Korean J Thorac Cardiovasc Surg 2012;45:196-198
□ Case Report □
ISSN: 2233-601X (Print) ISSN: 2093-6516 (Online)
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1Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, 2Department
of Thoracic and Cardiovascular Surgery, Konkuk University Chungju Hospital, Konkuk University School of Medicine,
Pathology, Konkuk University Medical Center, Konkuk University School of Medicine
Received: September 5, 2011, Revised: September 20, 2011, Accepted: October 16, 2011
Corresponding author: Jae Joon Hwang, Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Konkuk
University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 143-729, Korea
(Tel) 82-2-2030-7592 (Fax) 82-2-2030-7743 (E-mail) firstname.lastname@example.org
C The Korean Society for Thoracic and Cardiovascular Surgery. 2012. All right reserved.
CC This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creative-
commons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the
original work is properly cited.
Fig. 1. Ultrasonography shows an ill-defined and markedly hypo-
echoic mass with posterior acoustic shadowing and a surrounding
Granular Cell Tumor Occurring in the Chest Wall: A Case Report
Ji Young Park, M.D.1, Jae Joon Hwang, M.D.1, Song Am Lee, M.D.1, Woo Surng Lee, M.D.2,
Yo Han Kim, M.D.2, Hyun Keun Chee, M.D.1, Wan Seop Kim, M.D.3
Granular cell tumors are uncommon soft tissue neoplasm of nerve sheath origin, which are predominately benign.
Granular cells can be found at any site in the body including the tongue, skin, subcutaneous tissue, breast, gas-
trointestinal, and urogenital systems. However, granular cell tumors have only been rarely described in the chest
wall. Here we report a case of a granular cell tumor that occurred in the chest wall of a 59-year-old woman,
along with a review of the literature.
Key words: 1. Chest wall
2. Surgical operation
3. Granular cell tumor
A 59-year-old woman presented to our hospital with a
four-month history of a non-tender, hard mass at her left lat-
eral chest wall on the 7th rib. She had no previous history of
any significant illness. Physical examination revealed a 4×3
cm, movable, and mildly tender mass. It was located in the
subcutaneous tissue. The overlying skin was normal. Ultraso-
nography showed a solid mass 3 cm in diameter, which had
caused an acoustic shadowing in the posterior aspect (Fig. 1).
The patient underwent a surgical excision of the tumor. The
mass was carefully dissected using electrocautery as it was
severely attached to the latissimus dorsi muscle. The surgical
specimen was transferred to the department of pathology for
accurate diagnosis. The specimen (4.0×3.5×1.7 cm) consisted
of pinkish, soft tissue. On the cut section, the cut surface
Granular Cell Tumor
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Fig. 2. Upon gross examination, the cut surface shows a yellow
homogeneous appearance. There was no hemorrhage or necrosis
within the lesion.
Fig. 3. (A) Upon microscopic examination, the tumor was found to be composed of large polygonal cells arranged in cords or sheets that
were divided by slender fibrous tissue (H&E, ×400). (B) Upon immunohistochemical examination, the tumor was found to be positive for
S-100 protein (×400). (C) Electron microscopy revealed numerous variably sized phagolysosomes in the cytoplasm.
showed a yellow homogeneous appearance. There was no
hemorrhage or necrosis within the lesion, observed grossly
(Fig. 2). The histological examination revealed polygonal
cells with eosinophilic granular cytoplasm, fibrous septae be-
tween the clusters, cells with vesicular nuclei with a prom-
inent nucleolus, eosinophilic granular cytoplasm, and eosino-
philic intracytoplasmic particles surrounded by a clear halo
(Fig. 3A). The immunohistochemical examination showed that
S-100 protein and CD68 were positive, and cytokeratin was
negative (Fig. 3B). Electron microscopic findings showed the
basal membrane of the tumor cell, and autophagosome gran-
ules of varying size (Fig. 3C). These findings led us to the
diagnosis of benign granular cell tumor. The patient had an
unremarkable post-operative recovery and was discharged the
next day. After a 3-month follow-up, the lesion has shown no
The granular cell tumor (GCT) is rare and almost benign.
It usually develops as a painless mass, and most patients
present with a mass as the primary symptom. GCTs were
first described in the skeletal muscle of the tongue by
Abrikossoff as “myoblastic myomata” in 1926 . The GCT
incidence is higher for women than men, with a ratio of 1.8
−2.4/1. It is a rare tumor predominantly found in the skin or
subcutaneous tissue of the head and neck regions. Other fre-
quent locations are the tongue (40%), breast (15%), respira-
tory tract (10%), and esophagus (2%). GCTs can often be
multicentric (5% to 14% of cases) . In Korea, Seo et al.
 reported a GCT in the main bronchus. GCT is very rarely
found in the chest wall, and no Korean studies have reported
Abrikossoff  described this type of neoplasm as a myo-
blastoma, reflecting its probable origin from striated muscle
cells. The histogenesis of these tumors is still controversial,
but their immunohistochemical and ultrastructural features
Ji Young Park, et al
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have been accepted as neural or neuroectodermal in origin 
because they are immunoreactive for the S-100 protein and
neuron-specific enolase, and they demonstrate lysosomes on
electron microscopy. They are also characterized by im-
munopositivity for CD68 and inhibin-alpha, but they are neg-
ative for cytokeratins .
Microscopically, GCTs are characterized by large polygonal
tumor cells with an abundant granular cytoplasm and rela-
tively small nuclei. The granules in the cytoplasm are peri-
odic acid-Schiff-positive and diastase-resistant. The tumor
cells may on rare occasion show a moderate degree of the
nuclear atypism. The cells are arranged in nests or cords sep-
arated by fibrous connective tissue. The periphery of the tu-
mor is not sharply defined, and this creates an appearance of
infiltration that is highlighted when lymphoid tissue envelops
the tumor cells.
The differential diagnosis of GCT includes rhabdomyoma,
hibernoma, oncocytoma, extragastrointestinal stromal tumor
(EGIST), and the reactive changes associated with trauma and
injury. The histologic characteristics and reactivity toward
S-100 and CD68 distinguish GCT from rhabdomyoma, which
contains glycogen and hibernoma, which contains lipid
droplets. Ultrastructurally, the lack of mitochondria differ-
entiates GCT from oncocytoma. GCTs can mimic EGIST
with epithelioid cells. The negative reaction to c-kit and
CD34 distinguish GCT from EGIST. The inflammatory cells
and areas of necrosis in the reactive change from trauma and
injury are absent in GCT .
The distinction between a benign, atypical, and malignant
GCT is challenging based upon morphology alone, as the dif-
ferent grades are all histologically similar. Furthermore, ma-
lignant granular cell tumors are exceedingly rare, comprising
less than 1% of all granular cell tumors. The criteria pro-
posed to distinguish between them includes: The presence of
necrosis, spindle cell morphology, increased nuclear-to-cyto-
plasmic ratio, nuclear pleomorphism, prominent nucleoli, and
increased mitotic rate (＞2/10 high power fields) . GCTs
are classified as malignant if they display three or more of
these criteria, as atypical if they display two, and as benign if
they display only pleomorphism but no other criteria. The
prognosis of malignant GCT is poor due to local recurrence
The treatment of choice for malignant GCT is radical re-
section with clear surgical margins . Radiation and chemo-
therapy are not recommended due to the tumor’s high degree
of resistance to radiation or chemotherapy. Complete surgical
resection is considered curative. Even when negative margins
are not obtained, the prognosis is good. Patients with a ma-
lignant GCT are best managed with wide local excision and
regional lymph node dissection .
We describe here a rare case of GCT that occurred at the
chest wall. We expect that this report will assist in the under-
standing of the characteristics of GCT and in correctly diag-
nosing the disease.
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