonoscopy has become more common. Here we describe the case of a 41-yr-old man with a GCT in the descending colon that was detected after a screening colonoscopy. Endoscopic examination revealed a yellowish submucosal tumor, 13x12 mm in diameter, in the descending colon. Endoscopic mucosal resection (EMR) followed by histological examination revealed that the tumor was composed of plump histiocyte-like cells with an abundant granular eosinophilic cytoplasm and small round nuclei. The tumor cells expressed S-100 protein and stained with periodic acid-Schiff, but were negative for desmin and cytokeratin. The resected tumor was diagnosed as a GCT. Colonoscopists should consider the possibility of GCT in the differential diagnosis of yellowish submucosal tumors of the colon. In such patients, EMR seems to be a feasible and safe approach for diagnosis and treatment.
Adult ; *Colon, Descending/pathology ; Colonic Neoplasms/diagnosis/*pathology/surgery ; Colonoscopy ; Diagnosis, Differential ; Granular Cell Tumor/diagnosis/*pathology/surgery ; Humans ; Male ; S100 Proteins/metabolism

Adult ; Antigens, CD ; metabolism ; Antigens, Differentiation, Myelomonocytic ; metabolism ; Appendectomy ; Appendiceal Neoplasms ; complications ; metabolism ; pathology ; surgery ; Appendicitis ; etiology ; surgery ; Diagnosis, Differential ; Female ; Granular Cell Tumor ; complications ; metabolism ; pathology ; surgery ; Humans ; Paraganglioma ; metabolism ; pathology ; Phosphopyruvate Hydratase ; metabolism ; S100 Proteins ; metabolism

Aged ; Biomarkers ; metabolism ; Carcinoid Tumor ; metabolism ; pathology ; Carcinoma, Endometrioid ; metabolism ; pathology ; surgery ; Diagnosis, Differential ; Female ; Granular Cell Tumor ; metabolism ; pathology ; Humans ; Hysterectomy ; methods ; Keratin-7 ; metabolism ; Keratins ; metabolism ; Krukenberg Tumor ; metabolism ; pathology ; Middle Aged ; Mucin-1 ; metabolism ; Ovarian Neoplasms ; metabolism ; pathology ; surgery ; Sertoli Cell Tumor ; metabolism ; pathology ; Sex Cord-Gonadal Stromal Tumors ; metabolism ; pathology ; surgery

Cystectomy ; Fatal Outcome ; Female ; Glial Fibrillary Acidic Protein ; metabolism ; Granular Cell Tumor ; pathology ; secondary ; surgery ; Humans ; Immunohistochemistry ; Middle Aged ; S100 Proteins ; metabolism ; Urinary Bladder ; chemistry ; pathology ; surgery ; Urinary Bladder Neoplasms ; metabolism ; pathology ; surgery ; Vaginal Neoplasms ; metabolism ; secondary ; surgery

12E7 Antigen ; Actins ; metabolism ; Antigens, CD ; metabolism ; Cell Adhesion Molecules ; metabolism ; Female ; Granular Cell Tumor ; complications ; metabolism ; pathology ; surgery ; Humans ; Hysterectomy ; Immunohistochemistry ; Leiomyomatosis ; complications ; metabolism ; pathology ; surgery ; Middle Aged ; Ovarian Neoplasms ; complications ; metabolism ; pathology ; surgery ; Ovariectomy ; Receptors, Estrogen ; metabolism ; Uterine Neoplasms ; complications ; metabolism ; pathology ; surgery ; Vascular Neoplasms ; complications ; metabolism ; pathology ; surgery

Granular cell tumors (GCTs) are soft tissue tumors, which are thought to be derived from Schwann cells. Although most GCTs are reported to arise in tongue and oral cavity (30-50%), they can appear on any anatomic sites, even visceral organs. Herein, we report 5 cases of GCTs on unusual anatomic locations, such as palm, arm, thigh, finger, and vulvar area. Complete surgical excision is preferred treatment of choice to prevent recurrence. These cases emphasize that GCTs not involving oral cavity are more prevalent than expected, and the diagnosis should be histopathologically confirmed.
Adult ; Aged ; Biopsy ; Child ; Female ; Granular Cell Tumor/metabolism/*pathology/surgery ; Hand ; Humans ; Immunohistochemistry ; Middle Aged ; Mohs Surgery ; Neoplasm Recurrence, Local/*prevention & control ; S100 Proteins/analysis/metabolism ; Treatment Outcome

OBJECTIVETo investigate the clinicopathologic features of malignant granular cell tumor (MGCT) and evaluate the histologic criteria for diagnosis of malignancy.

METHODSThe clinical and pathologic profiles of 10 MGCT cases were evaluated. Immunohistochemical study was performed on paraffin sections of 9 cases. Electron microscopy was carried out in 3 cases with available fresh or formalin-fixed tissues. The biologic behavior was analyzed with follow-up data.

RESULTSFour patients were males and six were females. Their age ranged from 27 to 73 years (mean = 46 years). The main presenting symptom was a painless nodule or mass located in the subcutis or deep soft tissue. One case had peripheral nerve symptoms. Three of the tumors occurred in the lower extremity, two in the breast, two in the nuchal region, and one each in the chest wall, neck, and peritoneal cavity. The tumor size ranged from 2 to 11 cm (mean size = 4.8 cm). Microscopically, the tumor was composed of nests or sheets of polygonal cells which possessed abundant eosinophilic granular cytoplasm and closely resembled its benign counterpart. After careful assessment, 9 cases exhibited at least 3 of the following suspicious features: enlarged vesicular nuclei with prominent nucleoli, nuclear pleomorphism, high nuclear-to-cytoplasmic ratio, spindling of tumor cells, appreciable mitotic activity, and tumor necrosis. In addition, a hitherto undescribed feature characterized by multinucleated tumor cells was observed in 1 case. The remaining case demonstrated benign-appearing features but behaved in a malignant fashion. Immunohistochemical study showed positive staining for S-100 protein (9/9), neuron specific enolase (9/9) and CD68 (7/9). Electron microscopy demonstrated abundant intracytoplasmic autophagic vacuoles. Follow-up information available in 7 patients revealed local recurrence in 5, metastasis in 4 and tumor-related deaths in 2 patients.

CONCLUSIONSThe histologic criteria for malignancy in GCTs established in 1998 by Fanburg-Smith et al. are reproducible in most instances. In exceptional circumstances, however, the diagnosis relies on clinicopathologic correlation. Based on the current study and literature review, a modified criterion of mitotic count (> 5/50 HPF instead of > 2/10 HPF) is recommended. Wide local excision with regional lymph node dissection remains the mainstay of treatment. Chemotherapy and radiotherapy however have not been shown to significantly improve the clinical course of the disease. The morphologic spectrum of MGCT also includes a rare multinucleated variant.

Adult ; Aged ; Antigens, CD ; metabolism ; Antigens, Differentiation, Myelomonocytic ; metabolism ; Breast Neoplasms ; metabolism ; pathology ; surgery ; Female ; Granular Cell Tumor ; metabolism ; pathology ; surgery ; Humans ; Lower Extremity ; Lymph Node Excision ; Male ; Middle Aged ; Phosphopyruvate Hydratase ; metabolism ; Retrospective Studies ; S100 Proteins ; metabolism ; Soft Tissue Neoplasms ; metabolism ; pathology ; surgery