Track: Case Reports

Abstract:

Granular cell tumors are uncommon neoplasms composed of Schwaan cells estimated to represent 0.5% of soft tissue tumors. These proliferations typically present as painless, firm nodules and can arise in the skin, oral cavity, or gastrointestinal tract. The majority of these lesions are benign, with only about 2% classified as malignant. We are reporting a case of a 59-year-old male patient with an unremarkable past medical history, who presented with a necrotic left 3rd toe wound that had been worsening over the past year. An X-ray of the left lower extremity revealed bone erosion involving the third toe with soft tissue swelling; concerning for osteomyelitis. Additionally, the toe was enlarged and an underlying neoplastic process could not be excluded. The patient then received antibiotic therapy and underwent amputation. Gross examination was notable for a 2.3 cm hyperkeratotic exophytic mass involving the left 3rd digit. Histological examination revealed ulceration, and an underlying neoplastic cellular proliferation associated with robust pseudoepitheliomatous hyperplasia. The neoplastic cells demonstrated a sheet-like to trabecular arrangement, often interdigitating with the dermal collagen. The tumor cells displayed indistinct borders and granular eosinophilic cytoplasm, and were positive for S-100 and CD68 on immunohistochemical staining. Overall, these findings supported a diagnosis of granular cell tumor. Atypical features such as nuclear pleomorphism, necrosis, and/or increased mitoses were not identified. This case highlights the importance of considering underlying neoplasms in non-healing infections of the lower extremities, especially in patients who do not have a history of trauma, diabetes mellitus, or peripheral arterial disease.

Menu

David Saulino