2 cases of mammary granular cell tumor clinicopathologic and immunohistochemical analysis of_1405

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2 cases of mammary granular cell tumor clinicopathologic and immunohistochemical analysis of_1405

    2 cases of mammary granular cell tumor clinicopathologic and immunohistochemical analysis of

     Author: Zhang Jie, Xu Junlong, YIN Yanhua, Ren-bo

     Abstract Objective To investigate the mammary granular cell tumor of the clinical and pathological features and diagnosis and differential diagnosis. Methods Review of two cases of mammary granular cell tumor of the clinical and pathological data of pathological and immunohistochemical observation. The results of two cases of GCT without special

    clinical symptoms and signs, cell state clearly that large cell body, cytoplasm-rich, filled with large eosinophilic

    granules, invasive growth, tumor cells S 100, NSE (+), CEA

    (-). Healthy persons are not transferred, the prognosis is

    good. Conclusion breast rare granular cell tumor, clinical, cytology and frozen quickly pathological examinations are often misdiagnosed as malignant tumor, should raise the awareness of the disease and reduce unnecessary expansion of operations.

     Key words breast cancer; granular cell tumor;


     Granular Cell Tumor (GCT) of the Breast: A Clinical Pathologic Analysis of 2 Cases

     Department of Pathology, Liaocheng Hospital, Liaocheng 252000, ChinaAbstract: Objective To study the

    histopathological characteristics, diagnosis, differential diagnosis and prognosis of Granular cell tumor of the breast. Methods Two cases of Granular cell tumor of the breast were studied by histopathological observation and

    immunohistochemical staining. Results No special clinical situations were found in two cases and the tumor was charsterized by clear cell boundary, aboundant cytoplasm, full of acidophilic granules and it also infiltrated beyond the edge of the main tumor. Immunohistochemical study demonstrated

    that tumor cells were reacted with S 100, NSE but

    negatively with CEA. Those benign ones do not metastasize and such patients have favorable prognosis. Conclusion GCT of the breast, a rarely tumor that can be misdiagnosed by frozen

    section, clinical and cytological tests. The disease should be enforced to study and avoid being operated excessively and unnecessarily.

     Key words: Breast neoplasms; Granular cell tumor; Immunohistochemistry

     Mammary granular cell tumor (GCT) is a rare tumor, less than

    100 cases so far reported in the literature, clinical misdiagnosed as breast cancer [1]. Fine needle aspiration cytology and rapid frozen section diagnosis is often not clear. In this paper, two cases of breast city Review granular

    cell tumor patients with clinical and pathological data, combined with literature review of its histogenesis, clinical features, diagnosis, differential diagnosis, treatment and prognosis in order to enhance awareness of this tumor, reduce misdiagnosis and missed diagnosis of .

     1 Materials and methods

     1.1 Material samples were two cases of the city from 1985 to 2003 granular cell tumor diagnosis and treatment of breast surgery cases were smear and intraoperative rapid frozen section, all the regular slices are 10% of the formalin-fixed,

    regular dehydration, paraffin embedding, serial sections, HE staining and PAS staining.

     1.2 Methods review two cases of clinical data, fine needle aspiration cytology smears, intraoperative rapid biopsy

    and postoperative paraffin tissue sections, and to wax blocks of all cases re-3μm thick slices, rows SP France

    immunohistochemistry, antibody to S 100 protein, vimentin

    (Vimentin), cytokeratin (CK), neuron-specific enolase (NSE),

    myoglobin (myoglobin), carcinoembryonic antigen (CEA),

    estrogen (ER), progesterone ( PR). All for the taking of new products at the same time to do positive and negative controls.

     2 Results

     2.1 The sharp eyes and keen tumor and the surrounding ill-defined, the largest diameter 2.5cm quality of hard and tough, aspect gray + sallow, homogeneous shape. 2 cases with the surrounding fatty tissue.

     2.2 The fine needle aspiration cytology examination showed clusters of tumor cells flake, cell boundary is unclear, more cytoplasm, filled with eosinophilic granules, the nuclear small, round or oval. Chromatin smaller, uniform, showing a number of naked nuclei, no significant profiled (Figure omitted).

     2.3 frozen and paraffin tissue sections can be seen

    between the two cases of tumor tissue and normal breast tissue residue, tumor cells were irregular cord or nest-like, cells

    were round or polygonal, in part was fit shape, eosinophilic cytoplasm filled with granules, the majority of particles small, uniform, ranging from a few for the size of the ball. Nuclear round or oval, a small number of nuclear obvious depression, depressed area filled with eosinophilic granules, occasionally filling in the central core of eosinophilic granules, the nuclear chromatin, mostly dust-like, easy to see

    a small nucleolus, a small number of nuclear deep-dyed, multi

    - shape, nuclear fission rare, interstitial edema was like, tumor cells surrounding invasive growth, showing that tumor cell infiltration into the breast lobular. Conventional frozen

    section tissue section images and the same quality can be seen between the fibrous tissue around the tumor can be seen myelinated nerve bundles. PAS staining tumor cells showed weak to moderate positive. 2 cases of GCT of the

    immunohistochemical staining showed: S 100 protein, NSE,

    Vimentin, glial fibrillary acidic protein (GFAP)-positive,

    while the CEA, CK, myoglobin, ER, PR receptor negative tags (Tulio ).

     3 Discussion

     Granular cell tumor is a relatively rare tumor, was

    initially considered to be muscle-derived tumors, they have

    been known as the muscle blastoma. Most scholars believe that comes from the nerve sheath cells [2], and through immunohistochemistry and electron microscopy confirmed. This immunohistochemical examination, showing Vimentin-positive,

    CK, myoglobin, CEA negative, indicating the tumor from the mesenchyme, but not myogenic. S 100, NSE, GFAP-positive,

    support for the neurogenic GCT, electron microscopy also support this view [3,4]. ER, PR-negative and Ingram et al [4]

    reported the same. This shows that the mammary granular cell tumor, especially in men, the occurrence of granular cell tumor, development, and little to do with estrogen and progesterone. Reposted elsewhere in the paper for free download http://

     3.1 The clinical features of granular cell tumor is commonly found in soft tissue, nearly 1 / 3 occurred in the tongue [4], the rest occurred in breast, gastrointestinal, respiratory, urinary and reproductive systems. Occurred in breast were rare, accounting for about 5% of the tumor [5], mostly occurs in middle-aged women, male to female ratio is about 10:1. Mostly benign, more in diameter <3cm, the individual up to 6cm. About 2.5% of the breast malignant granular cell tumor, larger (average 7.9cm) [5]. Most of the

    lesions and isolated in nature, there are a few for the multiple [1,6]. Most patients were found to painless breast lump treatment, lesions occur in the inferior quadrant, the nipple may be violated. Palpation and breast cancer difficult

    to distinguish.

     3.2 Cytological characteristic cytology of this tumor showed irregularly arranged sheets, the cells were round or polygonal large cells realm of clear cytoplasm is very rich, large granular eosinophilic, partly due to puncture and damage

    the cytoplasm is lost, can be seen naked nuclei, nuclei smaller, more or less uniform size, shape than the rule, the more round nucleolus.

     3.3 frozen sections and tissue biopsies showed tumor cell nests or sheet-like distribution of spindle or polygonal

    cells, eosinophilic granular cytoplasm. Some cases, cytoplasm vacuolization or transparent-like, nuclear round or oval,

    prominent nucleoli, some cases of how some cells the nuclear polymorphism, and occasionally a number of nucleated cells,

    and can see very few nuclear fission. In tumors or satellite foci around to see the small nerve bundle, tumor showed invasive growth of tumor cells around the ducts and lobular can also be infiltrated into the lobular. Malignant growth and rapid, extensive local infiltration and disarrangement with hemorrhage and necrosis, cell shape clearly more than nuclear fission, the transfer may also occur [5].

     3.4 Diagnosis and differential diagnosis when fine needle aspiration cytology was found shape is not too abundant

    eosinophilic cytoplasm of tumor cells should be thought of the possibility of this tumor. Sweat gland, apocrine metaplasia, alveolar soft tissue sarcoma, paraganglioma of the cell shape easy to be confused with this disease. But their cell arrangement and smear backgrounds, careful observation can

    identify. In the frozen and paraffin sections on the disease is often misdiagnosed as breast cancer, especially when the frozen sections. When the lesion interstitial collagen when the cancer is very similar and hard, if the lesions found in

    ductal carcinoma in situ adenocarcinoma component should be considered sweat. Also need to lipid secretory and invasive cancer, carcinoma cells and squamous cell carcinoma of the identification. Mucus-like foci staining positive for

    cytokeratin immunohistochemistry (CK) and epithelial membrane antigen (EMA) positive support for cancer diagnosis, while the lack of granular cell tumor of epithelial markers, estrogen

receptor-negative, S 100 protein, strong positive

    expression. In addition, in the frozen sections and slices

    need and metastatic tumors (especially liver cancer), alveolar soft tissue sarcoma, yellow tumors, dormant tumors such as phase identification.

     3.5 Treatment and prognosis of the disease the treatment of common wide excision, the prognosis is good, but not completely removed, there may be local recurrence. Diagnosis of malignant wide local excision should be OK, but not the exact effects of chemotherapy and radiotherapy. Patients with more than 4 years after diagnosis died of extensive lymph node

    metastasis or hematogenous.


     [1] Kommoss F, Mercer L, Schmidt RA, et al. Granular cell tumor of the breast mimicking carcinoma in pregnancy [J]. Obstet Gynecol, 1989,73 (5): 898 ~ 900.

     [2] Armin A, Connelly EM, Rowden G. An immunoperoxidase Investigation of S 100 Protein in Granular Cell

    Myoblastomas Evidence for Schwann Cell Derivation [J]. Am J Clin Pathol, 1983,79 (1): 37 44.

     [3] Ingram DL, Mossler JA, Snowhitc J, et al. Granular cell

    tumors of breast [J]. Arch Path Lab Med, 1984, 108 (11): 897


     [4] Gu Sui Yue, et al. Practical surgical pathology [M]. 1st edition. Nanjing: Jiangsu Science and Technology Press, 1987.87.

     [5] Wu Zhong-pil, Yang Guanghua. Zhonghua surgical pathology

    [M]. Version 1. People's Health Publishing House, 2002.1681


     [6], Wuhan Force General Hospital, Hubei Medical College. Soft-tissue tumor Color Atlas of Histology [M]. Version 1. Wuhan: Hubei Science and Technology Press, 1983.139 141.

     Reposted elsewhere in the paper for free download http://

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