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CASE REPORT
Year : 2018  |  Volume : 45  |  Issue : 3  |  Page : 143-146

Granular cell tumor of urinary bladder in adult female: A rare case report


1 Department of Urology, Sentini Hospitals, Vijayawada, Andhra Pradesh, India
2 Department of Pathology, Sentini Hospitals, Vijayawada, Andhra Pradesh, India
3 Department of Radio-Diagnosis, Sentini Hospitals, Vijayawada, Andhra Pradesh, India
4 Department of Anaesthesiology, Sentini Hospitals, Vijayawada, Andhra Pradesh, India
5 Pulmonology, Sentini Hospitals, Vijayawada, Andhra Pradesh, India

Date of Web Publication28-Jun-2019

Correspondence Address:
Dr. Ajay Kumar Guntaka
Department of Urology, Sentini Hospitals (P) Ltd., Door No. 54-15-5 B and C, Besides Vinayak Theater, Ring Road, Vijayawada - 520 008, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.JSS_56_18

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  Abstract 


A 47-year-old female presented with dysuria and vague discomfort in the suprapubic region that had lasted for the previous 3 months. On evaluation, ultrasonography kidney-ureter-bladder (KUB) and computerized tomographic scan KUB revealed a nodular growth noted in the urinary bladder measuring 2 cm × 2 cm. Urine cytology was negative for malignant cells. Cystoscopy showed a nodular tumor approximately 2 cm × 2 cm in diameter that was located supratrigonal and extended to the posterior wall of the bladder. The patient underwent transurethral resection of the tumor. Histological examination and immunohistochemical staining showed a granular cell tumor (GCT). There were no features suggesting a malignant phenotype. On follow-up, the patient has remained free of bladder recurrence. We herein report this rare case of a GCT of the urinary bladder and review the literature.

Keywords: Granular cell tumor, immunohistochemistry, urinary bladder


How to cite this article:
Guntaka AK, Koti K, Prasad Babu B, Mutyala AK, Avuthu S. Granular cell tumor of urinary bladder in adult female: A rare case report. J Sci Soc 2018;45:143-6

How to cite this URL:
Guntaka AK, Koti K, Prasad Babu B, Mutyala AK, Avuthu S. Granular cell tumor of urinary bladder in adult female: A rare case report. J Sci Soc [serial online] 2018 [cited 2019 Aug 17];45:143-6. Available from: http://www.jscisociety.com/text.asp?2018/45/3/143/261667




  Introduction Top


Granular cell tumors (GCTs) were first described by Abrikossoff in 1926.[1] GCTs are rare soft tissue tumors, which are usually benign. Since then, however, the histogenesis of GCT has been a matter of serious controversy. This tumor most commonly arises from the head and neck region, especially the tongue. Bladder and other genitourinary organs are uncommon localizations for GCTs. Only 17 cases of GCTs of bladder origin have been reported to date, and only two of them were malignant.


  Case Report Top


A 47-year-old female presented to our hospital with dysuria and vague suprapubic discomfort of 3 months duration. Blood tests, urinalysis, urine cultures, ultrasonography (USG), abdomen/pelvis computerized tomography (CT) scan imaging, and cystoscopic examinations were performed. Urine analysis demonstrated the presence of few pus cells. Urine culture was negative for bacterial growth. USG and CT images showed an circumferential tumor approximately 2 cm × 2 cm in diameter that was located supratrigonal and extended to the posterior wall of the bladder [Figure 1]a and [Figure 1]b. Cystoscopic examination revealed a nodular mass that was approximately 2 cm × 2 cm in diameter localized supratrigonal and extended to the posterior wall of the bladder, protruding into the lumen [Figure 2]. The tumor was removed by transurethral resection. Macroscopically, the neoplasm was 1.8 cm × 1.7 cm in diameter, soft, and white-cream colored. Microscopically, there were cohesive groups of cells in the lobules that were divided by fibrous septae. On hematoxylin and eosin (H and E) at ×200, transurethral resection of a bladder tumor showed transitional lining [Figure 3]. On H and E at ×400, ovoid-to-spindled cells with eoisnophilic granular cytoplasm were observed [Figure 4]. There were no features of malignancy such as necrosis, high mitotic activity, spindling of tumor cells or nuclei with large nucleoli in the resected tumor. There was no evidence of muscle invasion. Immunohistochemical staining revealed diffuse cytoplasmic staining with neuron-specific enolase [Figure 5] and S-100 protein [Figure 6]. These data supported the diagnosis of GCT.
Figure 1: (a) Ultrasonography showing a circumferential tumor approximately 2 cm × 2 cm in diameter that was located supratrigonally and extended to the posterior wall of the bladder. (b) Computerized tomographic showing a circumferential tumor approximately 2 cm × 2 cm in diameter that was located supratrigonally and extended to the posterior wall of the bladder

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Figure 2: Cystoscopic examination showing a nodular mass of approximately 2 cm × 2 cm in diameter localized supratrigonally and extending to the posterior wall of bladder, protruding into the lumen

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Figure 3: Transurethral resection of a bladder tumor showing transitional lining

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Figure 4: Ovoid-to-spindled cells with eosinophilic granular cytoplasm

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Figure 5: Immunohistochemistry with neuron-specific enolase showing diffuse strong cytoplasmic positivity (×200)

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Figure 6: Immunohistochemistry with S-100 showing strong cytoplasmic positivity (×400)

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  Discussion Top


GCTs mostly arise in the upper part of the human body, with approximately two thirds presenting themselves in the head and neck region.[2],[3] Therefore, such a lesion in the urinary bladder is a very uncommon and rare entity with only 16 reported cases in the literature.[4],[5],[6],[7],[8],[9] The tumor shows a slight predominance in females, most often occurring between the ages of 30–60 years;[10] nevertheless, children affected by this neoplasm have also been reported.[6] Symptoms vary regarding the specific location – tumors situated in the urinary bladder frequently cause chronic hematuria, which may lead to severe decrease of hemoglobin and blood pressure. Other less common signs of disease include dysuria, incontinence, and abdominal pain.[4],[6],[8]

The term myoblastoma was first introduced in 1926 by Abrikossoff, who postulated the tumor as being derived from striated muscle cells as a regenerative process after injury to the tissue.[1] Up to now, based on histochemical and ultrastructural findings, three additional theories concerning the histogenesis of GCTs have been discussed:[10] histogenetic origin with histiocytes as the underlying cell population; multicentric origin; and the widely favored neurogenic histogenesis which postulates the derivation from Schwann cells.[11],[12] However, the overall histogenesis is still poorly understood, and although many authors favor a neurogenic origin, either from Schwann cells or modified cells of the neural crest, analysis has failed to identify the direct transition from a Schwann cell to myoblastoma.[13],[14] Histologically, GCTs of all anatomic sites share the same characteristics – they consist of polygonal cells with highly granular cytoplasm with fine eosinophilic granules and scattered larger droplets.[13] There often exists a secondary epithelial hyperplasia if the tumor appears near an epithelial surface.[8]

Granular cells are not unique to GCTs as cytoplasmic granularity typical of GCT (both benign and malignant) has been observed in neoplastic and in nonneoplastic conditions, such as ameloblastoma,[15] ameloblastic fibroma,[16],[17] severed nerves undergoing  Wallerian degeneration More Details,[18] traumatized muscle,[19] leiomyosarcoma,[12] angiosarcoma, and appendiceal granular cell lesions.

Benign and malignant GCT could be similar in histological appearance. Clinical features such as rapid growth, presence of metastases, and local recurrence generally indicate the tumor to be malignant. Microscopic features that favor a diagnosis of malignancy include cellular growth in sheets and clusters with invasion, nuclear hyperchromasia, presence of necrosis, and pleomorphism. Malignant GCTs tend to be slightly more cellular with smaller cells assuming spindle cell morphology. It has been noted that cellular variability or pleomorphism alone is not always a reliable diagnostic criterion. Other features, especially when seen in combination such as necrosis and large vesicular nuclei with large nucleoli and high MIB-1 values, favor malignancy.


  Conclusion Top


Since GCTs arising in the urinary bladder is very rare, careful histological examination should be performed to rule out a more malignant variant of the tumor, thus providing the patient with the best treatment. Transurethral resection is sufficient for most cases. In recent years, immunohistochemical staining has provided a helpful diagnostic tool to distinguish GCTs from various other entities; nevertheless, because of its rarity, diagnosis still may be challenging.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Abrikossoff AI. About fibromas of the striated muscles. Virchow Arch Pathol Anat 1926;260:215-33.  Back to cited text no. 1
    
2.
Le BH, Boyer PJ, Lewis JE, Kapadia SB. Granular cell tumor: Immunohistochemical assessment of inhibin-alpha, protein gene product 9.5, S100 protein, CD68, and ki-67 proliferative index with clinical correlation. Arch Pathol Lab Med 2004;128:771-5.  Back to cited text no. 2
    
3.
Fletcher CD. Diagnostic Histopathology of Tumours. 3rd ed. Philadelphia, PA, USA: Churchill Livingstone; 2007.  Back to cited text no. 3
    
4.
Ravich A, Stout AP, Ravich RA. Malignant granular cell myoblastoma involving the urinary bladder. Ann Surg 1945;121:361-72.  Back to cited text no. 4
    
5.
Kang HW, Kim YW, Ha YS, Min YK, Kim WT, Kim YJ, et al. Granular cell tumor of the urinary bladder. Korean J Urol 2010;51:291-3.  Back to cited text no. 5
    
6.
Abbas F, Memon A, Siddiqui T, Kayani N, Ahmad NA. Granular cell tumors of the urinary bladder. World J Surg Oncol 2007;5:33.  Back to cited text no. 6
    
7.
Yoshida T, Hirai S, Horii Y, Yamauchi T. Granular cell tumor of the urinary bladder. Int J Urol 2001;8:29-31.  Back to cited text no. 7
    
8.
Eandi JA, Asuncion A, Vandewalker KN, Javidan J. Granular cell tumor of the urinary bladder with pseudoepitheliomatous hyperplasia and colocalization with adenocarcinoma. Int J Urol 2007;14:862-4.  Back to cited text no. 8
    
9.
Kiyozuka Y, Yamamoto M, Matsuyama T, Miki K, Tsukamoto R, Shimano N, et al. Synchronous granular cell tumour of the bladder, endometrialcarcinoma and endometrial stromal sarcoma. Asia Pac J Clin Oncol 2006;2:64-7.  Back to cited text no. 9
    
10.
Caputo R, Bellone AG, Tagliavini R. Ultra structure of the granular cell myoblastoma. So-called Abrikossoff's tumour. Arch Dermatol Forsch 1972;242:127-36.  Back to cited text no. 10
    
11.
Garancis JC, Komorowski RA, Kuzma JF. Granular cell myoblastoma. Cancer 1970;25:542-50.  Back to cited text no. 11
    
12.
Fisher ER, Wechsler H. Granular cell myoblastoma – A misnomer. Electron microscopic and histochemical evidence concerning its Schwann cell derivation and nature (granular cell schwannoma). Cancer 1962;15:936-54.  Back to cited text no. 12
    
13.
Buley ID, Gatter KC, Kelly PM, Heryet A, Millard PR. Granular cell tumours revisited. An immunohistological and ultrastructural study. Histopathology 1988;12:263-74.  Back to cited text no. 13
    
14.
Stefansson K, Wollmann RL. S-100 protein in granular cell tumors (granular cell myoblastomas). Cancer 1982;49:1834-8.  Back to cited text no. 14
    
15.
Knief J, Becker JU, Kreipe HH, Kuczyk MA, Gabuev A, von Klot C. Granular cell tumour of the urinary bladder. Rare Tumors 2012;4:e22.  Back to cited text no. 15
    
16.
Miettinen M, Lehtonen E, Lehtola H, Ekblom P, Lehto VP, Virtanen I. Histogenesis of granular cell tumour–an immunohistochemical and ultrastructural study. J Pathol 1984;142:221-9.  Back to cited text no. 16
    
17.
Fanburg-Smith JC, Meis-Kindblom JM, Fante R, Kindblom LG. Malignant granular cell tumor of soft tissue: Diagnostic criteria and clinicopathologic correlation. Am J Surg Pathol 1998;22:779-94.  Back to cited text no. 17
    
18.
Na JI, Kim HJ, Jung JJ, Kim Y, Kim SS, Lee JH, et al. Granular cell tumours of the colorectum: Histopathological and immunohistochemical evaluation of 30 cases. Histopathology 2014;65:76474.  Back to cited text no. 18
    
19.
Gurzu S, Ciortea D, Tamasi A, Golea M, Bodi A, Sahlean DI, et al. The immunohistochemical profile of granular cell (Abrikossoff) tumor suggests an endomesenchymal origin. Arch Dermatol Res 2015;307:151-7.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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