Granular Cell Tumor of Vulva: Mesquerading Reactive Histiocytic Proliferation
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LETTER TO THE EDITOR
Granular Cell Tumor of Vulva: Mesquerading Reactive Histiocytic Proliferation Rashi Garg 1
&
Neelam Gupta 1 & Rajat Gupta 1 & Anchal Bhola 1
Received: 13 June 2020 / Accepted: 19 August 2020 # Indian Association of Surgical Oncology 2020
Sir, Granular cell tumors of vulva are an uncommon variety of tumors. They are believed to be neural in origin and derived from Schwann cells. Approximately 10% of these involve the vulva specially labia majora. Only a handful of cases are reported in the literature till date [1]. Here in, we report a rare case of benign vulvar granular cell tumor with extension in the surrounding adipose tissue. A 50-year-old female presented with a slow growing swelling on the left labia majora for the past 4 years. There was no history of bleeding or pain at the local site. The patient had undergone hysterectomy for uterine leiomyoma 4 years back and bi-lateral fallopian tubal ligation 27 years back. On examination there was a 4 × 2 cm swelling on the left labia majora. She underwent excision biopsy. On gross examination, the mass was a globular tissue piece measuring 4 × 2 × 1.5 cm. The outer surface was grayish white with surrounding fibrofatty tissue. It was firm in consistency with pale yellow to tan color on cut surface. Microscopic examination revealed a poorly circumscribed tumor composed of nests and lobules of round to polygonal cells embedded in thick collagenized stroma (Fig. 1a). Tumor cells were seen infiltrating into the surrounding fibrofatty tissue (Fig. 1b). The cells have small, round, bland nucleus; inconspicuous nucleoli; and abundant fine to coarse granular eosinophilic cytoplasm (Fig. 1c). Focal lymphoid follicles and lymphocytic infiltration were also noted (Fig. 1d). Surgical margins were free of tumor. Tumor cells were PAS positive and diastase resistant (Fig. 1e). On immunohistochemistry, tumor cells showed nuclear and cytoplasmic positivity for S-100 (Fig. 1f). So the final diagnosis of granular cell tumor was rendered.
* Rashi Garg [email protected] 1
Department of Pathology, Maharishi Markandeshwar Medical College & Hospital, Solan, Himachal Pradesh 173229, India
Granular cell tumors commonly involve the skin, submucosal or subcutaneous tissue of the head and neck, and especially the tongue and oral cavity. They rarely involve the vulva [1, 2]. The mean age range is 17–59 years. One to two percent of the cases are malignant and may be associated with regional or distant metastases. Large tumor size, deep soft tissue location, necrosis, and distant metastasis are the features which indicate malignancy [3]. These are slow growing, non-tender, mobile lumps which grow over months or years. Granular cell tumors rarely exceed a size of more than 4 cm in diameter and lack encapsulation. Overlying skin may be depigmented, may be occasionally ulcerated, or may be thickened [3]. Microscopically granular cell tumors have bland features with sheets and cords of large polygonal, round, or elongated cells with abundant and eosinophilic granular cyto
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