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CASE REPORT
Year : 2019  |  Volume : 22  |  Issue : 5  |  Page : 742-744

Granular cell tumour of the breast in a young female: A case report and literature review


1 Department of Pathology, Taibah University, Madinah, Kingdom of Saudi Arabia
2 Department of Pathology, King Fahad Hospital, Madinah, Kingdom of Saudi Arabia

Date of Acceptance29-Jan-2019
Date of Web Publication15-May-2019

Correspondence Address:
Dr. I A Ansari
Department of Pathology, Taibah University, P.O. Box 334, Madinah 42353
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_282_18

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   Abstract 


A granular cell tumour (GCT) of the breast is a relatively uncommon lesion. Often, it mimics carcinoma on clinical and radiological examinations. The striking feature of GCT is the presence of abundant granular eosinophilic cytoplasm, which can easily lead to a misdiagnosis of apocrine carcinoma or a metastatic lesion and may result in unnecessary surgery. To obtain a correct diagnosis, immunohistochemistry with S100 is required. We present a case of a GCT of the breast in a 19-year-old female who presented with a firm mass in the upper inner quadrant of the left breast, which was reported on a mammogram as the Breast Imaging Reporting and Data System (BIRADS) Category 4C. This report is of interest due to the young age of the patient and the rarity of the lesion. To our knowledge, this is the second reported case in all of Saudi Arabia and the first from the Madinah region.

Keywords: Breast mass, granular cell tumour, immunohistochemistry, S100


How to cite this article:
Albasri A M, Ansari I A, Aljohani A R, Alhujaily A S. Granular cell tumour of the breast in a young female: A case report and literature review. Niger J Clin Pract 2019;22:742-4

How to cite this URL:
Albasri A M, Ansari I A, Aljohani A R, Alhujaily A S. Granular cell tumour of the breast in a young female: A case report and literature review. Niger J Clin Pract [serial online] 2019 [cited 2019 Sep 19];22:742-4. Available from: http://www.njcponline.com/text.asp?2019/22/5/742/258268




   Introduction Top


A granular cell tumour (GCT) was first described by Weber in 1854. Later, it was Abrikossoff who described this tumour in detail in the tongue (1926) and breast (1931), and suspected a myogenic origin; and referred it as a granular cell myoblastoma.[1] The origin of this tumour is still somewhat controversial, but strong S100 positivity and the similarities revealed in the ultrastructural details of the tumour cells and those of the Schwann cells support the theory of neural or neuroectodermal origin.[2],[3] GCT is rare in the breast and frequently mimics carcinoma in clinical, radiological and frozen section examinations. Misdiagnosis of this tumour can lead to a radical mastectomy and may result in unnecessary medicolegal difficulties.[4] The objective of the present case report is to document the first case of a GCT of the breast in a young Saudi female from the Madinah region and to highlight the importance of immunohistochemistry in the differential diagnosis of this rare tumour.


   Case History Top


A 19-year-old otherwise healthy female presented at the Breast Clinic of King Fahad Hospital in Madinah, Saudi Arabia with a firm mass in the upper inner quadrant of her left breast for 6 weeks. Ultrasonography confirmed the presence of a solid lump with a maximum diameter of 1.8 cm. A mammogram was performed which showed a nodule in the left breast with ill-defined speculated margins, hence the Breast Imaging Reporting and Data System (BIRADS) Category 4C was given. The patient was subjected to lumpectomy. A 6 cm × 5 cm × 3 cm mass was removed. On gross examinations the cut surface showed a 1.5 cm × 1.2 cm × 1 cm well-circumscribed, greyish-white firm tumour in the centre. Microscopy of the tumour showed sheets and cords of large cells with centrally placed round nuclei and abundant eosinophilic granular cytoplasm. The tumour cells were intermingled with the fibrous stroma and normal breast parenchyma; no necrosis or mitotic figures were seen, and all the surgical margins were free from the tumour [Figure 1]. The cytoplasmic granules were positive for the Periodic acid–Schiff (PAS) reaction [Figure 2]. The tumour cells were positive for the S100 protein [Figure 3] and negative for the pancytokeratin immunostain [Figure 4]. The final diagnosis of a GCT of the breast was given. For the past year, the patient has been on a regular follow-up schedule and is clinically free from the disease at present.
Figure 1: Photomicrograph showing the sheets and clusters of large polyhedral tumour cells with abundant granular eosinophilic cytoplasm infiltrating into the surrounding breast parenchyma. (H and E 200×)

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Figure 2: Photomicrograph showing Periodic acid–Schiff positive cytoplasmic granules in the tumour cells. (PAS 400×)

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Figure 3: Photomicrograph showing the sheets and clusters of tumour cells with strong immunoreactivity to S100 protein. (IHC for S100 stain)

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Figure 4: Photomicrograph showing negative immunostaining for pan cytokeratin in the tumour cells. (IHC for pan CK stain)

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   Discussion Top


The rate of occurrence of GCT in the breast is quite low and a prevalence of 1 out of 1000 cases of all breast tumours has been widely reported in previous studies; however, the recent evidence suggests a prevalence of 1 in 617 among the population screened for breast malignancy and 6.7 out of 1000 cases in the total clinical population, thus making it of higher clinical significance than in previously recognised data.[1] A study conducted in the eastern province of Saudi Arabia by Amr et al.[5] reported only 1 case of GCT in 915 cases among all breast pathologies. Thus, our case is the second reported case of a GCT of the breast in the entire kingdom, and the first reported case in the Madinah region.

Historically, GCT of the breast is a disease of premenopausal women of African-American origin. Various previous studies have described the mean age of presentation is 40 years with a range in between 20 and 60 years.[3] The age of the patient in our case is 19 years which is quite young as compared to the previous studies. Clinically, a GCT is generally mobile, but several previous studies have reported poorly circumscribed and fixed tumours and various cutaneous changes such as tethering, thickening, dimpling and retracting, thus giving the tumour an appearance of a carcinoma on clinical examinations.[6] Although the majority of these tumours behave in a benign fashion, malignant counterparts have been known in a fewer than 3% of all GCT cases.[7],[8] Mammography and ultrasound scanning are the most commonly used imaging techniques for the diagnosis of GCT of the breast. The sensitivity of an ultrasound is lesser compared with that of a mammography; however, in younger patients, an ultrasound is preferred over a mammography because of increased density of the breast tissue, which may obscure the fine details of the mammography.[1],[4] The various findings on an ultrasonography, such as an ill-defined solid mass with a weak internal echo and acoustic enhancements and posterior shadowing, are highly suggestive of a carcinoma, which may lead to a wrong diagnosis. On a mammography, features of a GCT are often described as a small lesion of varying circumscription showing irregularity, stellation, spiculation, heterogenecity, isodensity or hypodensity. Thus, giving a variable imaging findings, and making it difficult to differentiate a GCT from carcinoma on both a mammography and an ultrasound because of the presence of numerous similarities.[6] Our case was also reported as highly suspicious of malignancy on mammography (BIRADS Category 4C).

It is impossible to make a definitive diagnosis of GCT solely on clinical and radiological examinations. Histopathological examinations are mandatory for a definitive diagnosis. On microscopic examination, GCT shows the large polyhedral tumour cells, which are arranged in sheets and cords with round nuclei and abundant granular eosinophilic cytoplasm. The granularity of the tumour cells is mainly due to the accumulation of lysosomes and shows positive reaction with PAS with diastase. However, this is a non-specific finding and can be observed in many tumours arising from connective tissues, smooth muscles, endothelial cells and epithelial cells. Although the histopathological features of GCT are quite characteristic, but the definitive diagnosis of GCT of the breast is made with IHC; the tumour cells are strongly positive for S100. They also show positivity for neuron-specific enolase (NSE), CD68 and vimentin. The tumour cells are negative for epithelial markers such as cytokeratin and epithelial membrane antigen and carcinoembryonic antigen.[1],[4],[8] In our case, the microscopic findings were supported by strong S100 positivity and pancytokeratin negativity.

To conclude, GCT of the breast is a rare neoplasm, but shows a significant increase in its incidence; hence, it should be considered in the differential diagnosis of breast lesions. Histopathological examination with IHC is the gold standard for the definitive diagnosis of this tumour.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Brown AC, Audisio RA, Regitnig P. Granular cell tumour of the breast. Surg Oncol 2011;20:97-105.  Back to cited text no. 1
    
2.
Adeniran A, Al-Ahmadie H, Mahoney MC, Robinson-Smith TM. Granular cell tumor of the breast: A series of 17 cases and review of the literature. Breast J 2004;10:528-31.  Back to cited text no. 2
    
3.
Ssi-Yan-Kai G, Barthier S, Trichot C, Prevot S, De Laveaucoupet J. Granular cell breast cancer: A rare misleading lesion. Diagn Interv Imaging 2015;96:287-9.  Back to cited text no. 3
    
4.
Hammas N, El Fatemi H, Jayi S, Hafid I, Fikri G, El Houari A, et al. Granular cell tumor of the breast: A case report. J Med Case Rep 2014;8:465-8.  Back to cited text no. 4
    
5.
Amr SS, Sa'di AR, Ilahi F, Sheikh SS. The spectrum of breast diseases in Saudi Arab females: A 26-year pathological survey at Dhahran Health Center. Ann Saudi Med 1995;15:125-32.  Back to cited text no. 5
    
6.
Rexeena B, Paul A, Nitish RA, Kurian C, Anila RK. Granular cell tumor of breast: A case report and review of literature. Indian J Surg Oncol 2015;6:446-8.  Back to cited text no. 6
    
7.
Pathania K, Bhargava S. Granular cell tumour of breast: A mimic of carcinoma. Med J Armed Forces India 2010;66:292-4.  Back to cited text no. 7
    
8.
Papalas JA, Wylie JD, Dash RC. Recurrence risk and margin status in granular cell tumors of the breast: A clinicopathologic study of 13 patients. Arch Pathol Lab Med 2011;135:890-5.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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