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Presented by Pedram Argani, M.D. and prepared by Shiyama Mudali, M.D.
Case 4: This is a 50 year old female with a spiculated breast mass.
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1. Question
Week 443: Case 4
This is a 50 year old female with a spiculated breast mass.images/1alex/07192010case4image1.jpg
images/1alex/07192010case4image2.jpg
images/1alex/07192010case4image3.jpgCorrect
Answer: Granular cell tumor
Histology: This is an ill defined proliferation of polygonal cells which granular pink cytoplasm. Mitotic activity is not evident, and cytological atypia is absent. The granularity is fine throughout the cytoplasm of the cells. Lesional cells are immunoreactive for S100 protein, and CD68, but negative for cytokeratin. These are the typical features of granular cell tumor.
Discussion: Alveolar soft part sarcoma would feature a more nested architecture, and more prominent nucleoli. Invasive lobular carcinoma would show greater cytologic atypia, a greater linear growth pattern, and would be immunoreactive for cytokeratin. Histiocytic reactions would label CD68 and not for S100 protein.
Incorrect
Answer: Granular cell tumor
Histology: This is an ill defined proliferation of polygonal cells which granular pink cytoplasm. Mitotic activity is not evident, and cytological atypia is absent. The granularity is fine throughout the cytoplasm of the cells. Lesional cells are immunoreactive for S100 protein, and CD68, but negative for cytokeratin. These are the typical features of granular cell tumor.
Discussion: Alveolar soft part sarcoma would feature a more nested architecture, and more prominent nucleoli. Invasive lobular carcinoma would show greater cytologic atypia, a greater linear growth pattern, and would be immunoreactive for cytokeratin. Histiocytic reactions would label CD68 and not for S100 protein.
