Abstract

Granular cell tumor (GCT) is a rare neoplasm most commonly involving the head and neck region, most frequently the tongue.¹ The tumor is typically benign and asymptomatic, and presents as a slow growing, solitary, subcutaneous nodule.² Often the skin overlying the mass appears normal or hyperpigmented.¹ Histologically, the tumor displays an unencapsulated infiltrative tumor composed of polygonal cells with eosinophilic granular cytoplasm and bland nuclei.³ Immunohistochemically, adult GCT are typically positive for S100 and CD68, which supports their suspected Schwannian origin.^3,4 Less than 2% of GCT are malignant, with histological features of necrosis, spindling, vesicular nuclei with large nucleoli, increased mitotic activity, high nuclear to cytoplasmic (N:C) ratio, and pleomorphism.^2,5 Granular cell tumors are typically treated with excision to prevent recurrence and possible conversion to malignancy.⁶ We report the case of a granular cell tumor which presented on the lateral neck of a young man with history of HIV. The lesion had been present and slowly growing over the last year and was asymptomatic.  On exam, a 1.2 cm firm nodule with verrucous surface was noted. Due to the verrucous appearance, the clinical differential included verruca, molluscum, and keratoacanthoma. Biopsy was conducted which displayed a granular cell tumor with prominent pseudoepitheliomatous hyperplasia. The tumor was excised with margins, however focal lateral margin involvement was present. Re-excision versus monitoring was discussed, and the patient elected to monitor the area. This case is notable for describing an unusual clinical appearance for this rare tumor.