Lack of Utility of Cytokeratins in Differentiating Pseudocarcinomatous Hyperplasia of Granular Cell Tumors from Oral Squamous Cell Carcinoma.

Kamal Al-Eryani,Faleh Sawair,Parish P Sedghizadeh,Saravanan Ram,Jumana Karasneh

doi:10.7314/apjcp.2016.17.4.1785

Kamal Al-Eryani, Faleh Sawair + Show 3 more

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https://doi.org/10.7314/apjcp.2016.17.4.1785

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Abstract

Granular cell tumor (GCT) of the oral cavity is a benign lesion. Half of oral GCTs demonstrate pseudocarcinomatous hyperplasia (PCH) of the mucosa which can mimic invasive islands of oral squamous cell carcinoma (SCC). Such similarity can be confusing when diagnosing or evaluating the two conditions, potentially leading to misdiagnosis or misclassification. Indeed, several misdiagnosed cases of oral GCT have been reported in the literature as OSCC or malignant oral GCT that resulted in unnecessary aggressive treatment for the affected patients. The aim of this study was to investigate if the cytokeratin pattern of the PCH can help in differentiating GCT from oral SCC. To distinguish between these two entities, we examined 12 patient specimens of oral GCT-PCH and oral SCC histologically and via immunohistochemistry (IHC) for CK13, CK17 and P75. The results suggest that the cytokeratin profile of PCH is similar to that of oral SCC. Therefore, consideration of IHC findings for epithelial markers alone may lead to erroneous diagnosis; thus, the presence of the granular tumor underneath the PCH and its immunopositivity for P75 or other neural definition markers can be essential to identify the underlying tumor and exclude oral SCC. Finally we recommend more studies on the molecular biology of PCH to understand how it can mimic oral SCC histologically without harboring its malignant phenotype clinically, which could have significant translational potential for understanding invasive oral SCC.

Highlights

Granular cell tumor (GCT) is a benign lesion
Lack of Utility of Cytokeratins for Differentiating Granular Cell Tumors from Oral Squamous Cell Carcinomas results show that while the pseudocarcinomatous hyperplasia (PCH) may be diagnostically challenging, the connective tissue findings are the most useful and simple way to distinguish between these two entities
That was achieved by emphasizing several findings: 1) It is very difficult to distinguish morphologically between oral squamous cell carcinoma (SCC) and GCT-PCH without consideration of the under lying connective tissue, 2) IHC stains for PCH to differentiate it from oral SCC might be misleading, and 3) IHC for GCT is a better guide for accurate diagnosis

Summary

Introduction

Granular cell tumor (GCT) is a benign lesion It can occur in almost any part of the human body such as the oral cavity, breast, large intestine and stomach (Lack, et al ,1980; Patti et al, 2006; Huyskens and Geniets 2014; Zhang et al, 2014). For both GCT and oral squamous cell carcinoma (OSCC), the most common growth site in the oral cavity is the tongue (Neville, 2009).

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