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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: 20 September 2012, last major update March 2010

Copyright: (c) 2002-2012, PathologyOutlines.com, Inc.

 

Definition

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● Tumor whose cells have granular eosinophilic cytoplasm and bland small nuclei

 

Epidemiology

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● Uncommon, <1 per 1000 malignancies (J Ultrasound Med 2008;27:467)

● More common in women in 40ís; 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

 

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)
● 64 year old woman with breast mass (Case of Week #252)

● 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

 

 

†† ††††††Figure 1.†††

 

††

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-

Granulomatous inflammation

Histiocytic tumors

Melanoma

Myoblastomatoid (histiocytoid) invasive carcinoma: keratin+

Renal cell carcinoma

 

Additional references

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eMedicine

 

End of Breast-nonmalignant > Benign tumors / changes > Granular cell tumor

 

 

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