原文題目(出處)： Histogenesis of Abrikossoff tumour of the oral cavity Int J Dent Hygiene 2010;8:68-74
原文作者姓名： F Haikal, JP Maceira, EP Dias, M Ramos-e-Silva
通訊作者學校： Federal University of Rio de Janeiro, Rio de Janeiro, Brazil 報告者姓名(組別)： 蔡欣慈 A 組
1. Abrikossoff tumour (granular cell tumour,簡稱 GCT) is an uncommon neoplasia.
2. Benign in most of the cases.
3. Its histogenesis is uncertern.
Four possible origin：
(1). myogenic origin (Aleksei Ivanovich Abvrikosov, 1926) (2). mesenchymal origin (Oliveira&Taube)
(3). neuroendocrine origin (Willians&Willians) (4).Schwann cell origin (Reichler et al.)
4. Schwann cells is the presence of vimentin (also found in schwannoma, and immunoreactivity for the lineage marker of the neural crest,S-100.)
5. Antigen-melanoma associated and the neuron-specific enolase (NSE) are tumour markers with the origin in the neural crest, not in Schwann cells.
6. Other researchers believe that GCT isn’t a specific entity, but a modification that can occur not only in the Schwann cells, but also in other cells.
1. Occur between the second and sixth decade, greater proportion among woman and blacks.
2. 45-65% in head and neck, 70%in oral cavity, especially on the tongue.
3. Papule or nodule shape, diameter<3cm in oral cavity, asymptomatic.
4. Benign form： granular cells-large size, polygonal or fusiform, with small nucleus, separated by collagen.
5. Malignant form：
(1) criteria-necrosis, distribution of the cells in fusiform strings, large nucleus with vesicular core, increased mitotic activity, N/C ratio↑,nuclear
pleomorphism.(3 or more of the criteria)
(2) occasionally local invasive, 2% distant metastases
6. First case of GCT：Abrikosov in 1926.He proposed a myogenic origin, and the tumour result in cell degeneration of the striated muscles.
7. Other authors agree with the neurogenic origin through immunoenzymatic
studies：(1) S-100(+) in neurons and Schwann cells.
(2) benign GCT：S-100(+), neuron enolase (+)
8. Four antibodies used in evaluation of the histogenesis of GCT：
(1) PGP9.5(human gene protein)：a monoclonal antibody(單株抗體),a neuron-specific protein, a marker for nervous and neuroendocrine cells.
(2) S-100：a polyconal antibody(多株抗體).It’s used in a description of an acid protein fraction of the bovine brain, so designated for its solubility in saturated ammonium sulphate. Present in glial cells(神經膠細胞), Schwann cells, condrocytes, melanocytes, Langerhans cells.
(3) Neuro-specific enolase(NSE)：a monoclonal antibody. Used as marker to define neuroendocrine tumour histogenesis, present in neural cells, neuroendocrine cells, but absent in Schwann cells.
(4) Vimentin：monoclonal antibody. One of the proteins of the intermediate filament (a protein which present in all nucleated cells as integrating
structures),reacts with mesenchymal cells , located mainly in the immature glia, widely found in schwannomas.
1. To study and analyse the histogenesis of the GCT of the oral cavity, using four antibodies commonly employed in evaluation of neoplasia of the neural and neuroendocrine lineage.
2. Analyse the differences found in GCT in staining by the HE method.
Material and methods
1. 11 Samples of oral cavity tissues of the buccal mucosa, tongue or lips.
2. Immunoperoxidase technique in incubation with four antibodies：
anti-PGP9.5,anti-S-100,anti-NSE, and anti-vimentin.
3. Histological sections stained by HE method.
4. Results were referred as with positivity when (1) Located focally-some limited areas.
(2) Located diffusely-dispersed areas.
(3) Light intensity-little stained (light brown).
(4) Moderate intensity-little more evident colouration (brown/brownish).
(5) Marked intensity-stronger colouration (brown).
(1) Normal nervous tissue observed on the sides of the tumour-for S-100,PGP9.5,and NSE
(2) Endocrinal cells of the normal pulmonary tissue.
(3) Sample of schwannoma-for vimentin
1. Histopathological findings：
nests and more diffuse areas of large, polygonal cells, with small nucleus and abundant granular eosinophilic cytoplasm in all cases. Pseudoepitheliomatous hyperplasia in almost all cases.
The tumour cell were compacted, some cases have imprecise limits, and some cases present delimit areas.
3. Immunohistochemical findings：(Table2)
(1) Most of the cases show marked positivity (3+) for S-100 and vimentin diffusely in the nucleus and cytoplasm of the tumour cells.
(2) 1 case was negative (0) for NSE, and the other cases were positive.
(3) Four cases were negative (0) for PGP9.5, and the other cases were positive.
1. It is revalent in females, with the patients’ age varying from 14 to 52 years (average 40 years) in this study.
2. Most of the cases were located in the tongue.
3. Histopathological analysis showed that GCT may be well present as well
delimited affecting the dermis focally, or poorly delimited, being distributed and more diffused.
4. 10 cases presented pseudoepitheliomatous hyperplasia .Highly irregular or milder pseudoepitheliomatous hyperplasia is a characteristic, but not invariable aspect of the GCT, and can be mistaken as SCC.
5. The neuroendocrine and/or from Schwann cells origin in GCT was questioned.
6. The reactivity for S-100 is also used to confirm the GCT diagnosis (due to marked pseudoepitheliomatous hyperplasia).
7. The expression of S-100 sustains the hypothesis that the GCT has origin in Schwann cells.
8. Vimentin suggests mesenchymal origin, however it is also expressed in other cells, being unspecific. It is additional support in the confirmation of the origin on the Schwann cells.
9. The NSE is more specific marker, and is used as marker of neuroendocrine cells.
10. PGP9.5 is a new marker for neuroendocrine tumors.
11. In our study, the moderate or weak possibility for NSE and PGP9.5 does not favour the neuroendocrine origin, but does not discard it.
12. Although almost all the GCT studies think its origin is Schwann cells, it is possible that GCT appears from more than one cell type.
13. Many authors consider GCT as a true neoplasia, while others think it represents a degenerative alteration or an abnormal metabolic process.
14. Some authors believe that this tumour presents so many controversies because the epithelial, mesenchymal and neurogenic cells originate from a common cellular precursor.
15. Schwann and neuroendocrine cells have origin in the neural crest, what may justify the positivity of all the markers and different intensities and patterns 16. The result may be associated to the low sensibility of the immunoperoxidase
1. The GCT is immunoreactive with the four tested markers：anti-PGP9.5, anti-S-100, anti-NSE, and anti-vimentin.
2. The origin of the GCT in lesions of the oral cavity is in the Schwann cells, although a neuroendocrine origin can’t be ruled out.
3. There is no specific immunohistochemical marker to define the histogenesis of GCT.
1 Abrikossoff tumour (granular cell tumour) 的來源有許多不同的說法,其中 較多學者採信的是哪一種 origin?
(A) Mesenchymal origin (B) Neuroendocrine origin (C) Schwann cell origin (D) Myogenic origin
答案 (C )
出處：Oral &Maxillofacial Pathology- second edition Page 465
2 以下何者為 granular cell tumour malignant form 的 criteria?
(A) Increased mitotic activity, N/C ratio↑,nuclear pleomorphism.
(B) Pseudoepitheliomatous hyperplasia ,N/C ratio↑,nuclear pleomorphism (C) Local invasive, large size, polygonal or fusiform granular cells
(D) Pseudoepitheliomatous hyperplasia , N/C ratio↑,small nucleus
出處：International Journal of Dental Hygiene, 2008 Histogenesis of Abrikossoff tumour of the oral cavity