Tumors of the Tongue: Fibroma or Schwannoma?
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Granular cell tumors (GCTs) are relatively rare benign tumors that can occur throughout the body. The tongue is involved in more than 60% of oral GCTs, although these tumors can also be found in the head and neck region, buccal mucosa, hard palate, lips and gingiva. Contrary to the belief that these tumors have a myogenic origin, an immunohistochemical study has revealed that they are of neural origin, with diffuse expression of S-100 protein present in almost every case. However, there is no clear consensus regarding the mechanism of tumor development. Therefore, the researchers aimed to evaluate the immunohistological characteristics of oral GCTs of the tongue.

In the present study, all cases exhibited PAS-positive granules in the tumor cells alongside positive staining for S-100 protein and vimentin. Furthermore, the tumor cells and normal nerve cells exhibited co-expression of nerve markers PGP 9.5, NSE, calretinin, and GFAP, suggesting that the nervous system plays a role in the development of this tumor.

The researchers reviewed records from cases of Oral Granular Cell tumors of the tongue, treated in the hospital during a 15-year period (2003–2017), and identified 7 cases that had been treated by resection. Paraffin-embedded specimens were available for all cases, which allowed them to perform detailed histopathological and immunohistochemical analyses.

As result it was found that all 7 tumors occurred in the tongues of middle-aged or elderly patients, all of whom had presented with a hard lump in their tongue. The tumor dimensions ranged from 5 to 29 mm. In all cases, the clinical diagnosis was fibroma. No cases of recurrence were observed over a maximum follow-up period of 15 years.

All cases stained positively for PAS, S-100 protein, vimentin, PGP 9.5, NSE, calretinin, GFAP, and CD68. The PAS-positive granules were also positive for the lysozyme glycoprotein marker, CD68. Nerve fibers of various sizes were observed in each tumor and granular cells were observed in the nerve fibers from a representative case. immunohistological findings suggest that GCTs are derived from Schwann cells. Furthermore, the CD68-positive findings indicate that Wallerian degeneration may also contribute to nerve injury. A safe surgical margin is needed to identify infiltrative growth of these tumors.

Source: https://head-face-med.biomedcentral.com/articles/10.1186/s13005-017-0158-9
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