Int. J. Oral Maxillofac. Surg. 1987: 16:236-238 (Key words:
tumor, granular cell; myoblastoma, granular cell; surgery, oral and maxillofacial)
Multiple granular cell tumors of the palate R-J. LAMEY, J. S. RENNIE-AND J. JAMES
Departments of Oral Medicine and Pathology and Oral Surgery Glasgow Dental Hospital and School, Glasgow, Scotland
ABSTRACT- - A report of a case of bilateral granular cell tumors of the soft palate is presented. This is an unusual location for the tumor and is the first report of bilateral tumors at this site.
(Accepted for publication 8 May 1986)
The granular cell t u m o r is an u n c o m m o n neoplasm which may occur at diverse anatomical locations 14. The skin is the most c o m m o n site, but approximately 25% of all tumors are f o u n d in the tongue 26. W h e n considering oral lesions alone, 87% arise in the tongue but other sites including lip and gingiva have been reported ~°,2t23. The palate is an u n u s u a l site there being 4 cases of the hard palate 4,5,9,~2, and one case of the soft palate 6 having been reported in the English language literature. The tumor is more comm o n in females, can arise at any age and has a very slow rate of growth ~6, with exceptional cases adopting a m o r e aggressive behaviour pattern t3. The histogenesis of the lesion has been controversial since first being described by Abrikossof in 1926 as a distinct and separate entity ~. It was originally believed to be ol~. striated muscle origin, or to derive from rests of aberrant myoblastic tissue H. Other work has indicated an origin from Schwann
cells2,8,18,~9,24,27, a n d recent studies Using antiserum to S-100 protein, which is only found outwith the central nervous system in Schw a n n cells and satellite cells of ganglia, have shown that granular cell tumors stain intensely for this protein 25.
Case report A 35-year-old Caucasian female was referred to the Department of Oral Medicine in March 1981 for investigation of a swelling of the left soft palate. The patient had noticed the swelling for approximately 9 months and was not aware of any recent change in size. The past medical history revealed nothing of note and extra-oral examination was unremarkable. Clinical examination revealed a 3 x 2 mm elevated swelling of the left soft palate. The overlying mucosa appeared healthy. Under local anaesthesia an excisional biopsy was performed. Subsequently the area healed well and the patient was reviewed annually. 4 years later, the patient stated that she had noticed a similar small painless lesion, this time on the right soft palate. Her medical history du-
MULTIPLE GRANULAR CELL TUMORS OF THE PALATE
healthy and not elevated. An excisional biopsy was again performed under local anaesthesia. At subsequent review appointments the biopsy site healed well.
Fig. 1. Prominent granular cells in the superficial connective tissue. (H&E x 160).
ring this period had not changed. There was no cervical lymphadenopathy. Intra-oral examination detected a 5 x 5 mm swelling on the right soft palate some 4 cm from the previous lesion on the opposite side. The overlying mucosa was
The first excisional biopsy consisted o f mucosa measuring 5 × 3 x 3 m m with an underlying firm tumor. The biopsy was trimmed, paraffin processed sections cut at 5 p m and stained with H & E . Histology revealed a superficial collection o f large pate eosinophilic cells with small rather indistinct nuclei (Fig. 1). The cells were mainly confined to the superficial connective tissue although involvement o f a m i n o r duct was noted in one area. Pseudoepitheliomatous hyperplasia was n o t a feature a n d the appearances are typical o f a granular cell tumor. The lesion excised 4 years later was similar but perhaps m o r e extensive with extension o f granular cells into the underlying fat and encroaching on m i n o r salivary tissue (Fig. 2). The lesion a p p e a r e d completely excised and, as previously, pseudoepitheliomatous hyperplasia was n o t a feature.
Discussion Multiple granular cell t u m o r s m a y account for 8-16% o f cases 2°,28 b u t intra-orally the tongue is the only site so far reported with multiple lesions 15. In this case the lesions were on different sides o f the soft palate and at least 4 cm apart. A l t h o u g h the initial lesion was present at the excision margin recurrence is infrequent after incomplete excision 3,29,indeed spontaneous regression can O c c u r 7,17"
References Fig. 2. Granular cells in fat and surrounding a
minor salivary gland duct. (H&E x 100).
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LAMEY, R E N N I E A N D JAMES
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P.-J. Larney Department of Oral Medicine and Pathology Glasgow Dental Hospital 378 Sauchiehall Street Glasgow, G2 3JZ Scotland