eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Oral Granular Cell Tumors: Differential Diagnoses & Workup

Author: Melinda Jen, MD, Resident Physician, Department of Dermatology, University of Connecticut
Coauthor(s): Steven Brett Sloan, MD, Assistant Professor, Department of Dermatology, University of Connecticut School of Medicine; Director of Nail Disease Clinic and Chief of Dermatology, Newington Veterans Affairs Medical Center
Contributor Information and Disclosures

Updated: Nov 12, 2008

Differential Diagnoses

Melanotic Neuroectodermal Tumor of Infancy

Other Problems to Be Considered

Verruciform xanthoma
Paraganglioma
Rhabdomyoma (extremely rare in the oral cavity)
Nerve sheath neoplasms
Peripheral odontogenic tumors (peripheral granular cell odontogenic tumor, peripheral odontogenic ghost cell tumor)
Alveolar soft part sarcoma
Developmental epithelial cysts (dermoid cysts, oral lymphoepithelial cysts)
Squamous cell carcinoma
Fibroma
Lipoma
Neurofibroma
Schwannoma
Neuroma

Workup

Laboratory Studies

  • No clinical laboratory tests are used for these lesions. A definitive diagnosis requires biopsy.

Procedures

  • Conservative excisional biopsy is indicated because both lesions are rarely larger than 2 cm in diameter.
    • As a general rule, the depth of biopsy for granular cell tumors approximates the diameter of the lesion. Margins do not need to be extensive; generally, a few millimeters is adequate.
    • The depth of biopsy for congenital epulis is the periosteum. Removal of bone is not indicated. Since these are exophytic lesions, surgical margins do not need to be much greater than the clinical margins.

Histologic Findings

The granular cell tumor is characterized by the presence of sheets or clusters of plump, polygonal cells with a granular cytoplasm. These lesions are not circumscribed and often come into intimate contact with the overlying surface squamous epithelium. A frequent finding is pseudoepitheliomatous hyperplasia of the overlying epithelial layer. These cells generally are uniform and do not exhibit significant atypical features. Malignant granular cell tumors, which fortunately are rare, may have a very benign histologic appearance. Tumor cells more or less stain uniformly positive for S-100 protein, neuron-specific enolase, CD68, and PGP9.5.

Congenital epulis also contains sheets and/or clusters of plump cells with a granular cytoplasm.

Pseudoepitheliomatous hyperplasia generally is not present. Congenital epulis lacks specificity for S-100 protein is vimentin positive.

More on Oral Granular Cell Tumors

Overview: Oral Granular Cell Tumors
Differential Diagnoses & Workup: Oral Granular Cell Tumors
Treatment & Medication: Oral Granular Cell Tumors
Follow-up: Oral Granular Cell Tumors
Multimedia: Oral Granular Cell Tumors
References
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References

  1. Becelli R, Perugini M, Gasparini G, Cassoni A, Fabiani F. Abrikossoff's tumor. J Craniofac Surg. Jan 2001;12(1):78-81. [Medline].

  2. Curtis BV, Calcaterra TC, Coulson WF. Multiple granular cell tumor: a case report and review of the literature. Head Neck. Oct 1997;19(7):634-7. [Medline].

  3. Junquera LM, de Vicente JC, Vega JA, Losa JL, Albertos JM, López-Arranz JS. Granular-cell tumours: an immunohistochemical study. Br J Oral Maxillofac Surg. Jun 1997;35(3):180-4. [Medline].

  4. Lapid O, Shaco-Levy R, Krieger Y, Kachko L, Sagi A. Congenital epulis. Pediatrics. Feb 2001;107(2):E22. [Medline].

  5. Le BH, Boyer PJ, Lewis JE, Kapadia SB. Granular cell tumor: immunohistochemical assessment of inhibin-alpha, protein gene product 9.5, S100 protein, CD68, and Ki-67 proliferative index with clinical correlation. Arch Pathol Lab Med. Jul 2004;128(7):771-5. [Medline].

  6. McGuire TP, Gomes PP, Freilich MM, Sándor GK. Congenital epulis: a surprise in the neonate. J Can Dent Assoc. Oct 2006;72(8):747-50. [Medline].

  7. Nagaraj PB, Ongole R, Bhujanga-Rao BR. Granular cell tumor of the tongue in a 6-year-old girl--a case report. Med Oral Patol Oral Cir Bucal. Mar 2006;11(2):E162-164. [Medline].

  8. Ordóñez NG. Granular cell tumor: a review and update. Adv Anat Pathol. Jul 1999;6(4):186-203. [Medline].

  9. Philipp K, Barnes EL, Carrau RL. Eagle syndrome produced by a granular cell tumor. Arch Otolaryngol Head Neck Surg. Dec 2001;127(12):1499-1501. [Medline].

  10. Stewart CM, Watson RE, Eversole LR, Fischlschweiger W, Leider AS. Oral granular cell tumors: a clinicopathologic and immunocytochemical study. Oral Surg Oral Med Oral Pathol. Apr 1988;65(4):427-35. [Medline].

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Further Reading

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Keywords

granular cell myoblastoma, granular cell schwannoma, Abrikossoff tumor, Abrikossoff’s tumor, tumor of Abrikossoff, granular cell neurofibroma

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Contributor Information and Disclosures

Author

Melinda Jen, MD, Resident Physician, Department of Dermatology, University of Connecticut
Melinda Jen, MD is a member of the following medical societies: Alpha Omega Alpha
Disclosure: Nothing to disclose.

Coauthor(s)

Steven Brett Sloan, MD, Assistant Professor, Department of Dermatology, University of Connecticut School of Medicine; Director of Nail Disease Clinic and Chief of Dermatology, Newington Veterans Affairs Medical Center
Steven Brett Sloan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Connecticut State Medical Society, New England Dermatological Society, and Texas Dermatological Society
Disclosure: Nothing to disclose.

Medical Editor

James W Patterson, MD, Director of Dermatopathology, Professor of Pathology and Dermatology, Departments of Pathology and Dermatology, University of Virginia Medical Center
James W Patterson, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Medical Association, American Society of Dermatopathology, Medical Society of Virginia, Royal Society of Medicine, Society for Investigative Dermatology, and United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

Drore Eisen, MD, DDS, Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati
Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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