Granular cell tumor of the lung

Abstract

A 46‐year‐old female with history of asthma, active smoking (20 pack‐years), and schizophrenia was evaluated for a persistent asymptomatic pulmonary nodule. Her past medical history was notable for hypertension, obesity, polycystic ovary syndrome, abnormal uterine bleeding, multinodular thyroid gland, and vitamin D deficiency. Seven months before presentation, a chest radiograph (CXR) was obtained to evaluate unintended weight loss, and showed a 3 cm spiculated mass in the left lower lobe concerning for a primary lung malignancy. Follow‐up computed tomography (CT) suggested that the left lower lobe mass corresponded to rounded atelectasis; however, at 6 month follow‐up, low‐dose chest CT scan revealed a 2.1 × 1.2 cm nodule within the central portion of the left lower lobe, with pleural thickening, and arising from or extending into the left lower lobe bronchus. The patient had no recent history of appetite change, exertional dyspnea, chronic cough, wheeze, fever, or other chest complaints. Her examination showed normal vital signs, oxygen saturation of 98% while inspiring room air, and an entirely normal lung and general physical examination, except for diminished breath sounds at the left base with no wheeze. An endobronchial ultrasound (EBUS) with fine‐needle aspiration (FNA) and endobronchial biopsy was performed.

Atypical cytological presentation of granular cell tumour: Tumour‐associated fibrosis may affect fine‐needle aspiration cytology accuracy

“…In our series, cases 5 and 7 showed fibrosis score 3‐4, and FNAC was less cellular and mainly represented by naked nuclei as occurred in other experiences 13 , 17 . Specimen cellularity may be variable, ranging from scant to abundant on FNAC samples 7‐20 and the presence of naked nuclei may depend on the fibrosis associated with the tumour 2 , 29 . Therefore, when smears are poorly cellular, attention should be paid to the finely granular background containing few whole cells, which may be the only features to suggest GCT.…”

“…FNAC is now a valid and accurate means in the preoperative evaluation of mesenchymal tumours 19‐21 . FNAC features of GCT may be sufficient, in typical cases, for an accurate FNAC diagnosis 7 , 8 , 10‐12 , 14 , 15 , 18 . Nonetheless, because of the rarity and atypical anatomical or cytological presentation, GCT has been cytologically confused with proliferative myositis, 7 breast apocrine cells 11 or thyroid Hurthle cells 9 , 13 .…”

“…Fine needle aspiration cytology (FNAC) features of GCT have been described 2‐21 but, even though GCT may arise in different sites, FNAC reports mainly account for GCT from specific sites that are more frequently targeted by FNAC (ie, breast, thyroid, skin) 2‐21 . GCT cytological features and diagnostic criteria are well known and sufficiently typical to suggest the FNAC diagnosis 2‐20 . Nonetheless, in some cases, cytological features may be less specific and the FNAC diagnosis of GCT may be difficult or impossible 11 , 13 , 17 .…”

Cytologic and histological features of rare nonepithelial and nonlymphoid tumors of the thyroid

“…Their diagnosis is challenging mostly due to the rarity in this exact anatomic location and because their clinical‐radiological findings mimic malignancy 1,2,4,56‐63 . The majority of reported patients were women between the ages of 20 and 50 years 51‐65 …”

“…51 Their most common location is the head and neck, particularly the tongue. 1,2,[51][52][53][54][55][56][57][58][59][60][61][62][63][64][65] To date, around 20 GCTs arising in the thyroid gland have been described in the literature. Their diagnosis is challenging mostly due to the rarity in this exact anatomic location and because their clinical-radiological findings mimic malignancy.…”