Granular cell tumour of the left breast

Case contributed by Dr Mark Holland

Presentation

2nd round breast screen patient recalled due to 8mm, spiculated mass on the edge of the film. At breast assessment clinic there was no palpable breast mass, no mass on further mammographic views and no breast mass at ultrasound. MR confirmed the true postion of the mass, just inferior to the axilla and an ultrasound biopsy was performed

Patient Data

Age: 55 years
Gender: Female
Mammography

Breast assessment mammogram

Spiculated mass overlying the left pectoral muscle that is better seen on an extended lateral film

BIRADS R4 (Tabar / Nottingham  4A) appearance at mammography, ultrasound and MR

Biopsy result is a benign granular cell tumour that expresses S100   (P2)

Tumour was surgical resected and the patient reassured.

Pathology

Macroscopy

An irregular firm stellate  lesion with white cut surface measuring 20 x 15 x18 mm.

Microscopy

Solid nests of cells , cords and sheets of cells  with abundant eosinophilic granular cytoplasm, prominent nucleoli and moderate cellular atypia.

Polygonal , spindle-like cells resting in a hyaline, fibrous stroma.

The cells have distinct borders, small centrally to eccentrically placed nuclei , inconspicuous nucleoli and abundant eosinophilic cytoplasm. B

The cytoplasm contains numerous fine granules as well as scattered larger eosinophilic granules.

There is no evidence of nuclear pleomorphism, multinucleated cells or mitosis.

Stains and Immunohistochemistry

  • DPAS positive
  • Nuclear and cytoplasmic positivity for S100.
  • Cytoplasmic staining for CD68, due to their lysososmal activity.
  • Negative for Cytokeratins, HMB45 and MelanA

Case Discussion

Ganular cell tumours were originally described by Abrikossoff in 1926 and are usually found in the mouth or skin but 6% occur in the breast. Up to 10% are multiple.

Incidence < 1 in a 1000 breast masses

Occurs from 20 – 80 but around 40 years of age most common with slight preponderance in premenopausal black women

Usually less than 30mm in size, and are most frequently found in the upper inner quadrant (supraclavicular nerve territory) followed by the axillary tail. 

They are a neuroendocrine tumour of perineural or Schwann cell origin that typically express S100 and CD68 (KP-1)

At mammography -  range from a round well-circumscribed mass, to an indistinct or spiculated lesion. Microcalcifications are not usually a feature.

At ultrasound, present as solid, poorly marginated lesions with marked posterior shadowing or as more benign-appearing well-circumscribed solid masses. Lesion often have a reflective halo or are partially hyper-reflective which is due its infiltrative growth pattern.

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Case information

rID: 19062
Case created: 4th Aug 2012
Last edited: 30th Jan 2016
System: Breast
Inclusion in quiz mode: Included

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