Multiple granular cell tumour in a teenager

Multifocal Cutaneous Granular Cell Tumor in Children: A Rare Entity

ABSTRACT

Granular cell tumors (GCTs) are rare soft tissue tumors of Schwann cell origin that manifest as papulonodular lesions and occur mainly in adults. The diagnosis is usually confirmed by histopathology. Most of GCTs are benign, but some lesions may exhibit malignant criteria. This study is a retrospective case series including all children with histopathologically documented multiple GCTs who attended the dermatology department of the university hospitals between February 2008 and March 2021. The objective of our study was to raise awareness to this unrecognized and rare entity in such age group. The study included 9 patients (6 girls and 3 boys) with multiple GCTs. Their age ranged between 5 and 13 years. The lesions were skin-colored to light brown, firm, smooth-surfaced nodules. Most of the lesions were on the extremities, and their mean diameter was 160.5 mm2. None of the lesions exhibited any malignant criteria on histopathology. No extracutaneous or mucosal lesions were detected. Dermatologists should be aware of this rare condition in children because early recognition allows more conservative resection of the tumor and less invasive reconstruction of the defect. Our study highlights that multifocality does not necessarily indicate malignancy or other systemic comorbidities.

[Multiple granular cell tumours in a patient with Noonan's syndrome and juvenile myelomonocytic leukaemia]

BACKGROUND

Granular cell tumour (GCT) is a rare form of tumour comprising Schwann cells. Herein, we report a case of a child presenting Noonan syndrome complicated by juvenile myelomonocytic leukaemia (JMML) and who also developed a multiple form of GCT. We discussed the molecular mechanisms that might account for this association.

PATIENTS AND METHODS

A six-year-old boy with Noonan syndrome complicated by JMML presented three asymptomatic subcutaneous nodules on his back, forearm and neck. Histological analysis revealed GCT. A literature review revealed seven cases of Noonan syndrome presenting GCT, none of which were associated with JMML. Mutation of gene PTPN11, via hyperactivation of intracellular Ras signalling may cause the development of GCT and JMML in children presenting Noonan syndrome.

DISCUSSION

Detailed clinical examination is recommended in children presenting GCT to screen for multiple forms and for signs of malformation suggestive of a genetic syndrome. Ours is the first case to be described of Noonan syndrome complicated by JMML associated with multiple GCT. This association once again raises the important question of the role of the Ras-MAPK signalling pathway in the development of benign and malignant tumours of solid organs or blood, associated with genetic syndromes.

Multiple cutaneous granular cell tumors, joint hypermobility and mild facial dysmorphism in a child

BACKGROUND

The association of multiple cutaneous granular tumors with systemic defects is extremely rare. To date, 14 cases have been described.

CASE REPORT

A 14-year-old boy presented multiple nodular lesions on his arms and legs; facial dysmorphism and joint hypermobility were also present. Histopathologic examination of two nodules showed granular cell tumors. We review the literature regarding multiple granular cell cutaneous tumors in children with associated somatic defects and genetic syndromes.

CONCLUSIONS

The combination of multiple cutaneous granular tumors with alterations in other organs is not only fortuitous, justifying the proposal of a distinct syndrome, termed "Bakos's syndrome" after the author who first described this association. The relation with neurofibromatosis type 1 is discussed, and an association is suggested with the range of variants of this syndrome.

Multiple plaques on the back: S-100 negative benign granular cell tumor

Granular cell tumor is a rarely seen disease characterized by a gradually developing nodular lesion, which is difficult to diagnose. It has been thought to originate from Schwann cells. The tumor usually appears in the 4th-6th decades of life, more frequently in women and blacks, and has a multifocal location in 10-25% of the cases. The malignancy potential is 1-3%, with 70-74% of the cases in women. Ninety-eight percent of the cases are S-100 positive. The present paper describes an 18-year-old female patient with benign granular cell tumor. This rarely seen type of tumor was S-100 negative and has been detected in biopsies taken from multiple asymptomatic plaques and maculopapular lesions. They were 0.5-4 cm in diameter, light brown in color, and with clear contours and had been gradually growing on her back the last nine years.