Granular cell tumour of the breast

The conundrum of breast cancer mimics

The BIRADS lexicon ensures a standard reporting terminology in breast imaging and serves as a means of smooth communication between the radiologist and the referring physician. BIRADS assessment categories 4 and 5 warrant a biopsy to rule out underlying malignancy. However, a substantial number of cases in these categories sometimes turn out to be benign on biopsy. These benign mimics encompass inflammatory, sclerosing, neoplastic and a few other miscellaneous conditions. Awareness of these various mimics of breast cancer can equip the radiologist to handle these apparent cases of radiologic-pathological (rad-path) discordance better, guide overall patient management, avoiding inadvertent excisional biopsies and help alleviate patient anxiety and confusion.

Granular Cell Tumor Mimicking Breast Carcinoma: A Report of Two Cases

Granular cell tumor (GCT) of the breast is a rare neoplasm that can mimic the clinical and radiological features of breast carcinoma. This paper presents two case reports - a rare male case and a more common female case - to underline the diagnostic challenges posed by GCT in the breast. The male patient was initially suspected of having a breast tumor based on mammography and ultrasound findings. The female patient also exhibited radiological signs suggestive of breast cancer. In both cases, the mammograms showed irregular lesions, while ultrasounds revealed solid masses with posterior shadowing and echogenic halos, mimicking carcinoma. Dynamic contrast-enhanced magnetic resonance imaging (MRI) suggested benign patterns in both cases, but only histopathologic examination post-core needle biopsy confirmed the diagnosis of GCT. These cases highlight the variability of GCT imaging presentations and the potential for misdiagnosis as breast carcinoma. The tumors exhibited distinct histopathological features, such as large polygonal cells with granular eosinophilic cytoplasm and S100 protein, differentiating them from breast carcinoma. However, imaging alone proved insufficient for diagnosis, emphasizing the need for histopathologic confirmation. The report discusses the importance of including GCT in differential diagnoses and utilizing core needle biopsy for accurate evaluation. Both cases had no recurrence during follow-up after wide resection, indicating a favorable prognosis for GCT when properly managed.

Granular cell tumor of the breast: A case report and review of literature

BACKGROUND

Granular cell tumor (GCT) of the breast (GCTB) is a rare neoplasm that can exhibit malignant characteristics both clinically and radiologically. This tumor can also coexist and colocalize with breast carcinoma.

CASE SUMMARY

We present a patient with this uncommon tumor and discuss the diagnostic and therapeutic approaches in order to further the knowledge of GCTB and prevent misdiagnosis and overtreatment. The characteristics of the tumor, methods of diagnosis, therapy and postoperative pathological outcomes were analyzed, and relevant literatures of GCTs were reviewed. The patient underwent surgery after core needle biopsy, and the excised neoplasm was sent for pathological examination. Histological analysis revealed nests of cells with abundant pink granular cytoplasm, confirming the diagnosis of GCTB.

CONCLUSION

As manifestations of GCT and malignancy can mimic each other, a careful histological examination is essential before major surgery. Treatment consisting of complete excision with close clinical follow-up is recommended.

Case report: Abrikossoff's tumor of the facial skin

Abrikossoff tumors, also known as granular cell tumors (GCT), originate from Schwann cells. The most common location is in the oral cavity, followed by the skin, but they can also be found in the breast, digestive tract, tracheobronchial tree, or central nervous system. They can affect both sexes at any age, with a higher incidence between 30 and 50 years and a slight predisposition for female sex. They are usually solitary tumors but may also be multifocal. Most of the time, they are benign, with malignancy being exceptional in <2% of cases. Clinically, they appear as solid, well-defined, painless tumors, located subcutaneously with dimensions that can reach up to 10 cm. The definitive diagnosis is based on the immunohistochemical examination, and the treatment for benign tumors consists of surgical excision. Chemotherapy or radiotherapy may be required for malignant lesions, but the treatment regimens and their benefits remain unclear. This manuscript presents the case of a 12-year-old girl with a benign GCT, located in the skin on the mandibular line.

Granular Cell Tumor of the Axillary Accessory Breast: A Case Report

Granular cell tumors (GCTs) are rare benign soft tissue tumors that can occur throughout the body, particularly the head and neck; only 5%-8% of GCTs occur in the breast. We report a case of a GCT of the axillary accessory breast, which is a rare location of this tumor. A 50-year-old woman had a 2-month history of a palpable mass in the left axilla. Physical examination, as well as mammographic and ultrasonographic findings suggested a breast malignancy. Histopathological examination showed a benign GCT, and wide local excision was performed. The patient has remained disease-free over 2 years postoperatively. Although most GCTs are benign, wide complete resection of the tumor and follow-up are required considering the possibility of recurrence. The radiologist should know the characteristics of GCTs as a differential diagnosis of breast and axillary lesions to prevent unnecessary treatment.

Pitfalls in breast pathology

Accurate pathological diagnosis is the cornerstone of optimal clinical management for patients with breast disease. As non-operative diagnosis has now become the standard of care, histopathologists encounter the daily challenge of making definitive diagnoses on limited breast core needle biopsy (CNB) material. CNB samples are carefully evaluated using microscopic examination of haematoxylin and eosin (H&E)-stained slides and supportive immunohistochemistry (IHC), providing the necessary information to inform the next steps in the patient care pathway. Some entities may be difficult to distinguish on small tissue samples, and if there is uncertainty a diagnostic excision biopsy should be recommended. This review discusses (1) benign breast lesions that may mimic malignancy, (2) malignant conditions that may be misinterpreted as benign, (3) malignant conditions that may be incorrectly diagnosed as primary breast carcinoma, and (4) some IHC pitfalls. The aim of the review is to raise awareness of potential pitfalls in the interpretation of breast lesions that may lead to underdiagnosis, overdiagnosis, or incorrect classification of malignancy with potential adverse outcomes for individual patients.

Granular Cell Tumor Originating from the Pectoral Muscle: A Rare Extramammary Finding on Mammography

A granular cell tumor (GCT) is a rare soft tissue tumor that usually arises from the striated muscle of the tongue. Few literatures have reported pectoral muscle involvement of the GCT. Herein, we report a rare case of a GCT originating from the pectoral muscle below the breast with multimodal imaging appearance.

Low to Intermediate (Borderline) Grade Breast Spindle Cell Lesions on Needle Biopsy: Diagnostic Approach and Clinical Management

Spindle cell proliferations of the breast are a heterogeneous group of lesions ranging from benign or reactive lesions to aggressive malignant neoplasms. Diagnosis on core biopsy can be particularly challenging as lesions displaying different lineages associated with variable outcomes share overlapping morphologies (scar vs. fibromatosis-like metaplastic carcinoma) whereas individual entities can exhibit a large variety of appearances (myofibroblastoma). In this review, lesions are grouped into lineage, when possible, including those showing fibroblastic/myofibroblastic differentiation, ranging from entities that require no additional management, such as scar and nodular fasciitis, to those with unpredictable clinical outcomes such as fibromatosis and solitary fibrous tumor or locally aggressive behavior such as dermatofibrosarcoma protuberans. The review of low-grade vascular lesions includes atypical vascular lesion and low-grade angiosarcoma. Also discussed are various adipocytic lesions ranging from lipoma to liposarcoma, and rare smooth muscle and neural entities more commonly encountered in locations outside the breast, such as leiomyoma, neurofibroma, schwannoma, or granular cell tumor. Optimal histological evaluation of these entities merges clinical and radiologic data with morphology and ancillary testing. We present our approach to immunohistochemical and other ancillary testing and highlight issues in pathology correlation with imaging. Recent updates in the management of breast spindle cell lesions are addressed. In a well-sampled lesion with radiographic concordance, the core biopsy diagnosis reliably guides management and we advocate the inclusion of management recommendations in the pathology report. Precise characterization using up to date guidelines is important to identify a subset of patients who may safely avoid unnecessary surgical procedures. A multidisciplinary approach with close collaboration with our clinical colleagues is emphasized.

Contrast-enhanced ultrasound of granular cell tumor in breast: A case report with review of the literature

Granular cell tumor is an infrequent, predominantly benign tumor originating from Schwann cells. Granular cell tumor of the breast (GCTB) can simulate breast malignant carcinoma on the clinical assessment. We herein present a rare case of GCTB which recurred in the contralateral breast. We believe the contrast-enhanced ultrasound (CEUS) findings of GCTB have never been described. The high similarity of breast malignant carcinoma makes its differential diagnosis difficult on the clinical and radiological features. In this report, we present the CEUS findings from a rare case of GCTB, explore the possible value of CEUS in differential diagnosis between benign breast lesions and malignant ones, and briefly review the literature.

An Update on Cutaneous Granular Cell tumours for Dermatologists and Dermatopathologists

Granular cell tumours are rare soft tissue neoplasms which occur at a wide variety of sites and commonly involve the skin. Distinction between benign and malignant granular cell tumours is important because benign tumours are commonly cured by complete excision and malignant tumours commonly recur and cause fatal metastatic disease. Communication between the dermatologist and pathologist is also important, as the pathologist may provide false reassurance by evaluating a benign appearing part of a clinically malignant tumour. The following review summarises the current literature on the epidemiology, clinical presentation, pathology, radiology, treatment and prognosis of cutaneous granular cell tumours, with a focus on improving diagnosis and management for dermatologists and dermatopathologists.

Abrikossoff Tumor Clinically Mimicking Carcinoma in Accessory Axillary Breast Tissue

Abrikossoff tumors are rare benign soft-tissue lesions also known as granular cell tumors (GCT). The histogenesis of these tumors was initially considered to be myogenic but recent studies have revealed a neuroectodermal origin. GCTs of the breast may mimic breast carcinoma based on the triad of radiological, clinical, and pathological features. This hallmark trait lends to the misdiagnosis of these tumors and their subsequent inappropriate management. We report a rare case of a 28-year-old female patient with an accessory axillary breast GCT. The diagnosis, histogenesis, and management of Abrikossoff tumors of the breast are discussed.

Mimickers of breast malignancy: imaging findings, pathologic concordance and clinical management

Many benign breast entities have a clinical and imaging presentation that can mimic breast cancer. The purpose of this review is to illustrate the wide spectrum of imaging features that can be associated with benign breast diseases with an emphasis on the suspicious imaging findings associated with these benign conditions that can mimic cancer. As radiologic-pathologic correlation can be particularly challenging in these cases, the radiologist’s familiarity with these benign entities and their imaging features is essential to ensure that a benign pathology result is accepted as concordant when appropriate and that a suitable management plan is formulated.

Imaging features of granular cell tumor in the breast: Case report

RATIONALE

Granular cell tumor of the breast (GCTB) is a benign rare tumor. There are limited reports on its imaging manifestations. GCTB is often misdiagnosed as breast cancer, which results in unnecessary radical mastectomy and excessive treatment. In this article, we have reported a case of a 56-year-old postmenopausal woman with GCTB and highlighted the imaging features to differentiate this rare tumor from breast cancer.

PATIENT CONCERNS

A 56-year-old postmenopausal patient had a chief complaint of a subcutaneous nodule in the upper outer quadrant of her right breast for 2 months. She underwent physical examination, color Doppler ultrasonography, mammography, magnetic resonance, and postoperative pathology.

DIAGNOSES

The final diagnosis was GCTB. The tumor cells were intermingled with the fibrous stroma and normal breast parenchyma and showed positive immunoreaction to S-100, CD68, and neuron-specific enolase.

INTERVENTIONS

The patient underwent lumpectomy and sentinel lymph node biopsy.

OUTCOMES

The patient recovered well after lumpectomy and had no complications during the 2-year follow-up.

LESSONS

There are some important imaging features of GCTB that can be used to distinguish it from breast carcinoma to reduce misdiagnosis.

Granular cell tumor of the breast: correlations between imaging and pathology findings

Objective

To review the imaging features of granular cell tumors of the breast (on mammography, ultrasound, and magnetic resonance imaging), establishing a pathological correlation, in order to familiarize radiologists with this entity and make them aware of the differential diagnoses, other than malignancy, of lesions with spiculated margins.

Materials and Methods

We reviewed the medical records (from a clinical-pathology database and picture archiving and communication system) of five patients with a pathologically confirmed diagnosis of granular cell tumor of the breast, treated at the Portuguese Oncology Institute of Lisbon, in the city of Lisbon, Portugal, between January 2012 and December 2018.

Results

All five tumors exhibited imaging features highly suggestive of malignancy (BI-RADS 5 lesions), namely spiculated margins, significant depth, and posterior acoustic shadowing (on ultrasound). One tumor showed a kinetic curve indicative of washout on magnetic resonance imaging, two were adherent to the pectoralis muscle, and one was accompanied by skin retraction. Pathology provided the definitive diagnosis in all cases.

Conclusion

Granular cell tumors of the breast pose a diagnostic challenge because they can present with clinical and imaging features mimicking malignancy, and the diagnosis is therefore provided by pathology. Radiologists should be familiarized with this entity, so they can be aware of the fact that breast lesions with spiculated margins can be indicative of diagnoses other than malignancy.

Granular Cell Tumor Breast Masquerading as a Malignancy Cytologically: a Rare Case Presenting a Diagnostic Dilemma

Granular cell tumor (GCT) also known as Abrikossoff's tumor is an uncommon soft tissue tumor of neurogenic origin. GCT of the breast accounts for < 0.1% of breast tumors and 6% of all reported cases of granular cell tumor. Although GCT is a benign tumor, malignant GCT can be seen in 1% v of the cases. GCT of the breast is diagnostically challenging as it can imitate carcinoma clinically and radiologically but need to be differentiated from breast malignancy since they have totally different approach in treatment and prognosis. GCT has a great ability to mimic a variety of lesions from benign histiocytic to malignant epithelial/mesenchymal lesions, thereby presenting a diagnostic challenge to the practicing cytopathologist. We report a case of GCT of breast cytologically masquerading as a malignancy in a 45-year-old female. Although, fine needle aspiration (FNA) is a first-line diagnostic tool, the present case reemphasizes the role of histopathology as the gold standard for a definite diagnosis clubbed with ancillary techniques like immunohistochemistry and special stains.

Granular cell tumor of the breast: a multidisciplinary challenge

Granular cell tumors are rare soft tissue tumors; they are almost never malignant, but can mimic a carcinoma clinically, radiologically and microscopically. The finding of a suspicious lump often entails subsequent diagnostic procedures that can pose significant anxiety on patients before reaching a challenging differential diagnosis. The physical and psychological burden is even more significant when such findings occur during the follow up of a previous oncologic condition. Sometimes the fear for a potential local or distant recurrence can be responsible for a misdiagnosis and lead to patient overtreatment.

Granular cell tumour of the breast: A rare presentation of a breast mass in an elderly female with a subsequent breast cancer diagnosis

A 74-year-old female patient presented with a hard breast mass and dimpling with a clinical suspicion of a carcinoma. Histological evaluation revealed a granular cell tumour. Granular cell tumour is a rare neoplasm, mostly benign in origin that may arise in every body site, 5%–15% of cases occur in the breast. It is strongly suggested that granular cell tumours origin is Schwann cells. Clinically, granular cell tumours presentation may mimic mammary carcinoma and their similar features on mammography and ultrasound make it difficult to differentiate between them.

Rare Mesenchymal Breast Entities that Mimic Malignancy: A Single-institution Experience of a Challenging Diagnosis

Background

Benign mesenchymal tumors of the breast are rare and may mimic invasive carcinoma on imaging and morphology, thus becoming clinically challenging for clinicians, radiologists, and pathologists. To improve the understanding of these lesions and to avoid erroneous diagnosis and inappropriate treatment, we report our institution’s experience with seven cases of granular cell tumor (GCT) and myofibroblastoma (MFB) in the past 10 years.

Materials and methods

Seven cases of benign mesenchymal tumors of the breast were identified at the University of Texas Medical Branch from 2008 to 2018. Breast biopsies were collected from all patients after mammography and ultrasound imaging classified their results as suspicious or highly suggestive of malignancy by the Breast Imaging Reporting and Data System (BI-RADS ≥ 4A). All cases were reviewed to study the morphologic features and their immunoprofiles. The demographic characteristics, methods of treatment, postoperative pathological results, and follow-up results of the cases were then analyzed and compared to peer-reviewed literature.

Results

The study consisted of five females and two males with a mean age of 50 years in the GCT patients and 62 years in MFB patients. We identified four cases of GCT and three cases of MFB. The mean tumor size was 1.9 cm. Clinically, five patients presented with a palpable nontender mass, one with breast asymmetry, and one was asymptomatic. All patients underwent imaging studies prior to core needle biopsy. BI-RADS was ≥4B in patients with GCT and 4A-C in MFB. Definitive diagnosis was made by histopathology and confirmed by immunohistochemistry in accordance with the features described in the literature. Six patients underwent wide excision. The mean follow-up duration was 44.5 months. All patients remained well, without recurrence.

Conclusions

MFB and GCT can mimic malignant neoplasms and the clinical significance of these entities lies primarily in their recognition as distinctive benign neoplasms. The gold standard for the diagnosis of GCT and MFB is histopathology. All the cases in our series were clinically or radiologically mistaken for carcinoma, which has been largely reported in the literature. Pathologists should bear this in mind to avoid misdiagnosis and unnecessary treatment.

Granular cell tumor of the breast mimicking malignancy: a case report with a literature review

Granular cell tumor (GCT) is a rare neoplasm of the soft tissues and <1% of all GCTs are malignant. Initially, GCT was considered a myogenic lesion affecting the female breast (myoblastoma). We report the case of an 83-year-old woman with a palpable lump in the left breast; mammography and ultrasound showed an irregular lesion. It was difficult to differentiate it from a malignant lesion; therefore, we performed core needle biopsy and histopathologic examination and immunohistochemical studies revealed a GCT of the breast.

Adjuvant radiation therapy for malignant Abrikossoff's tumor: a case report about a femoral triangle localisation

Background

Granular cell or Abrikossoff’s tumors are usually benign however rare malignant forms concern 1 to 3% of cases reported. Pelvic locations are exceptional.

Case presentation

We report a case of a 43-years-old patient who had a benign Abrikossoff’s tumor localized in the right femoral triangle diagnosed at the biopsy. The patient underwent a surgical tumorectomy and inguinal lymph nodes resection. Histologically, the tumor showed enough criteria to give diagnosis of malignancy: nuclear pleomorphism, tumor cell spindling, vesicular nuclei with large nucleoli. Moreover, five lymph nodes were metastatic. Immunohistochemistry findings confirmed the diagnosis of granular cell tumor which is positive for S100 protein and CD68 antibodies. The mitotic index was nevertheless low with a Ki67 labeling index of 1–2%. A large surgical revision with an inguinal curage following radiotherapy were decided on oncology committee. Adjuvant radiotherapy on the tumor bed and right inguinal area of ​​50 Gy in conventional fractionation was delivered with the aim of reducing local recurrence risk. There was no recurrence on longer follow-up (10 months post radiotherapy).

Conclusions

Adjuvant radiotherapy seems an appropriate therapeutic approach, even if controversial, given that some authors report effectiveness on local disease progression.

Ultrasonographic manifestations of a rare granular cell tumor of the accessory breast: A case report

RATIONALE

The ultrasound manifestations of granular cell tumor (GCT) is a consequence of the histopathological characteristic of the tumor and can be distinguished from breast cancer.

PATIENT CONCERNS

A GCT is a rare, benign, hyperplasia-based lesion. Approximately 1% to 2% of GCTs are malignant. About 5% to15% of the cases occur in the breast, and it is relatively rare in the axillary accessory breast. There are no effective preventive measures for GCTs, early detection combined with a thorough and wide complete resection of the tumor remains the best treatment for a favorable outcome.

DIAGNOSES

A 45-year-old female patient with an axillary mass of more than 3 months duration was examined through physical examination, color Doppler ultrasound and postoperative pathology.

INTERVENTIONS

A provisional diagnosis of left axillary lymph node enlargement was made and necessary investigations were advised.

OUTCOMES

A differential diagnosis of accessory breast in the left arm pit, possibly malignant, or a solid mass in the left arm pit secondary to chronic inflammation. Postoperative pathology: GCT of axillary accessory breast, with tumor-free margins. Immunohistochemical staining showed strong S-100 positivity, CD68 positivity, and negative periodic acid-Schiff staining.

LESSONS

The ultrasound examination can detect GCT mass in the breast/accessory breast and is not easy to misdiagnosis.

Peripheral nerve sheath tumors of the breast

Benign and malignant peripheral nerve sheath tumors can involve the breast, presenting as masses in the dermis, deep breast parenchyma or axillary soft tissue. Although the histologic features are frequently characteristic, diagnosis can be challenging on core needle biopsy, and the differential diagnosis includes a variety of other benign and malignant spindle cell lesions of the breast. Here, we review the key clinical and pathological features of breast schwannoma, neurofibroma, granular cell tumor, and malignant peripheral nerve sheath tumor.

Benign breast lesions that mimic malignancy

Many benign and reactive lesions of the breast show morphological overlap with malignant lesions. These benign mimics of malignancy often present diagnostic challenges to even the most experienced pathologists. This review focuses on several benign lesions of the breast that mimic malignant entities. For each of these lesions, we describe the key morphological and immunohistochemical features, potential diagnostic pitfalls, and our approach to arriving at the correct diagnosis.

Myoblastoma of the breast: Our experience and review of literature

INTRODUCTION

Breast myoblastoma or granular cell tumor involving the breast parenchyma has been described in detail for the first time since Abrikossoff in 1931. The location of this injury to the breast is very rare, accounting for between 5% and 15% of all cases of cancer of the granular cells. We present our experience regarding the identification of two cases because of the relative rarity of this tumor. It is often confused with breast cancer on clinical and radiological, and its diagnosis can then be difficult for physicians, radiologists and pathologists.

PRESENTATION OF CASES

We report the cases of two young women who came to our attention because of the presence of mass shoveled breast, mobile and accompanied by pain cycle independent. In both cases, mammography and ultrasound revealed the presence of heterogeneous mass and irregular, but in one of two such mass located at the Union of external quadrants of the left breast and was in contact with his serratus anterior and suspicion for malignancy. In both cases the 'histology combined with immunohistochemical study proved to be a granular cell tumor.

CONCLUSION

Although a granular cell tumor of the breast is a rare tumor breast, should be considered in the differential diagnosis of benign and malignant lesions. Surgeons and pathologists should keep in mind when considering a granular cell tumor cells with abundant granular cytoplasm containing materials to avoid misdiagnosing breast cancer, which could lead to unnecessary surgery.

[Rare benign breast tumors including Abrikossoff tumor (granular cell tumor), erosive adenomatosis of the nipple, cytosteatonecrosis, fibromatosis (desmoid tumor), galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma: Guidelines for clinical practice]

OBJECTIVES

To provide guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF), based on the best evidence available, concerning rare benign breast tumors: Abrikossoff (granular cell tumor), erosive adenomatosis of the nipple, cytosteatonecrosis, fibromatosis (desmoid tumor), galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma.

METHODS

Bibliographical search in French and English languages by consultation of Pubmed, Cochrane and international databases.

RESULTS

For erosive adenomatosis of the nipple, surgical excision is recommended to exclude Paget's disease or cancer (grade C). When surgery is performed for breast desmoid tumor or syringomatous adenoma, free margins are recommended (grade C). Without clinico-radio-histologic discordance, surgical abstention may be proposed for Abrikossoff tumor (granular cell tumor), cytosteatonecrosis, galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma (grade C).

Pediatric Granular Cell Tumor of the Breast: A Case Report and Review of the Literature

Objective. Granular cell tumors arise from neurogenic mesenchymal stem cells and can occur anywhere throughout the body. They rarely present as breast masses and should be included in the differential diagnosis of pediatric breast neoplasms. We report a rare presentation of a pediatric breast granular cell tumor and a review of the literature. Participant. A 15-year-old female presented with an enlarging breast mass. She underwent ultrasound imaging and excisional biopsy, which revealed a granular cell tumor. Granular cell tumors of the breast are difficult to diagnose using ultrasound and mammography due to numerous similarities to other breast masses. Histopathologic staining best differentiates breast granular cell tumors from other breast masses with their positive staining for S100, CD68, and neurospecific enolase. Conclusion. Although rare, granular cell tumors of the breast should be considered as a possible diagnosis for pediatric breast masses to allow for proper management and follow-up for these patients. Although rare, these tumors do have malignant potential necessitating a correct and timely diagnosis.

Granular Cell Tumor of Breast: a Case Report and Review of Literature

This is an article reporting a case of granular cell tumor in the left breast in a 58 year old lady. Patient presented with a 3 × 3 cm mass in the left breast. Mammography reported a BIRADS 5 lesion in the left breast. With a clinical and radiological diagnosis of malignancy, patient was sent for FNAC (Fine needle aspiration Cytology). The cytology report was granular cell tumor. Following this patient underwent wide excision of the mass. Histopathology confirmed the cytological diagnosis of granular cell tumor of the breast. Patient is on regular follow up and is presently free of disease. The case report is followed up by a brief review of literature of granular cell tumor of the breast.

Granular cell tumor of the breast: a case report

Introduction

A granular cell tumor involving the breast parenchyma was first described by Abrikossoff in 1931. Localization of this lesion to the breast is very rare, accounting for between 5% and 15% of all granular cell tumor cases. We present this case because of the rarity of this tumor. It is frequently confused with breast carcinoma on clinical and radiological examination, and its diagnosis can therefore be challenging for clinicians, radiologists and pathologists.

Case presentation

We report the case of a 32-year-old Moroccan woman who presented with a palpable mass in her right breast. Mammography and ultrasound examination revealed a heterogeneous, irregular and poorly limited mass, located at the union of the outer quadrants of her right breast. The mass was in contact with her latissimus dorsi and suspicious for malignancy. A histological examination combined with immunohistochemical study revealed it to be a granular cell tumor.

Conclusion

Although a granular cell tumor of the breast is a rare breast neoplasm, it should be considered in the differential diagnosis of benign and malignant lesions. Pathologists should bear in mind a granular cell tumor when examining material containing cells with abundant granular cytoplasm to avoid misdiagnosing breast carcinoma, which could lead to unnecessary surgery.

Granular cell tumor of the breast during lactation: A case report and review of the literature

Granular cell tumor of the breast (GCTB) is a rare tumor, particularly in lactating women. This tumor can clinically and radiologically mimic breast carcinoma, which poses particular problems. The association between GCTB and sex hormones should receive particular attention. The present study reports a case of GCTB in a lactating patient. In this tsudy, the case of a 29-year old female who presented with a mass in the right breast is decribed. Immunohistochemical and cytological analysis revealed a GCT and subsequently wide local excision was performed. At 15 months following surgery, the patient is well and no tumor recurrence has been identified. A comprehensive review of the literature was also performed to assess and compare all cases of GCTB, with particular attention to hyperestrogenic and hyperprolactinemic states. Further studies are required to explore the association between granular cell tumors and hyperestrogenic and hyperprolactinemic states.

An unusual breast lesion: granular cell tumor of the breast with extensive chest wall invasion

Granular cell tumors (GCT) are generally benign soft tissue tumors. When located in the breast, they may be misdiagnosed as more typical tumors, such as invasive ductal carcinoma, based on misleading clinical or radiologic features. GCTs are frequently found in the setting of a known malignancy. We report the case of a patient with a large infra-mammary fold GCT, the management of which required a multidisciplinary operative approach due to extensive chest wall invasion.

[Granular cell tumor of the male breast]

The granular cell tumor of the breast (TCGS) is a rare benign tumor, which grows from Schwann cells. It can be confused with a cancerous tumor clinically and radiologically. Only the histological appearance can make the diagnosis. We report a case of TCGS in a man, discovered as a result of self-examination of a breast lump. The authors emphasize the problem of differential diagnosis with breast cancer: clinically, a hard lump with an occasional skin retraction or a fixity to the deep plane; radiologically a stellar opaque appearance with irregular contours, sonographically unspecific, and even macroscopically during surgery, this lesion having morphological characteristics which need histologic examination and even immunohistochemistry in order to exclude a malignant tumor. They are cured by wide local excision and have generally a good prognosis.

Malignant clinical presentation of a benign granular cell tumor of breast in a patient with previously treated contralateral invasive ductal carcinoma

GCT is a rare neoplasm and usually shows the benign character. GCT can occur in any body site and may be multifocal. The most common involved site is tongue which accounts for nearly 30% of all cases but skin and subcutaneous tissue are also affected frequently. Breast is an unusually involved site and accounts for 6% of all GCTs. The histiogenesis of GCT is still controversial but further investigations and immunohistochemical examinations were exposed to neural origin and the tumor is thought to be derived from Schwann cells of peripheral nerves. Generally used technique to diagnose GCT is the positivity of S-100 immunohistochemical staining. Despite its benign nature, GCT may mimic breast carsinoma clinically and radiologically and easily be misdiagnosed for breast cancer. We herein report a case of granular cell tumor that arose in a 56 year-old female patient who previously had been treated from an invasive ductal carcinoma in contralateral breast.

A rare case of primary rhabdoid melanoma of the urinary bladder treated with ipilimumab, an anti-CTLA 4 monoclonal antibody

Primary melanoma of the urinary bladder is a rare subentity of melanoma. The same applies for melanoma of the rhabdoid histopathologic phenotype. A female patient was initially diagnosed with melanoma of unknown origin caused by macroscopic lymph node metastasis in the left inguinal and parailiacal regions. Because of the extent of the disease, radical surgery could not be performed. The patient underwent systemic chemotherapy with dacarbazine, followed by the experimental compound tasisulam. Upon sudden macrohematuria, cystoscopy showed a large infiltrating tumorous structure located on the left side of the urinary bladder. Clinically, the amelanotic tumor showed endophytic growth into the lumen; on the histopathological specimen, the growth pattern was partially undermining the urothelium, which is commonly observed in primary melanoma of the urinary bladder. Cytologically, the tumor cells were classified as rhabdoid melanoma, a very rare variant of melanoma, which is commonly amelanotic and expresses S100, vimentin and Ncam. Mutational analysis showed positive results for BRAF V600E. After detecting the primary melanoma, the patient received anti-CTLA4 antibody treatment with 3 mg/kg ipilimumab, through which a partial response was achieved. Past computed tomography scans should be re-evaluated for suspicious lesions, and cystoscopy should be included in the clinical workup if the pattern of metastasis is congruent with the drainage sites of the urinary bladder.

Juvenile fibroadenoma and granular cell tumor of the breast in an adolescent

We describe a case of a 15-year-old girl who presented with 2 painful masses in her right breast. Ultrasound confirmed the presence of 2 lesions, both of which appeared noncharacteristic for fibroadenomas. Both lesions were surgically resected. One was found to be a fibroadenoma and the other a granular cell tumor, both benign upon further histologic evaluation. Breast masses are rare in the pediatric population. The finding of a concurrent fibroadenoma and granular cell tumor is unique and has not been previously reported. Granular cell tumors of the breast are relatively uncommon. Often, they are mistaken for a breast malignancy. The concerning clinical and radiographic findings in this patient warranted operative excision.

Granular cell tumors: a report of six cases

Granular cell tumor is a soft tissue neoplasm that originates in the nervous system and arises at virtually any body site, but is mainly found in the skin, oral cavity or digestive tract. Most are benign and reportedly malignant cases are rare, occurring in only 1% or 2% of cases. We report on our findings in six patients who developed granular cell tumor in the mammary gland, esophagus, subcutaneous tissue and muscle. Of six patients, two had granular cell tumor located in the breast, two in the submucosa of the esophagus, and the other two under the skin of the left axillary cavity and in the right latissimus dorsi muscle, respectively. One of the two patients with tumor in the submucosa of the esophagus also had esophageal cancer. Patients' age ranged from 41 to 70 years (average, 59.1 years). Two patients with tumor in the submucosa of the esophagus were men, and the others were women. All of them were given a diagnosis of granular cell tumor by tissue biopsy and examination of excised specimens, but no evidence of malignancy was found. No recurrence has been noted in the patients who underwent surgical tumor removal.

Malignant granular cell tumor of the breast: case report and literature review

Granular cell tumors (GCTs) are uncommon soft tissue tumors that mostly occur in patients between 40 and 60 years of age and can occur at various body sites. Malignant granular cell tumors (MGCTs) comprise less than 2 % of GCTs and are mostly found on the lower extremities, especially the thighs. These tumors grow more rapidly than benign GCTs, and most importantly, they can metastasize. We describe an MGCT that presented as a right breast mass in a 79-year-old Japanese woman. Local excision was performed for the primary tumor, which was diagnosed as an atypical GCT, but 15 months later, the tumor recurred at the same site. Thereafter, right mastectomy with axillary lymph node dissection was performed. Metastatic disease was identified in 2 of 12 lymph nodes. The pathological examination revealed that the tumor had progressed to an MGCT after recurrence. Multiple liver, lung and bone metastases were revealed 4 months after the second surgery, and the patient died 34 months after the primary surgery. Our findings highlighted the difficulty in diagnosing MGCTs using histological features alone and suggested the usefulness of Ki67 values. A tumor with a high level of Ki67 should be treated as malignant, even if the tumor has few pathological features of malignancy.

Granular cell tumor of the male breast: two case descriptions and brief review of the literature

A granular cell tumor of breast is a rare and usually benign tumor originating from Schwann cells. The mammographic and sonographic appearances of a granular cell tumor pose a diagnostic dilemma because of its similarity to breast malignancy. We describe 2 cases of breast granular cell tumors in male patients, which were confirmed after surgical excision and histologic examination.

Evidence of tricellulin expression by immune cells, particularly microglia

Tight junctions (TJs) are elaborate structures located on the apical region of epithelial cells that limit paracellular permeability. Tricellulin is a recently discovered TJ protein, which is concentrated at the structurally specialized tricellular TJs but also present at bicellular contacts between epithelial cells, namely in the stomach. Interestingly, several TJ proteins have been found in other than epithelial cells, as astrocytes, and tricellulin mRNA expression was reported in mature dendritic cells. These findings prompted us to look for tricellulin expression in both epithelial and immune cells in the stomach, as well as in microglia, the brain resident immunocompetent cells. Immunohistochemical analysis of human stomach tissue sections revealed peroxidase staining at three-corner contact sites, as well as at the contact between two adjacent epithelial cells, thus evidencing the expression of tricellulin not only at tricellullar but at bicellular junctions as well. Such analysis, further revealed tricellulin immunostaining in cells of the monocyte/macrophage lineage, scattered throughout the lamina propria. Cultured rat microglia exhibited a notorious tricellulin staining, consistent with an extensive expression of the protein along the cell, which was not absolutely coincident with the lysosomal marker CD68. Detection of mRNA expression by real-time PCR provided supportive evidence for the expression of the TJ protein in microglia. These data demonstrate for the first time that microglia express a TJ protein. Moreover, the expression of tricellulin both in microglia and in the stomach immune cells point to a possible role of this new TJ protein in the immune system.