title: Granular cell tumour: malignant or benign?
abstract: BACKGROUND
  Granular cell tumours (GrCTs) are uncommon soft tissue tumours that are usually benign (approximately 0.5%-2.0% have been reported as malignant). They are very rarely found at the extremities. Differentiating a malignant GrCT from a benign one is important as the former is aggressive and has a poor prognosis, whereas the latter, after surgical resection, has excellent outcomes. A malignant lesion can be suspected on clinical presentation and confirmed via histopathological examination using the Fanburg-Smith criteria.
  
  
  METHODS
  This was a retrospective review of all cases of GrCT of the extremities that presented to the Orthopaedic Oncology Unit of University Malaya Medical Centre, Malaysia, from September 2006 to March 2013.
  
  
  RESULTS
  There were a total of five cases, all of which involved female patients aged 13-40 (mean age 24) years. Three cases involved the upper limbs and two involved the lower limbs. Using the Fanburg-Smith criteria, three cases were classified as benign, one as atypical and one as malignant. Wide local excision was performed in all five cases and the outcomes were excellent except for the patient with a malignant tumour. That patient presented with lung metastasis about three months after surgery.
  
  
  CONCLUSIONS
  Malignant and benign GrCTs can be differentiated on clinical presentation and by using the Fanburg-Smith criteria. We believe that wide local excision is the best treatment for both benign and malignant tumours. The role of adjuvant chemotherapy and radiotherapy in malignant GrCTs should be studied. All patients with GrCTs should receive follow-up to check for recurrence and metastasis.
authors.affiliation: Orthopaedic Oncology Unit, Department of Orthopaedics, University of Malaya, Malaysia.
authors.forename: Vivek Ajit
authors.initials: VA
authors.lastname: Singh
authors.affiliation: Orthopaedic Oncology Unit, Department of Orthopaedics, University of Malaya, Malaysia.
authors.forename: Jayaletchumi
authors.initials: J
authors.lastname: Gunasagaran
authors.affiliation: University Malaya Medical Center, Department of Pathology, University of Malaya, Malaysia.
authors.forename: Jayalakshmi
authors.initials: J
authors.lastname: Pailoor
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D016586:Granular Cell Tumor / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008296:Malaysia; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000175:diagnosis* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: benign; granular cell tumour; malignant