대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Malignant granular cell tumor

Radiologic Findings

Figure 1. Chest radiography revealed blunting right CP angle with interlobar fissure fluid collection. RLL basal passive atelectasis is suggested.
Figure 2. CECT axial scan showed nodular enhancing pleural thickening with residual pleural fluid collection, post insertion of pig tail catheter. Nodular enhancing lesion is shown in right upper outer breast.
Figure 3. Axial CECT scan showed localized rib destruction and pleural mass infiltrating the chest wall
Figure 4. Coronal CT scan enhancing nodular pleural thickening, dominant mediastinal aspect.

This tumor showed positive result for S-100 protein and CD68.

Brief Review

Granular cell tumors (GCT), first described by Abrikossoff in 1926, are an uncommon mesenchymal soft tissue neoplasm of Schwann cell origin. These tumors may occur throughout the body, usually in the head and neck, skin or subcutaneous tissues of the trunk and upper extremities, breasts and female genital region. They are usually benign and solitary; however, approximately 2% occur as malignant tumors, and 5-10% as multiple lesions. The common sites for distant metastases include bone, peripheral nerves, the peritoneal cavity and the lung.
Due to extensive pleural metastastic nodules, dominant in the mediastinal aspect of pleura, initial imaging differential diagnoses were pleural metastases from lung cancer, mesothelioma. Biopsy from right upper breast nodule and pleura were done revealed same histopathology. Intense contrast enhancing pleural nodules is one of characteristics of granular cell tumor. In case of thorax, mediastinal and tracheobronchial involvements are relatively common than parenchymal involvement.

References

1. Mukai M: Immunohistochemical localization of S-100 protein and peripheral nerve myelin proteins (P2 protein, P0 protein) in granular cell tumors. Am J Pathol 1983;112: 139-146.
2. Gokaslan ST, Terzakis JA and Santagada EA. Malignant granular cell tumor. J Cutan Pathol 1994;21: 363-370.
3. Lack EE, Worsham GF, Callihan MD, Crawford BE, Klappenbach S, Rowden G and Chun B. Granular cell tumor: a clinicopathological study of 110 patients. J Surg Oncol 1980;13: 301-316.
4. Curtis BV, Calcaterra TC and Coulson WF. Multiple granular cell tumor: a case report and review of the literature. Head Neck 1997;19: 634-637

Keywords

pleura, malignant tumor, granular cell,