Abstract
BackgroundGranular cell or Abrikossoff’s tumors are usually benign however rare malignant forms concern 1 to 3% of cases reported. Pelvic locations are exceptional.Case presentationWe report a case of a 43-years-old patient who had a benign Abrikossoff’s tumor localized in the right femoral triangle diagnosed at the biopsy. The patient underwent a surgical tumorectomy and inguinal lymph nodes resection. Histologically, the tumor showed enough criteria to give diagnosis of malignancy: nuclear pleomorphism, tumor cell spindling, vesicular nuclei with large nucleoli. Moreover, five lymph nodes were metastatic. Immunohistochemistry findings confirmed the diagnosis of granular cell tumor which is positive for S100 protein and CD68 antibodies. The mitotic index was nevertheless low with a Ki67 labeling index of 1–2%. A large surgical revision with an inguinal curage following radiotherapy were decided on oncology committee. Adjuvant radiotherapy on the tumor bed and right inguinal area of 50 Gy in conventional fractionation was delivered with the aim of reducing local recurrence risk. There was no recurrence on longer follow-up (10 months post radiotherapy).ConclusionsAdjuvant radiotherapy seems an appropriate therapeutic approach, even if controversial, given that some authors report effectiveness on local disease progression.
Highlights
Granular cell or Abrikossoff’s tumors are usually benign rare malignant forms concern 1 to 3% of cases reported
Local surgical excision with clear margins and Mohs micrographic surgery have been utilized for treatment of benign and malignant Granular cell tumors (GCT) [9,10,11]
Here an unusual case of a patient who was treated for an atypical GCT localized in the right inguinal region with surgery and radiotherapy due to the malignant lesion and the lymph node metastasis
Summary
Granular cell tumors (GCT), a rare entity, were first described in 1926 by Abrikossoff, at tongue location [1,2,3,4,5]. Here an unusual case of a patient who was treated for an atypical GCT localized in the right inguinal region with surgery and radiotherapy due to the malignant lesion and the lymph node metastasis. CT scan confirmed the presence of this inguinal mass, measuring 5.8 × 4.9 × 3.2 cm and extending within the Marchand Crety et al Radiation Oncology (2018) 13:115 right femoral triangle in contact with the long adductor muscle, without enhanced contrast, and without locoregional lymph node (Fig. 1). The pathological analysis diagnosed a granular cell tumor (Abrikossoff’s tumor) without any malignant signs (absence of mitosis, necrosis and cytonuclear atypias). Tumorectomy of this inguinal mass were performed three weeks later. Due to the unpredictable tumor, the follow up strategy is a physical examination with a CT scan every 4 months for the first 2 post-operative years, every 6 months for up 5 years and yearly thereafter, as a sarcoma
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