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LETTER TO EDITOR Table of Contents   
Year : 2010  |  Volume : 53  |  Issue : 3  |  Page : 578-579
Granular cell tumor of gastric mucosa


1 Department of Pathology, Shri Sathya Sai Medical College and Research Institute, Thiruporur, India
2 Transplantation Immunology & Molecular Biology, Pathology and Lab Medicine, MIOT Hospitals, Manapakkam, Chennai, India

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Date of Web Publication22-Oct-2010
 

How to cite this article:
Rekha K, Srinivas C N. Granular cell tumor of gastric mucosa. Indian J Pathol Microbiol 2010;53:578-9

How to cite this URL:
Rekha K, Srinivas C N. Granular cell tumor of gastric mucosa. Indian J Pathol Microbiol [serial online] 2010 [cited 2021 Oct 21];53:578-9. Available from: https://www.ijpmonline.org/text.asp?2010/53/3/578/68254


Sir,

Granular cell tumor (GCT) was first described in 1926 by Abrikosof, as cited by Patti et al in their article. [1] GCT has a variable site of occurrence. The theory of histogenesis has been a long lasting controversy. They can occur at multiple sites or as single lesions. The classical location of GCT is the tongue. However, it has been reported in many other sites, such as the cervix, bladder pancreas, and skin. It is reported to present as an isolated lesion or in multiplicity.[ 2],[3 ] There is no age or gender predilection documented. GCT of the gastric mucosa is rare, representing about 1-2% of all benign tumors; they are small in size and hard in consistency. Although GCTs have a variable site of occurrence, there have been very few cases reported in the gastric mucosa. [2]

A 30-year-old man was screened for complaints of upper abdominal discomfort. On endoscopic evaluation, a single polypoidal growth was detected and excised. The well-circumscribed mass measured 2 cm in diameter and had a smooth external surface.


   Microscopic Examination Top


The submitted endoscopic biopsy showed unremarkable gastric epithelium. The lamina propria revealed a tumor composed of sheets of large polygonal to round cells [Figure 1]. The cells showed granular eosinophilic cytoplasm [Figure 2]. The tumor cells are arranged in an ill-defined acinar pattern. The stroma showed thin fibrovascular core. There was no evidence of necrosis or nuclear atypia. Periodic acid Schiff stain was noncontributory. An immunohistochemical stain with S-100 showed weak positivity. A diagnosis of GCT was made as it had all the features.

Microscopically the tumor shows large cells with abundant highly granular cytoplasm. Histochemically these granules contain large amounts of hydrolytic enzymes (acid phosphatase) that are luxol-fast-blue positive. [3] They may present with a basal lamina-like material around the granular cells, indicating repeated injury and repair. The immunohistochemical markers, such as S-100 protein, laminin, myelin basic protein, calretinin, and carcinoembryonic antigen, have been found to be positive. [4]
Figure 1: Gastric mucosa with granular cells in the lamina (H and E, ×200)

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Figure 2: Tumor cells with abundant eosinophilic granular cytoplasm (H and E, ×400)

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Most often they have a benign course. The features favoring malignancy in GCT are necrosis, spindling of tumor cells, vesicular nuclei with large nucleoli, and increased mitotic activity. [5]

The histogenesis of the granular cell is a lasting controversy between Schwann cells and smooth muscle cells and tumor ameloblasts. [6] It has further been analyzed that GCT is not a specific entity but rather the expression of degenerative changes leading to the cytoplasmic accumulation of liposomes. [6] This secondary change can occur in either the Schwann cells or any other cells that are part of a normal lesion or form a part of a malignant neoplasm. [7],[8],[9]

The diagnosis of GCT is favored only when the entire lesion presents with the morphology of granular cytoplasmic feature. Our case presented as an isolated polypoidal lesion with the classical microscopic features of a GCT. The individual had no other neoplastic or metabolic disorder. The documentation of such isolated presentation with no associated neoplasm and its staining property would support the theory of its histogenesis to neuroendocrine origin.

 
   References Top

1.Patti R, Almasio PL, Di Vita G. Granular cell tumor of stomach: A case report and review of literature. World J Gastroenterol 2006;12:3442-5.  Back to cited text no. 1      
2.Chandrasoma P, Fitzgibbons P. Granular cell tumor of the intrapancreatic common bile duct. Cancer 1984;53:2178-82.   Back to cited text no. 2      
3.Copas P, Dyer M, Hall DJ, Diddle AW. Granular cell myoblastoma of the uterine cervix. Diagn Gynecol Obstet 1981;3:251-4.  Back to cited text no. 3      
4.Mittal KR, True LD. Origin of granules in Granular cell tumor. Intracellular myelin formation with auto digestion. Arch Pathol Lab Med 1988;112:302-3.  Back to cited text no. 4      
5.Fine SW, Li M. Exp of calretinin and the alpha sub unit of inhibin in granular cell tumor. Am J Clin Pathol 2003;119:259-64.  Back to cited text no. 5      
6.Fanburg-Smith JC, Meis-Kindblom JM, Fante R, Kindblom LG. Malignant granular cell tumor of soft tissue: Diagnostic criteria and Clinicopathological correlation. Am J Surg Pathol 1998;22:779-94.  Back to cited text no. 6      
7.Ordσρez NG, Mackay B. Granular cell tumor a review of the pathology and histogenesis. Ultrastruct Pathol 1999;23:207-22.  Back to cited text no. 7      
8.Finkel G, Lane B. Granular cell variant of neurofibromatosis: ultrastructure of benign and malignant tumors. Hum Pathol 1982;13:959-63.  Back to cited text no. 8      
9.Miettinen M, Lehtonen E, Lehtola H, Ekblom P, Lehto VP, Virtanen I. Histogenesis of granular cell tumor: An immunohistochemical and ultrastructural study. J Pathol 1984;142:221-9.  Back to cited text no. 9      

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Correspondence Address:
K Rekha
H54/16 South Avenue, Kamaraj Nagar, Thiruvanmiyur, Chennai -600 041, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.68254

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