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LETTER TO EDITOR
Year : 2022  |  Volume : 70  |  Issue : 4  |  Page : 1710-1711

Granular Cell Tumor of the Median Nerve Masquerading as Neurofibroma


1 Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
3 Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission23-Oct-2020
Date of Decision27-Jan-2021
Date of Acceptance15-Feb-2021
Date of Web Publication30-Aug-2022

Correspondence Address:
Debajyoti Chatterjee
Department of Histopathology, Research Block A, 5th Floor, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.355105

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How to cite this article:
Joshi RP, Chatterjee D, Gaba S. Granular Cell Tumor of the Median Nerve Masquerading as Neurofibroma. Neurol India 2022;70:1710-1

How to cite this URL:
Joshi RP, Chatterjee D, Gaba S. Granular Cell Tumor of the Median Nerve Masquerading as Neurofibroma. Neurol India [serial online] 2022 [cited 2022 Oct 7];70:1710-1. Available from: https://www.neurologyindia.com/text.asp?2022/70/4/1710/355105




Sir,

Granular cell tumor (GCT) is an uncommon tumor of soft tissue showing schwannian differentiation, which usually affects middle-aged females. It frequently affects the head and neck with the tongue being the most common site followed by skin and subcutaneous tissue.[1] Its origin from peripheral nerves is very rare. To our knowledge, only two cases of GCT arising from the median nerve and its branches have been reported in the literature [Table 1].[1],[2] Herein, we document another case of GCT of the median nerve.
Table 1: Cases of granular cell tumor involving the median nerve

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A 48-year-old female presented with swelling and difficulty in moving the right upper arm for 15 years. Tingling sensation and paresthesia were noted over median nerve distribution. On examination, a vague mass was palpable in the arm measuring 4 × 4 × 3 cm, which was tender, hard in consistency, fixed to the underlying structure, and free from overlying skin. Magnetic resonance imaging (MRI) showed an oblong-shaped, encapsulated, heterogeneously enhancing, mild T2-weighted (T2W) hyperintense and T1-weighted (T1W) hypointense lesions measuring 2.3 × 2.4 × 4.4 cm in the right mid-arm along the course of the median nerve. A possibility of neurofibroma was suggested and the patient underwent surgery. Intraoperatively, an 8-cm long segment of the median nerve involvement by the tumor was noted [Figure 1]. It was dissected carefully along with part of the median nerve and sent for pathological examination.
Figure 1: (a) and (b) Operative photograph showing a fusiform tumor (black arrows) attached to and infiltrating the median nerve (blue suture)

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Cut surface showed partially circumscribed grayish-white, homogenous tumor. Microscopic examination revealed a tumor arranged in varying size lobules separated by dense fibrous stroma, predominantly involving the epineurium, and also extending into the endoneurium of the nerve fascicles at places. These tumor cells were large, polygonal with mild nuclear pleomorphism, vesicular chromatin, and abundant coarse granular eosinophilic cytoplasm. No mitosis, necrosis, or spindle cell component was noted thereby ruling out malignant GCT. On performing immunohistochemistry, the tumor cells were positive for S100 and CD68 [Figure 2] and negative for desmin, vimentin, cytokeratin, epithelial membrane antigen (EMA), and CD 34 ruling out myogenic tumors, epithelioid sarcoma, and vascular tumors, respectively. Hence, it was diagnosed as GCT. At 13 months of follow-up, the patient was asymptomatic without any recurrence.
Figure 2: (a, b, and c) Microphotograph shows the tumor arranged in varying size lobules in a fibrous stroma, involving the epineurium and also extended into the endoneurium of the nerve fascicles (hematoxylin and eosin, ×100), (d) The tumor cells are large, polygonal and contain abundant granular eosinophilic cytoplasm (hematoxylin and eosin, ×200), (e and f) S-100 immunostain highlights the tumor cells (lower half) as well as the nerve (upper half), CD68 immunostain highlights the tumor cells while the nerve fascicle is negative (immunohistochemistry, ×100)

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GCT of the peripheral nerve is an uncommon occurrence.[3] Hence, preoperative diagnosis is difficult. Though peripheral nerve sheath tumors more commonly involve peripheral nerve, a possibility of GCT should be considered, especially when the MRI is suggestive.[4]

A complete excision followed by nerve grafting is associated with a good prognosis and decreased recurrence rate.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Tsukamoto S, Takeda M, Honoki K, Omokawa S, Tanaka Y. Malignant granular cell tumor of the median nerve: A case report with a literature review of 157 cases. Skeletal Radiol 2019;48:307-16.  Back to cited text no. 1
    
2.
Condit DP, Pochron MD. Granular cell tumor of the palmar cutaneous branch of the median nerve. J Hand Surg 1991;16:71-5.  Back to cited text no. 2
    
3.
Mindea SA, Kaplan KJ, Howard MA, O'Leary ST. Granular cell tumor involving the axillary nerve: An unusual occurrence. Case report. Neurosurg Focus 2007;22:E24.  Back to cited text no. 3
    
4.
Blacksin MF, White LM, Hameed M, Kandel R, Patterson FR, Benevenia J. Granular cell tumor of the extremity: Magnetic resonance imaging characteristics with pathologic correlation. Skeletal Radiol 2005;34:625-31.  Back to cited text no. 4
    


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