PMC4260431_01
(a) High-power magnification of biopsy specimen (5 mitoses per 10 high power field), (b) S-100 immunohistochemistry stain of biopsy specimen, (c) CD68 immunohistochemistry stain of biopsy specimen, and (d) KI-67 proliferation marker of biopsy specimen.
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fig1
The nuclei were vesicular and contained nucleoli; mitoses were numerous with 5 mitoses per high-power field; and scattered foci of necrosis were present (Figure 1). Immunohistochemistry was positive for S100 and CD68 and negative for keratin, EMA, CD34, MART1, and synaptophysin (Figure 1). The proliferation rate assessed by the KI-67 stain was 25% (Figure 1).
Preoperative assessment of recurrent malignant granular cell tumor at site of previous surgical excision.
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fig2
The primary lesion first appeared on his right upper back in October 2011 and was excised in Cuba, and by April of 2012, the mass recurred at the original site with multiple satellite lesions in right axilla as well as right axillary lymphadenopathy (Figure 2).
Intraoperative picture after wide local excision and right axillary lymph node dissection.
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fig3
Subsequently, he underwent a palliative resection of the recurrent primary tumor and satellite lesions on the upper right back as well as of the large matted right axillary nodal mass (Figure 3).
Postoperative visit status postsplit-thickness skin graft.
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fig4
The graft take was 100% and the final result upon postoperative follow-up was satisfactory (Figure 4).