IP Archives of Cytology and Histopathology Research

Print ISSN: 2581-5725

Online ISSN: 2456-9267

CODEN : IACHCL

IP Archives of Cytology and Histopathology Research (ACHR) open access, peer-reviewed quarterly journal publishing since 2016 and is published under the Khyati Education and Research Foundation (KERF), is registered as a non-profit society (under the society registration act, 1860), Government of India with the vision of various accredited vocational courses in healthcare, education, paramedical, yoga, publication, teaching and research activity, with the aim of faster and better dissemination more...


  • Article highlights
  • Article tables
  • Article images

Article statistics

Viewed: 76

PDF Downloaded: 36

Bhadani and Jamal: Granular cell tumor of nasal cavity: An uncommon occurrence with review of literature


Introduction

GCTs are rare benign neoplasms affecting mucus membranes of upper aerodigestive tract. About one -third of all GCTs occur in head and neck region. The most common site is anterior part of tongue. Most GCTS are benign with 10% malignant behaviour. GCTs are most commonly seen in 4th -6th decades of life.1

Case Report

A 15 year old female patient presented with a fleshy mass protruding from left nasal cavity associated with epistaxis since 4-5 months. On examination the entire left nasal cavity was filled with reddish brown polypoidal fleshy mass protruding outside. (Figure 1) CT scan revealed normal paranasal sinuses and oral cavity. A clinico -radiological diagnosis of foreign body associated Polypoidal growth was suspected. The mass was excised and sent for histopathology. Grossly a globular greyish white soft tissue mass was received of size 5x 2x 1.5 cm. Cut section was solid, greyish white , homogenous with tiny cystic areas. (Figure 2)

Microscopy revealed sheets of plump polygonal cells arranged in nests and diffuse sheets having centrally placed round nuclei with abundant eosinophilic granular cytoplasm. At places chronic inflammatory infiltrate and bacterial colonies also noted. Special stain PAS revealed diffuse, intense and granular cytoplasmic positivity in tumor cells (Figure 3). IHC S-100 was recommended for further confirmation, IHC was done outside the Institute, which showed immunoreactivity with this marker. Based on these findings a histopathological diagnosis of Granular cell tumor (GCT) was rendered.

Discussion

Abrikosoff first described GCT as granular cell myloblastoma in 1926 as it was thought to originate from myoblast initially.2 Holland et al. proposed a neurogenic origin on the basis of close association of tumor with nerves and similar ultrastructural findings.3

Nasal masses can have a wide variety of possible differential diagnoses, including inflammatory proliferative lesions, infective lesions, and neoplastic conditions that are either benign or malignant. A GCT is also one of the possibilities as well. There is a wide age -range of occurrence in GCTs as they have been reported in patients as young as 11 months and as old as 104 years, but these lesions occur most frequently in patients who are in between their fourth and sixth decades.4

GCTs are seen frequently arising in the head and neck regions; they are found most often on the tongue, but also occur on the skin and in the stomach, bronchi, and bile ducts. Within the head and neck regions, GCTs have been found in the larynx, soft palate, labial mucosa, uvula, oral floor, gingivae, orbits, lacrimal sacs, nasolacrimal ducts, and parotid glands. (Table 1).5, 6 It is difficult to differentiate GCT in nasal cavity from Congenital epulis, Granular cell ameloblastoma and rhabdomyoma clinically.

Table 1

Summary of GCT in nasal andparanasal sinus reported in literature.

Study

Age in years

Sex

Location

Size

Presentation

Treatment

Salman et al. (1989) 7

22

Male

Maxillary sinus

NA

Facial swelling

Partial maxillectomy

Hwang et al. (2001) 4

6

Female

Nasal septum

0.6 cm

Nasal discharge

Excision biopsy

Sasaki et al. (2007) 8

69

Female

Nasal septum

0.19 cm

Recurrent epistaxis

Excision biopsy

Yang et al. ( 2012) 9

24

Male

Maxillary sinus

0.13 cm

Nasal discharge

Multiple sinusectomy

Present study (2020)

15

Female

Nasal cavity

5cm

Nasal obstruction with epistaxis

Excision biopsy

Figure 1

Clinical photograph of patient showing a reddishpolypoidal mass projecting from left nasal cavity.

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/a6cbcf80-8b7b-446e-b84e-daa0d3c4fc4aimage1.png
Figure 2

Gross photograph of excised mass in pieces having a solid, greyish white, homogenous appearance.

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/a6cbcf80-8b7b-446e-b84e-daa0d3c4fc4aimage2.png
Figure 3

Microphotograph of excised mass showing sheets of polygonal cells with abundanteosinophilic cytoplasm (H &E; 100X), Inset show diffuse strong PAS positivity (PAS stain; 400x)

https://s3-us-west-2.amazonaws.com/typeset-prod-media-server/a6cbcf80-8b7b-446e-b84e-daa0d3c4fc4aimage3.png

Two distinct subtypes have been described. 1) A congenital epulis or gingival GCT of infancy and 2) adult GCT. The tumor mostly presents as solitary lesion, with multifocal presentation accounting for only 5-10% of all cases.5, 6

GCTs are microscopically characterised by sheets and nests of large, polygonal, pale to eosinophilic tumor cells with a granular cytoplasm and centrally placed bland nuclei. Microscopically it resembles sheets of histiocytes where it is often misdiagnosed as an inflammatory condition.8 Most GCTs are benign but malignancy is reported in approximately 10% of cases.7 The malignant potential of GCT is reflected by cellular and nuclear pleomorphism, necrosis and increase mitotic activity. Such cases require close long term follow up. Large size of the lesion, rapid growth, infiltration of adjacent bony and soft tissues and metastasis to regional and distant lymph nodes denotes malignant potential of this lesion.7, 9, 10 GCTs express S-100, Neuron specific enolase and also CD68 which is a histiocytic marker.11

Histopathologically, GCTs can mimic granular cell variants of other tumors, such as leiomyoma, dermatofibrosarcoma, and angiosarcoma. Immunohistochemistry can be used to confirm a GCT diagnosis: GCTs are consistently positive for the S-100 protein and consistently negative for desmin, cytokeratins, the smooth muscle antigen and the epithelial membrane antigen.12

Surgical excision is the first choice of treatment for GCTs originating in common sites such as the skin. However when they arise in the nasal cavity, there are no accepted standards for the management of GCTs.13

Conclusion

GCT is a rare soft tissue tumor arising from mucosa of nasal cavity. The small size of this lesion and unusual location makes clinical and radiological diagnosis difficult. Histopathology along with IHC plays a vital role in correct diagnosis.

Source of Funding

No financial support was received for the work within this manuscript.

Conflict of Interest

The authors declare they have no conflict of interest.

References

1 

M Bitar KA Al Afif MI Fatani Granular cell tumor: Case reportJ Saudi Soc Dermatol Dermatol Surg201115125710.1016/j.jssdds.2010.10.005

2 

H Lee E Goh S Park S Kong A case of granular cell tumor of postauricular areaKorean J Otorhinolaryngol Head Neck Surg2009529213

3 

J C Fanburg-Smith J M Meis-Kindblom R Fante L G Kindblom Malignant granular cell tumor of soft tissue: diagnostic criteria and clinicopathologic correlationAm J Surg Pathol19982277994

4 

JSG Hwang H K Ang C Y Aw Case report of a granular cell tumour in the nasal septum of a childSingapore Med J20014283789

5 

H Elkousy J Harrelson L Dodd S Martinez S Scully Granular Cell Tumors of the ExtremitiesClin Orthop Related Res2000380191810.1097/00003086-200011000-00026

6 

D J Kim H W Kim S B Park C W Choi D H Kang J B Hong A case of gastric granular cell tumor:review of literature and features of endoscopic ultrasonographyKorean J Helicobacter Upper Gastrointestinal Res20151515963

7 

T Sasaki K Yamamoto T Akashi Granular cell tumour arising from the Kiesselbach's area of the nasal septumJ Laryngology Otol20071212170310.1017/s002221510600394x

8 

C Yang S Chin Granular cell tumor of the left maxillary paranasal sinus in a 24-year-old manTzu Chi Med J2012241168

9 

RA Salman JA Leonetti L Salman AP Chaudhry Adult benign granular cell tumor of the maxillaJ Oral Pathol Med1989189517910.1111/j.1600-0714.1989.tb01354.x

10 

B Rekhi NA Jambhekar Morphologic spectrum, immunohistochemical analysis, and clinical features of a series of granular cell tumors of soft tissues: a study from a tertiary referral cancer centerAnn Diagn Pathol2010143162710.1016/j.anndiagpath.2010.01.005

11 

P. C. Ramos D. S. Kapp T. A. Longacre N. N. H. Teng Malignant granular cell tumor of the vulva in a 17-year-old: Case report and literature reviewInt J Gynecol Cancer20001054293410.1046/j.1525-1438.2000.010005429.x

12 

J C Fanburg-Smith J M Meis-Kindblom R Fante L G Kindblom Malignant granular cell tumor of soft tissue: diagnostic criteria and clinicopathologic correlationAm J Surg Pathol19982277994

13 

H J Kim M G Lee Granular cell tumors on unusual anatomic locationsYonsei Med J20155617311735



jats-html.xsl

© 2020 Published by Innovative Publication Creative Commons Attribution 4.0 International License (creativecommons.org)


Article type

Case Report


Article page

309-311


Authors Details

Punam Prasad Bhadani, Iffat Jamal


Article Metrics


View Article As

 


Downlaod Files