Granular cell tumors of the urinary bladder.
BACKGROUND
Granular cell tumors (GCTs) are extremely rare lesions of the urinary bladder with only nine cases being reported in world literature of which one was malignant. Generally believed to be of neural origin based on histochemical, immunohistochemical, and ultrastructural studies; they mostly follow a clinically benign course but are commonly mistaken for malignant tumors since they are solid looking, ulcerated tumors with ill-defined margins.


METHODS
We herein report two cases of GCTs, one benign and one malignant, presenting with gross hematuria in a 14- and a 47-year-old female, respectively.


RESULTS
Histopathology revealed characteristic GCTs with positive immunostaining for neural marker (S-100) and negative immunostaining for epithelial (cytokeratin, Cam 5.2, AE/A13), neuroendocrine (neuron specific enolase, chromogranin A, and synaptophysin) and sarcoma (desmin, vimentin) markers. The benign tumor was successfully managed conservatively with transurethral resection alone while for the malignant tumor, radical cystectomy, hysterectomy with bilateral salpingo-oophorectomy, anterior vaginectomy, plus lymph node dissection was done. Both cases show long-term disease free survival.


CONCLUSIONS
We recommend careful pathologic assessment for establishing the appropriate diagnosis and either a conservative or aggressive surgical treatment for benign or localized malignant GCT of the urinary bladder, respectively.
Abbas
Farhat
F
Department of Surgery (Urology), The Aga Khan University Hospital, Karachi, Pakistan. farhat.abbas@aku.edu
Memon
Amanullah
A
Siddiqui
Tanya
T
Kayani
Naila
N
Ahmad
Nazim Ali
NA
D000293:Adolescent; D001707:Biopsy, Needle; D003558:Cystoscopy / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D016586:Granular Cell Tumor / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D006417:Hematuria / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D009403:Nephrostomy, Percutaneous / Q000379:methods; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery