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RESIDENT
CASE
STUDIES
September 11,
2003: Case 2 Table
of Contents | List
of Diagnoses | Case 1 | Case 2 |
Case
3 | Case 4
66 year old female with a mass in her left breast
Discussion by Kathryn Rizzo, DO, PhD
Granular cell tumor occurs in a wide
variety of visceral and cutaneous sites and is composed of granular cells
which have a schwann cell derivation.
Prevalence: Five percent of granular
cell tumors originate in the breast.
Distribution: Typically found in
middle-aged woman, however 10% are found in males.
Gross Appearance: Firm
hard mass either well-circumscribed or with infiltrative borders.
Typically forms a stelate mass with a dense core.
Microscopic
Appearance:
- Nests or sheets of
polygonal cells with abundant eosinophilic cytoplasmic granules
- Can see cytoplasmic
vacuolation and clearing
- Cells have a uniform
round to slightly oval pyknotic nuclei with an open chromativ pattern
and prominent nucleoli
- Occasional mitotic
figures
- Infiltrative growth
pattern often surrounds ducts and lobules and invades adipose tissue.
Diagnostic
Criteria:
- Composed of sheets or nests of polygonal
cells with abundant eosinophilic granular cytoplasm
- Cells stain positive for S-100 and
cytokeratin negative
- Nuclei are round and uniform with open
chromatin pattern and prominent nucleoli.
Immunostains:
S 100 positive, PAS positive.
Cytogenic and molecular techniques:
EM demonstrates myelin figures and numerous lysosomes.
Differential Diagnosis:
- Fat necrosis
- Apocrine carcinoma
- Histiocytic lesion of the breast
- Metastatic neoplasms
References:
- Haber M. et al, Differential diagnosis in surgical pathology, Copyright 2002.
- Rosen, P.P. Breast Pathology, Copyright
1997.
- Tavassoli FA. Pathology of the Breast (2nd ed.). (1999). McGraw-Hill.
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