Indian Journal of Pathology and Microbiology
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CASE REPORT  
Year : 2013  |  Volume : 56  |  Issue : 2  |  Page : 161-162
Granular cell tumor of the scrotum: A case report and literature review


1 Department of Clinical Pathology, Tri-Service General Hospital, Songshan Branch; Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
2 Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

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Date of Web Publication23-Sep-2013
 

   Abstract 

Granular cell tumors (GCTs) on the male genitalia are exceedingly rare. Solitary tumors have been reported on the penile shaft, prepuce, corpus cavernosum, glans penis, and scrotum. According to the latest serial analysis by using a MEDLINE search of the literature from January 1970 to December 2011, we identified seven reported GCTs involving the scrotum. We present a new case and perform a brief literature review.

Keywords: Granular cell tumor, scrotum, painless nodule

How to cite this article:
Chen KH, Shang HS, Lin HC, Lee HS, Gao HW. Granular cell tumor of the scrotum: A case report and literature review. Indian J Pathol Microbiol 2013;56:161-2

How to cite this URL:
Chen KH, Shang HS, Lin HC, Lee HS, Gao HW. Granular cell tumor of the scrotum: A case report and literature review. Indian J Pathol Microbiol [serial online] 2013 [cited 2019 May 22];56:161-2. Available from: http://www.ijpmonline.org/text.asp?2013/56/2/161/118674



   Introduction Top


Granular cell tumors (GCTs) are uncommon soft tissue neoplasms. Approximately 50% of all lesions arise in the head and neck, and over half of these lesions arise on the tongue. Women are more commonly affected than men, and Blacks are more commonly affected than Whites. The most common presentation is a < 2 cm smooth asymptomatic skin-colored nodule. This lesion is believed to be of neural origin, although granular cell changes have been reported in a wide variety of neoplastic lesions, including smooth muscle tumors. [1],[2] Rare malignant GCTs have been reported. The characteristic histopathology of a GCT is a non-encapsulated group of polygonal cells with coarse granular eosinophilic cytoplasm that is believed to consist of lysosomes. Although malignant GCTs are rare, features suggesting the diagnosis include necrosis, high mitotic activity, cell spindling, vesicular nuclei with large nucleoli, and pleomorphism. We report a GCT of the scrotum in this study.


   Case Report Top


An 89-year-old Chinese male presented with a painless nodule that was covered by smooth epidermis on the right side of the scrotum, measuring 15 mm in diameter. The nodule was present for approximately 3 weeks and it exhibited no recent enlargement. There was no history of trauma or infection. The mass was excised under spinal anesthesia. A transverse section through the center of the specimen revealed a firm, gray-brown mass without conspicuous capsule. Microscopically, the specimen revealed a well-circumscribed neoplasm in the dermis that was composed of relatively uniform polygonal cells with small basophilic nuclei, eosinophilic granular cytoplasm, and an indistinct cell borders [Figure 1]; nerve involvement was also identified [Figure 1]; inset]. The overlying epidermis displayed no hyperplastic features.
Figure 1: Nerve tissue surrounded by the tumor cells that have characteristic eosinophilic granular cytoplasm and an indistinct cell border (hematoxylin and eosin, ?200). Inset shows nerve involvement (hematoxylin and eosin, ×400)

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   Discussion Top


GCTs are infrequently encountered soft tissue neoplasms. They usually present as solitary, painless nodules of the head, neck, and subcutaneous tissues of the trunk and upper extremities. The most common location for solitary GCTs is the tongue, where 40% of these tumors arise. [2] To our knowledge, most solitary GCTs reported are benign, although malignant tumors have also been reported. They are usually larger than 3 cm in diameter and are extremely rare (1-3% of all reported cases), and these lesions usually present as multiple cutaneous GCTs. Approximately two-thirds of GCT cases occur in females, and two-thirds of all cases are reported in Blacks. [3] According to the latest serial analysis by using a MEDLINE search of the literature from January 1970 to December 2011, we identified seven reported GCTs involving the scrotum. Excluding our present case (89 years old) and the case (6 years old) reported by Sidwell et al. [4] [Table 1], these patients have a similar age distribution as those with GCTs in other locations, which usually arise in their third to fifth decade of life, although GCTs have infrequently been reported in children and the elderly. All seven reported GCTs of the scrotum presented as painless intradermal nodules, including the case with epidermal ulceration. Through serial immunohistochemical studies, GCTs are currently considered to originate from Schwann cells. GCTs surrounded by or involving nerve tissue as observed in our case [Figure 1] have been reported in other soft tissues. However, this finding has not been described in scrotal lesions previously. Because of its indolent clinical course, it is reasonable to deduce that GCTs of the scrotum are common and may not be excised often. Any suspicious lesion should be excised and sent for pathological examination. The majority of GCTs are benign. However, despite the rarity of malignant GCTs, GCTs should be included in the differential diagnosis of scrotal masses, and simple excision with adequate margins is a sufficient treatment.
Table 1: Granular cell tumors of the scrotum reported in the literatures

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[10]

 
   References Top

1.Mentzel T, Wadden C, Fletcher CD. Granular cell change in smooth muscle tumours of skin and soft tissue. Histopathology 1994;24:223-31.  Back to cited text no. 1
[PUBMED]    
2.Ordonez NG. Granular cell tumor: a review and update. Adv Anat Pathol 1999;6:186-203.  Back to cited text no. 2
    
3.Peters JS, Crowe MA. Granular cell tumor of the toe. Cutis 1998;62:147-8.  Back to cited text no. 3
[PUBMED]    
4.Sidwell RU, Rouse P, Owen RA, Green JS. Granular cell tumor of the scrotum in a child with Noonan syndrome. Pediatr Dermatol 2008;25:341-3.  Back to cited text no. 4
[PUBMED]    
5.Bryant J. Granular cell tumor of penis and scrotum. Urology 1995;45:332-4.  Back to cited text no. 5
[PUBMED]    
6.Altman CE, Hamill R, Pujals J. Multiple cutaneous granular cell tumors of the scrotum. Cutis 1999;63:77-80.  Back to cited text no. 6
[PUBMED]    
7.Medina Perez M, Valpuesta Fernandez I, Valero Puerta J, Perez Martin D. Granular cell tumor of the scrotum with high pseudoepitheliomatous hyperplasia. Arch Esp Urol 1999;52:169-70.  Back to cited text no. 7
    
8.Menendez Lopez V, Osman Agha G, Lopez Almansa M, Funez Liebana R, Garcia Gonzalez E. Unusual localization of granulosa cell tumor. Arch Esp Urol 2001;54:374-5.  Back to cited text no. 8
    
9.Craig E, Rodriguez R, Ruben B. Granular cell tumor of the scrotum. Dermatol Online J 2005;11:25.  Back to cited text no. 9
    
10.Godoy G, Mufarrij PW, Tsou HC, Torre P, Taneja SS. Granular cell tumor of scrotum: A rare tumor of the male external genitalia. Urology 2008;72:716.e7-9.  Back to cited text no. 10
    

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Correspondence Address:
Hong-Wei Gao
No. 325, Sec.2, Chenggong Road, Neihu District, Taipei City
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.118674

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