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HISTORICAL
• 1st case reported by Weber in 1854 for a tumor of
the tongue
Fisher KW, Hattab EM. Nerve tumors. in Nerves and nerve injuries, vol 2. Pain, treatment, injury, disease, and future directions. Tubbs RS, Rizk E,
Shoja MM, Loukas M, Barbaro N, Spinner RJ (eds). Elsevier 2015
• When associated with the
skin, granular cell tumors
can cause a benign reaction
called pseudo-
epitheliomatous hyperplasia
of the overlying skin that
can mimic squamous cell
carcinoma, both grossly and
histologically
Fisher KW, Hattab EM. Nerve tumors. in Nerves and nerve injuries, vol 2. Pain, treatment, injury, disease, and future directions. Tubbs RS, Rizk E,
Shoja MM, Loukas M, Barbaro N, Spinner RJ (eds). Elsevier 2015
RECURRENCE ?
• Curative treatment consists of local excision with
negative margins, resulting in a local recurrence
rate of less than 10%
• 110 cases (95 pts) from Memorial Hospital over a 3I-year period. 7 involved the
fingers , two the palms, two the wrist and seven the arm (Strong).
• 110 patients from a 32-year period at the National naval medical center with no
nerve reported (Lack)
• In a 30-year review of 543 peripheral nerve tumors, only two GCTs were reported,
both of which involved the brachial plexus and not the peripheral nerve trunks (Kim).
Kato R, Kino Y, Hattori Y, et al. (1987). Granular cell tumor of the radial nerve in the upper arm. Seikeigeka, 38: 1589–1591.
PALMAR CUTANEOUS BRANCH OF THE MEDIAN 72 Condit and Pochron
NERVE
• 25 year-old female
Vol. 16A. No.1
January 1991 Granula
• 12 month history of a
painful volar 5 x 4 mm mass Fig. 1. Fusiform mass in the palmar cutaneous branch of the median nerve, radial to the palm
longus tendon.
Condit DP, Pochron MD. Granular cell tumor of the palmar cutaneous branch of the median nerve. J Hand Surg 1991;16A:71–75
could not be dissected free from the ner ve. The surrounding tumors . This protein is found only in n
soft tissue was not involved. The mass and 2 to 3 mm of The majority of the present literature s
nerve, proximally and distally, were excised. cept of a neural origin for this tumor. \
DIGITAL CUTANEOUS NERVE
Weinreb I, Bray P, Ghazarian D. Plexiform intraneural granular cell tumour of a digital cutaneous sensory nerve. J Clin Pathol 2007;60: 725–726.
DIGITAL NERVE: 4 REPORTED CASES
• Slutsky DJ. Granular Cell Nerve Tumor in the Hand: Case Report. J
Hand Surg 2009;34A:1512–1514.
• Ha SY, Suh YL, Sung CO. Granular cell tumour arising in a digital
nerve. J Hand Surg Eur Vol. 2011 Mar;36(3):249-50.
DIGITAL NERVE GRANULAR CELL NERVE TUM
• 23 year-old male
Enghardt MH, Jordan SE. Granular cell tumor of a digital nerve. Cancer 1991;68:1764–1769.
DIGITAL NERVE
• No details available
Bue P, Holck S, Holst-Nielsen F. Granular cell tumor localized in a digital nerve [in Danish]. Ugeskr Laeger 1984;146:2319–2320.
DIGITAL NERVE
• 18 year-old woman
• Whadwa V, Salaria SN, Chhabra A. Granular Cell Tumor of the Ulnar Nerve:
MR Neurography Characterization. Radiology Case. 2014 Jun; 8(6):11-17
ULNAR NERVE
• All had some combination of numbness, weakness, wasting, and positive Tinel’s sign.
• In the case reported by Yasutomi et al., the tumor was shelled out. At 2 years, the pain had resolved, but
the patient had persistent weakness.
• In the case reported by Dahlin et al., the nerve was so intimately involved that the authors were unable
to resect the tumor and performed a biopsy only. Because of increasing weakness and enlargement of
the tumor size to 4 cm, another biopsy was performed 2.5 years later. There was no change in the
histologic findings, and the authors continued to observe the tumor.
• In the case reported by Davis, the patient had muscle grade of 0 power (no contraction) of the
interossei and abductor digiti minimi, with grade 2 power (antigravity) in the ulnar innervated lumbricals.
Davis performed an interfascicular neurolysis and resected a 4.5-cm tumor, preserving 3 normal fascicles.
The defect was reconstructed with a 5-cm nerve graft harvested from the medial antebrachial
cutaneous nerve. At 12 months, the patient reported improved sensory function and had regained
grade 3/5 power (against mild resistance) of abduction but no adduction of the fingers.
• In the case of Whadwa, resection of the tumor while preserving the motor branch was possible.
ULNAR NERVE
• 51-year-old, right-handed man with a 3-month history of numbness on the
ulnar side of the right hand and a 2-month history of weakness of thumb
and little finger adduction
• A tender 1.5 × 1.0 cm mass 3 cm proximal to the distal wrist crease on the
ulnar side of the palmaris longus tendon.
Yasutomi T, Koike H, Nakatsuchi Y. Granular cell tumour of the ulnar nerve. J Hand Surg 1999;24B:122–124.
We present a rare case of a granular cell tumour arising
Granular cell tumour is a relatively common and usually
in the ulnar nerve. longitudinally. The tumour compressed and displaced
benign neoplasm that most often occurs in the tongue, the fascicles of the ulnar nerve towards the ulnar side.
skin and subcutaneous tissue. The histogenesis of this Macroscopically, no nerve fascicles were involved and
CASE REPORT tumour is controversial. Many reports advocate the the tumour was dissected from around the fascicles and
concept that this tumour is of Schwann cell origin shelled out. The excised tumour measured 1.5 × 0.7 × 0.7
A 51-year-old, (Fisher
ULNAR NERVE
and Wechsler,
right-handed man 1962; Stefansson with
presented and Wollmann,
a cm (Fig 2). It was encapsulated by smooth fibrous tissue
1982). Nevertheless, a granular cell tumour arising in a and revealed a solid, homogeneous, light yellow cut
3-month historyperipheral
of numbnessnerveon the is
trunk ulnar side of the
an extremely rareright
occurrence. surface.
hand and a 2-month history
We present ofcase
a rare weakness of thumb
of a granular and arising
cell tumour
little finger in
adduction. Except for non-insulin-
the ulnar nerve.
dependent diabetes mellitus diagnosed 10 years previously,
his past and family
CASE history
REPORT disclosed nothing remarkable.
• A Physical
firm, examination oftumour
vermiform the right forearm
involving revealed a
A 51-year-old, right-handed man presented with a
tender 1.5 × 1.0 cm mass
3-month history3 of
cmnumbness
proximal on thetoulnar
the side
distal
of the right
the
wrist ulnar nerve
crease on the and
hand located
ulnar inside
side ofhistory
a 2-month the palmaristhe longus
of weakness of thumb and
tendon. The mass littlewasfinger
firm and rubberyExcept
adduction. and it for was non-insulin-
not
epineurium without
fixed to the skindependent
or the underlying adhesion
diabetes mellitus
tissue. to
diagnosed
Percussion10 years previously,
over
surrounding
the mass elicited soft
his past
tissues.
and family history
paraesthesia in the disclosed
ringnothing remarkable.
and little
Physical examination of the right forearm revealed a
fingers. The sensations
tender 1.5of× light 1.0 cmtouch
mass and 3 cmpinprick
proximal were to the distal
Fig 1 Intraoperative photograph. Digits are to the right and the
decreased in these fingers and over the right palm.
wrist crease on the ulnar side of the palmaris longus There elbow to the left. The lesion is seen on the radial side of the
• Macroscopically,
was atrophy of the
tendon.
fixed to
noskinnerve
hypothenar
The
the
mass
or
was
the
fascicles
eminence
firm and
underlying
and
rubbery
tissue.
dorsal
and it
Percussion
was not
over
ulnar nerve.
interossei, and manual muscle testing demonstrated
were
weakness involved and
in allthethemassinterosseithe paraesthesia
elicited tumour
and was
in
the abductor the ring and little
digiti
fingers. The sensations of light touch and pinprick were
dissected
minimi. from
Froment’s sign
decreased
clawing of the ring
around
inwas
these the
positive,
fingers andfascicles
but there
over waspalm.
the right no There Fig 1 Intraoperative photograph. Digits are to the right and the
elbow to the left. The lesion is seen on the radial side of the
was or little of
atrophy fingers.
the hypothenar eminence and dorsal
and shelled interossei,
Radiographs out
of the and wrist
manual weremuscle normal.testing Ultra-
demonstrated
ulnar nerve.
• Mass 22x13x6 cm
• No clinical aggravation
• No recurrence at 1 year
Jia W, Chen C, Chen L, Yu C, Kondo T. Large malignant granular cell tumor with suprascapular nerve and brachial plexus invasion. case report
and literature review. Medicine (2017) 96:44:1-3
OUR EXPERIENCE
• Complete resection