A 63-year-old male presented with swelling in the right inguinal region for the past 10 years with a sudden increase in size since two months. On examination, a single, firm three cm swelling was felt in the right inguinal region. No abnormality was detected in the left inguinal region. No other lesion such as an ulcer or swelling was noted in the right leg or thigh.
There was no history of fever, rigors and loss of weight or appetite in the recent past. Patient gave no history of exposure to tuberculosis.
On general examination, patient was well built and nourished. There was no pallor or generalized lymphadenopathy. No abnormality was detected on systemic examination. Base line blood investigations were found to be within normal limits. An ultrasonogram of the right inguinal mass showed circumscribed hypoechoic mass suggestive of a lymph node shadow. An ultrasound guided aspiration was done and the smears were submitted for cytological examination. Ultrasonogram of the abdomen was unremarkable.
Cytosmears examined were moderately cellular with dual cell population, composed predominantly of oval to polygonal cells with abundant cytoplasm and round bland nuclei resembling histiocytes [Figure 1]. These cells were arranged in loose clusters and as isolated forms. The background showed few discrete round cells with round nuclei and scanty cytoplasm suggestive of mature lymphocytes [Figure 1]. No precursor lymphoid cells were seen on cytosmears. In correlation with clinical and image findings, an impression of reactive lymph node was suggested on cytology. A clinical follow-up and excision was advised if clinically suspicious or lesion further increased in size.
An excision biopsy was performed which showed skin with a neoplasm located in lower dermis and subcutis. Tumor cells were arranged in nests with focal diffuse pattern. Individual cells appeared round to oval with abundant granular eosinophilic cytoplasm and centrally placed bland nuclei [Figure 2]. Focal collections of lymphocytes were also seen [Figure 2]. Tumor cells were seen surrounding the adnexal structures and nerve fibres. Immunohistochemistry showed S100 positivity in nucleus and cytoplasm ([Figure 2] inset). Immunostains for CD68 and inhibin showed cytoplasmic positivity. A final diagnosis of granular cell tumor was given based on histology and immunoprofiling.