A Rare Case: Malignant Granular Cell Tumor in Axillary Region

Granular cell tumors (GCT) are rare soft tissue tumors. Although it is frequently seen in the upper extremity, it can be seen anywhere in the human body. The majority of tumor cases are benign and approximately 2% are malignant. It is seen in the breast at a rate of 5-8%. They present with a slow growing, painless, mobile mass. The definitive diagnosis is made histopathologically and the treatment is wide excision. A 75-year-old woman presented with an ulcerated exudative mass in the right axilla. Mastectomy and axillary dissection were performed by general surgery 8 months ago for BIRADS 3 mass that was determined on mammography in the right breast. Breast specimen was identified as a phyllodes tumor. GCT was detected in five of thirty lmph nodes in the axilla. Incisional biopsy was performed on the axillary mass. Histopathological measurements showed S-100 and CD68 positivity, eosinophilic staining in tumor cells and pleomorphic nuclei with marked nucleolus. The tumor was removed with wide excision and the defect area was closed with a splint thickness skin graft. The pathological measurements revealed that the GCT in the axilla was not a breast metastasis, it was actually malignant GCT which was originated from skin. Ki-67 proliferation index was found as 10%. Surgical margins were seen as tumor free. There were no complications in the postoperative follow-up. GCTs in the axilla are generally seen as a result of breast metastasis and the vast majority are benign. Malignant skin-derived GCT is a rare case

The role of Immunohistochemical antibodies, Namely, Napsin A, Caveolin-1, Type III Collagen and Tenascin-X, in the differential diagnosis of primary lung adenocarcinoma and pleural epithelioid malignant mesothelioma

Malign mezotelyoma, başta plevrayı ve diğer serozal yüzeyleri döşeyen mezotel hücrelerinden gelişen, kötü seyirli, nadir görülen malign bir tümördür. Malign mezotelyomanın çeşitli histolojik paternler göstermesi nedeniyle, özellikle epiteloid tip plevral malign mezotelyomanın, periferik yerleşimli ve plevra invazyonu oluşturan primer akciğer adenokarsinomuyla ayırıcı tanısı patologlar açısından zordur. Bu durumda immünohistokimyasal antikorlar ayırıcı tanıya yardımcı olabilir. Çalışmamızda, akciğer adenokarsinomuyla epiteloid tip malign mezotelyomaların ayırıcı tanısında, napsin A, caveolin-1, tip III kollajen ve tenascin-X immünohistokimyasal antikorlarının değerini belirlemeyi amaçladık. Çalışmamız için 2005-2014 yılları arasında, Uludağ Üniversitesi Tıp Fakültesi Tıbbi Patoloji bölümünde tanı almış 35 akciğer adenokarsinomu ile 35 epiteloid tip malign mezotelyoma olgusunun tümör içeren parafin bloklarına, napsin A, caveolin-1, tip III kollajen ve tenascin-X antikorları uygulandı, her iki tümördeki boyanma oranları incelendi. Adenokarsinom olgularının 25’i erkek, 10’u kadın (erkek/ kadın 2.5), malign mezotelyoma olgularının 19’u erkek, 16’sı kadın (erkek/ kadın oranı 1.1) olarak belirlendi. Olguların yaş ortalaması adenokarsinomda 62, malign mezotelyomada 62 olarak saptandı. Adenokarsinom olgularında; napsin A ile %94.3 oranında, caveolin-1 ile %40 oranında, tenascin-X ile %37.2 oranında pozitivite görülürken, tip III kollajen ile pozitiflik saptanmadı. Malign mezotelyoma olgularında; napsin A ile %2.9 oranında, caveolin-1 ile %97.2 oranında, tip III kollajen ile %17.1 oranında, tenascin-X ile %88.6 oranında pozitiflik belirlendi. Her 4 antikorun immünohistokimyasal boyanmasında, adenokarsinom ve malign mezotelyoma olguları arasında, istatistiksel olarak anlamlı bir fark tespit edildi. Sonuç olarak; napsin A, caveolin-1, tip III kollajen ve tenascin-X antikorlarının, akciğer adenokarsinomu ve plevral epiteloid tip malign mezotelyomaların ayırıcı tanısında yarar sağlayabileceği kanısına varıldı.Malignant mesothelioma is a rare malignant tumour, with a poor outcome, which develops in the mesothelial cells lining serosal surfaces, primarily the pleura. Since malignant mesothelioma may display a variety of histological patterns, there may be problems, for the pathologists, in the differential diagnosis of pleural epithelioid malignant mesothelioma from lung adenocarcinoma which is localized in the periphery of lung and invades pleura. In such cases, immunohistochemical antibodies might be useful for the differential diagnosis. In our present study, we aimed to determine the value of napsin A, caveolin-1, type III collagen and tenascin-X markers in the differential diagnosis of lung adenocarcinoma and epithelioid malignant mesothelioma. The study included 35 cases of lung adenocarcinoma and 35 cases of epithelioid malignant mesothelioma which were diagnosed in the Uludag University Medical Faculty, Department of Pathology, between the years of 2005-2014. Tumour-containing paraffin-embedded tissue sections of these cases were applied napsin A, caveolin-1, type III collagen and tenascin-X antibodies by use of immunohistochemistry and immunohistochemical expression characteristics of these markers in both tumours were evaluated. Among the 35 adenocarcinoma cases, 25 cases were male and 10 were female (gender ratio of 2.5:1) and the median age was 62 years. 19 cases of the malignant mesothelioma patients were male and 16 cases of them were female (gender ratio of 1.1:1) and the median age was also 62 years. Adenocarcinoma cases were napsin A positive in 94.3%, caveolin-1 positive in 40% and tenascin-X positive in 37.2%. All of the cases were negative for type III collagen. Malignant mesothelioma cases were napsin A positive in 2.9%, caveolin-1 positive in 97.2%, type III collagen positive in 17.1% and tenascin-X positive in 88.6%. A statistically significant difference was found between the cases of adenocarcinoma and malignant mesothelioma in immunohistochemical staining of all these markers. In conclusion, napsin A, caveolin-1, type III collagen and tenascin-X markers were evaluated to be useful in the immunohistochemical differential diagnosis of pulmonary adenocarcinoma and pleural epithelioid malignant mesothelioma

The role of immunohistochemical antibodies, namely, napsi̇n A, caveolin-1, TYPE III collagen and tenascin-x, in the differential diagnosis of primary lung adenocarcinoma and pleural epithelioid malignant mesothelioma

Malign mezotelyoma, başta plevrayı ve diğer serozal yüzeyleri döşeyen mezotel hücrelerinden gelişen, kötü seyirli, nadir görülen malign bir tümördür. Malign mezotelyomanın çeşitli histolojik paternler göstermesi nedeniyle, özellikle epiteloid tip plevral malign mezotelyomanın, periferik yerleşimli ve plevra invazyonu oluşturan primer akciğer adenokarsinomuyla ayırıcı tanısı patologlar açısından zordur. Bu durumda immünohistokimyasal antikorlar ayırıcı tanıya yardımcı olabilir. Çalışmamızda, akciğer adenokarsinomuyla epiteloid tip malign mezotelyomaların ayırıcı tanısında, napsin A, caveolin-1, tip III kollajen ve tenascin-X immünohistokimyasal antikorlarının değerini belirlemeyi amaçladık. Çalışmamız için 2005-2014 yılları arasında, Uludağ Üniversitesi Tıp Fakültesi Tıbbi Patoloji bölümünde tanı almış 35 akciğer adenokarsinomu ile 35 epiteloid tip malign mezotelyoma olgusunun tümör içeren parafin bloklarına, napsin A, caveolin-1, tip III kollajen ve tenascin-X antikorları uygulandı, her iki tümördeki boyanma oranları incelendi. Adenokarsinom olgularının 25'i erkek, 10'u kadın (erkek/ kadın 2.5), malign mezotelyoma olgularının 19'u erkek, 16'sı kadın (erkek/ kadın oranı 1.1) olarak belirlendi. Olguların yaş ortalaması adenokarsinomda 62, malign mezotelyomada 62 olarak saptandı. Adenokarsinom olgularında; napsin A ile %94.3 oranında, caveolin-1 ile %40 oranında, tenascin-X ile %37.2 oranında pozitivite görülürken, tip III kollajen ile pozitiflik saptanmadı. Malign mezotelyoma olgularında; napsin A ile %2.9 oranında, caveolin-1 ile %97.2 oranında, tip III kollajen ile %17.1 oranında, tenascin-X ile %88.6 oranında pozitiflik belirlendi. Her 4 antikorun immünohistokimyasal boyanmasında, adenokarsinom ve malign mezotelyoma olguları arasında, istatistiksel olarak anlamlı bir fark tespit edildi. Sonuç olarak; napsin A, caveolin-1, tip III kollajen ve tenascin-X antikorlarının, akciğer adenokarsinomu ve plevral epiteloid tip malign mezotelyomaların ayırıcı tanısında yarar sağlayabileceği kanısına varıldı.Malignant mesothelioma is a rare malignant tumour, with a poor outcome, which develops in the mesothelial cells lining serosal surfaces, primarily the pleura. Since malignant mesothelioma may display a variety of histological patterns, there may be problems, for the pathologists, in the differential diagnosis of pleural epithelioid malignant mesothelioma from lung adenocarcinoma which is localized in the periphery of lung and invades pleura. In such cases, immunohistochemical antibodies might be useful for the differential diagnosis. In our present study, we aimed to determine the value of napsin A, caveolin-1, type III collagen and tenascin-X markers in the differential diagnosis of lung adenocarcinoma and epithelioid malignant mesothelioma. The study included 35 cases of lung adenocarcinoma and 35 cases of epithelioid malignant mesothelioma which were diagnosed in the Uludag University Medical Faculty, Department of Pathology, between the years of 2005-2014. years. Tumour-containing paraffin-embedded tissue sections of these cases were applied napsin A, caveolin-1, type III collagen and tenascin-X antibodies by use of immunohistochemistry and immunohistochemical expression characteristics of these markers in both tumours were evaluated. Among the 35 adenocarcinoma cases, 25 cases were male and 10 were female (gender ratio of 2.5:1) and the median age was 62 years. 19 cases of the malignant mesothelioma patients were male and 16 cases of them were female (gender ratio of 1.1:1) and the median age was also 62 years. Adenocarcinoma cases were napsin A positive in 94.3%, caveolin-1 positive in 40% and tenascin-X positive in 37.2%. All of the cases were negative for type III collagen. Malignant mesothelioma cases were napsin A positive in 2.9%, caveolin-1 positive in 97.2%, type III collagen positive in 17.1% and tenascin-X positive in 88.6%. A statistically significant difference was found between the cases of adenocarcinoma and malignant mesothelioma in immunohistochemical staining of all these markers. In conclusion, napsin A, caveolin-1, type III collagen and tenascin-X markers were evaluated to be useful in the immunohistochemical differential diagnosis of pulmonary adenocarcinoma and pleural epithelioid malignant mesothelioma