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Breast-nonmalignant
Benign tumors / changes
Granular cell tumor of breast
Reviewer: Hind Nassar, M.D. in January 2009 (see Authors page)
Revised: 18 July 2010, last major update March 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Tumor whose cells have granular eosinophilic cytoplasm and bland small nuclei
Terminology
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●
Epidemiology
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● Uncommon, <1 per 1000 malignancies (J Ultrasound Med 2008;27:467)
● More common in women in 40’s; may be more common in African-American women
Sites
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● Usually inner quadrants of breast
Etiology
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● Appears to derive from Schwann cells of peripheral nerves (at all sites)
Clinical features
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● Resembles invasive carcinoma clinically, but almost always benign
● Xray: suggestive of malignancy due to apparent infiltration
Prognostic factors
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Case reports
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● 22 year old woman (Cases J 2009 Aug 10;2:8551)
● 47 year old woman with 10 year history of breast mass (Archives 2003;127:1525)
● 55 year old woman with 2 cm tumor (Cases J 2008;1:142)
● 57 year old woman with coexisting DCIS and invasive ductal carcinoma (Archives 2002;126:731)
● Two lesions with features of granular cell tumor and traumatic neuroma (Archives 2000;124:709)
● Malignant chest wall tumor with recurrence in breast and axilla (Archives 1992;116:206)
Treatment
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● Local excision
Clinical images
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Large cystic cavity
Gross description (Macroscopy)
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● Firm, homogenous, gray-white-yellow, usually 3 cm or less and ill-defined
Gross images
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Firm tumor with irregular borders, Somewhat circumscribed
suggestive of carcinoma
Dense pale homogenous tumor
with infiltrating margins (AFIP)
Other images: granular cell tumor
Micro description (Histopathology)
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● Infiltrating sheets/cords of polygonal bland cells with well-defined cell borders and abundant eosinophilic granular cytoplasm
● Round/oval nuclei with prominent nucleoli
● Collagenous stroma
● May be close to small nerve bundles and have infiltrative margins; occasional multinucleation
● Overlying epithelium may show pseudoepitheliomatous hyperplasia
● Rare mitotic figures, no/mild atypia
Micro images
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Core biopsy Clusters of tumor cells
infiltrate between collagen bundles
Cells have abundant, eosinophilic granular cytoplasm
Beneath squamous epithelium (not necessarily breast): H&E and S100
Malignant tumor (lung)
S100+ With DCIS and invasive ductal carcinoma
Granular cell traumatic neuroma
Fig 1/2: mass with ill defined borders
Fig 3: nests of cells with eosinophilic and granular
cytoplasm and no atypia, within fibrohyaline stroma
Infiltration into fat S100+ tumor cells and myoepithelial cells
Virtual Slides
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Videos
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Cytology description
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● Highly cellular, large cohesive groups and single cells mixed with connective tissue
● Cells have ill defined, abundant granular cytoplasm and bland small nuclei with inconspicuous nucleoli
● No mitotic figures, no necrosis (Diagn Cytopathol 2007;35:725)
Cytology images
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Positive stains
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● PAS (diastase resistant), S100, CD68 (due to phagolysosomes)
● Focal CEA and vimentin
Negative stains
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● Keratin, EMA, mucin
● Alpha-1-antitrypsin, myoglobin, ER, PR (Archives 1984;108:897)
Electron microscopy descriptions
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● Myelin figures, lysosomes
Electron microscopy images
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Molecular / cytogenetics description
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Molecular / cytogenetics images
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Differential Diagnosis
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● Alveolar soft part sarcoma: cells are divided into packets by thin walled vessels
● Apocrine carcinoma: usually ductal carcinoma also present, keratin+, mucin+, S100-
● Histiocytic tumors
● Melanoma
● Myoblastomatoid (histiocytoid) invasive carcinoma: keratin+
● Renal cell carcinoma
Additional references
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End of Breast-nonmalignant > Benign tumors / changes > Granular cell tumor
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