Breast
Other benign tumors
Granular cell tumor
Author: Monika Roychowdhury, M.D.
Editorial Board Member: Emily S. Reisenbichler, M.D.
Last author update: 1 August 2017
Last staff update: 29 October 2024 (update in progress)
Copyright: 2003-2024, PathologyOutlines.com, Inc.
PubMed Search: Granular cell tumor [title] breast
Table of Contents
Definition / general | Essential features | Terminology | Epidemiology | Sites | Etiology | Clinical features | Radiology description | Radiology images | Prognostic factors | Case reports | Treatment | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Cytology description | Cytology images | Positive stains | Negative stains | Electron microscopy description | Differential diagnosis | Additional references | Board review style question #1 | Board review style answer #1Cite this page: Roychowdhury M. Granular cell tumor. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/breastgct.html. Accessed November 27th, 2024.
Definition / general
- Tumor whose cells have granular eosinophilic cytoplasm and bland small nuclei
Essential features
- Uncommon benign breast tumor that may present as a mass lesion
- Imaging shows ill defined spiculated lesion mimicking malignancy
- Microscopy shows sheets / cords of polygonal cells with abundant eosinophilic cytoplasm, round nuclei and prominent nucleoli; no mitosis or atypia seen
- Treated by complete excision
Terminology
- First described by A.I. Abrikosoff in 1926 as "myoblastic myoma" (Virchows Arch A Pathol Anat 1926;260:215)
Epidemiology
- Uncommon, < 1 per 1000 malignancies (J Ultrasound Med 2008;27:467)
- More common in women in 40s; may be more common in African American women
- Can occur anywhere, breast accounts for 5 - 8% of all granular cell tumors (Br J Radiol 2007;80:970)
Sites
- Usually inner quadrant of breast
Etiology
- Appears to derive from Schwann cells of peripheral nerves (at all sites)
Clinical features
- Resembles invasive carcinoma clinically but almost always benign
- Xray: suggestive of malignancy due to apparent infiltration
- Painless lump most commonly in upper middle and medial quadrants
Radiology description
- On mammography appears as an ill defined spiculated lesion mimicking malignancy
- On ultrasound appears as solid, hypoechoic mass with posterior shadow
Radiology images
Contributed by Mark R. Wick, M.D.
Mammogram spot film
Images hosted on other servers:
Fig 2, case 1:
ultrasonography
revealed a tumor
7 x 8 mm in size
Mammograph of the breast
Prognostic factors
- Most are benign and reportedly malignant cases are rare, occurring in only 1% or 2% of cases
- Metastasis to liver, lung, bone and axillary lymph nodes are reported with malignant granular cell tumor (J Ultrasound Med 2011;30:1295)
Case reports
- 22 year old woman with granular cell tumor of the breast (Cases J 2009;2:8551)
- 32 year old woman with granular cell tumor of the breast (J Med Case Rep 2014;8:465)
- 36 year old woman with metachronous GCT of breast, skin and scalp (Case Rep Pathol 2016;2016:8043183 )
- 47 year old woman with outer quadrant breast mass (Arch Pathol Lab Med 2003;127:1525)
- 52 year old woman with granular cell tumor of the breast (Breast Cancer (Dove Med Press) 2017;9:245)
- 55 year old woman with granular cell tumour of the pectoral muscle mimicking breast cancer (Cases J 2008;1:142)
- 55 and 67 year old women with granular cell traumatic neuroma (Arch Pathol Lab Med 2000;124:709)
- 57 year old woman with colocalized granular cell tumor and infiltrating ductal carcinoma of the breast (Arch Pathol Lab Med 2002;126:731)
- 57 year old woman with benign granular cell tumor of the breast (Radiol Case Rep 2016;10:1116)
- 64 year old woman with small irregular mass on her left breast (Case of the Week #252)
- Malignant granular cell tumor in the right breast (Arch Pathol Lab Med 1992;116:206)
- Two patients with granular cell tumors in breast (World J Surg Oncol 2012;10: 204)
Treatment
- Local excision, local recurrence reported with incomplete excision
Gross description
- Firm, homogenous, gray white and yellow, usually 3 cm or less and ill defined
Gross images
Contributed by Mark R. Wick, M.D. and AFIP
Dense
homogenous
tumor with
infiltrating margins
Various images
Images hosted on other servers:
Firm tumor with irregular borders
Granular cell tumor in right breast
52 year old woman with 1 cm nodule
Microscopic (histologic) description
- Infiltrating sheets / cords of polygonal bland cells with well defined cell borders, abundant eosinophilic granular cytoplasm and 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
- Histologic criteria for malignancy (proposed by Fanburg-Smith et al., Am J Surg Pathol 1998;22:779):
- Spindling
- Necrosis
- Vesicular nuclei with large nucleoli
- High N/C ratio
- Nuclear pleomorphism
- Increased mitotic activity
- 1 or 2 of 6 criteria are considered atypical and 3 or more are considered to be associated with malignant behavior (Breast J 2004;10:528, Arch Pathol Lab Med 2004;128:771), but metastasis remains the only unequivocal sign of malignancy (Virchows Arch 2016;468:527)
Microscopic (histologic) images
Contributed by Emily S. Reisenbichler, M.D., Mark R. Wick, M.D., Dr. Oleksandr Grygoruk, AFIP and @ThatGlassTho on Twitter
Infiltration into fat
S100+ tumor cells and myoepithelial cells
Granular cell tumor
Various images
Various images
S100
Granular cell tumor
9 year girl with a 2 cm granular cell tumor near the left nipple, unchanged in size over past 3 years
9 year girl with a 2 cm granular cell tumor near the left nipple, unchanged in size over past 3 years
Images hosted on other servers:
Core biopsy
Abundant eosinophilic, granular cytoplasm
Beneath squamous epithelium (not necessarily breast): H&E and S100
Compact nests of polygonal cells
Cells contained granular eosinophilic cytoplasm
IHC study showed reactivity for S100 protein
H&E staining of granular cells
Cytology description
- Highly cellular, large cohesive groups and single cells mixed with connective tissue
- Cells have ill defined, abundant granular cytoplasm and bland small nuclei with prominent nucleoli
- No mitotic figures, no necrosis (Diagn Cytopathol 2007;35:725)
Cytology images
Contributed by Mark R. Wick, M.D.
FNAB
Positive stains
Negative stains
Electron microscopy description
- Myelin figures, lysosomes
Differential diagnosis
- Alveolar soft part sarcoma: cells are divided into packets by thin walled vessels
- Apocrine carcinoma: usually ductal carcinoma also present, keratin+, mucin+, S100-
- Granulomatous mastitis (idiopathic)
- Histiocytic tumors
- Melanoma
- Myoblastomatoid: keratin+
- Renal cell carcinoma
Additional references
Board review style question #1
- A 45 year old woman presents with a breast mass. Excisional biopsy shows a granular cell tumor. Which one of the following is not in the differential diagnosis based on morphologic findings?
- Apocrine carcinoma
- Melanoma
- Metastatic renal cell carcinoma
- Tubular carcinoma
Board review style answer #1
D. Tubular carcinomas form angulated tubular structures composed of mildly atypical ductal cells whereas granular cell tumors have sheets of large cells with abundant eosinophilic granular cytoplasm.
Comment here
Reference: Granular cell tumor
Comment here
Reference: Granular cell tumor
