Oral Oncology EXTRA (2006) 42, 277– 280

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CASE REPORT

Granular cell odontogenic tumour: Case report

and review of literature
Carolina Cavaliéri Gomes, Marcelo Drummond Naves, Marcos Vinı́cio Pereira,
Luciano Marques Silva, Ricardo Alves Mesquita, Ricardo Santiago Gomez *

Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais,
Belo Horizonte, Brazil

Received 9 June 2006; accepted 3 July 2006

KEYWORDS Summary Granular cell odontogenic tumour (GCOT) is a rare benign odontogenic neoplasm
Granular cells; composed of granular cells and ameloblastic epithelium. The GCOT tends to occur in the pos-
Odontogenic tumours; terior region of the mandible, especially in 50-year-old women. We report a case of GCOT that
Granular cell odontogenic occurred in the mandible of a 20-year-old woman. Immunohistochemically, while a low prolif-
tumour erating cell nuclear antigen (PCNA) staining was observed in the granular cells, the epithelium
showed a significant PCNA labelling, which suggests that the odontogenic epithelium may have
an important role on the GCOT tumorigenesis.
c 2006 Elsevier Ltd. All rights reserved.

Introduction and/or odontogenic features have been considered a dis-

Granular cell odontogenic tumour (GCOT) is a benign odon-
togenic neoplasm. There is a great controversy regarding
the concept and definition of this lesion. Such lesion has also
been referred to as granular cell ameloblastic fibroma,1
central granular cell tumour of the jaw,2 central granular
cell odontogenic fibroma3 and central odontogenic fibroma,
granular cell variant.4 Recently, however, tumours predom-
inantly composed of granular cells and showing ameloblastic
tinct entity and named GCOT.5–10
The GCOT tends to occur in the posterior region of the
mandible, especially in 50-year-old women. GCOT is a rare
condition and only 33 cases have been reported.1–7,9–21 In
the present study we report a case of GCOT that occurred
in the mandible of a woman. A review of literature and
immunohistochemical features of the tumour is also
presented.

* Corresponding author. Present address: Faculdade de Odonto-

logia da UFMG, Disciplina de Patologia Bucal, Av. Antônio Carlos,
6627 Belo Horizonte, CEP 31270-901, Brasil. Tel.: +55 31 3499 2477;
fax: +55 31 3499 2430.
E-mail address: rsgomez@ufmg.br (R.S. Gomez).
Case report
A 20-year-old white woman came to dental clinics complain-
ing of a swelling on the left-posterior region of the mandi-
ble. Oral examination and computed tomography showed


1741-9409/$ - see front matter c 2006 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ooe.2006.07.001
278 C.C. Gomes et al.

an intra-osseous lesion measuring 5 cm at its largest dimen- bone (Fig. 1A and B). Computed tomography also showed
sion and involving the pre-molars and molars area and lead- the presence of calcified material (Fig. 1B). Aspiratory
ing to an expansion and erosion of the vestibular cortical punction was negative to liquid.

Figure 1 (A) Clinical view showing a swelling in pre-molars and molars area. (B) Computed tomography demonstrating an
expansion and erosion of the vestibular cortical bone (arrows) and calcified material (asterisk). (C) Photomicrograph showing
odontogenic epithelial cords, granular cells and cementum-like calcified material (Haematoxylin and eosin, original magnification
·100). (D) Columnar odontogenic epithelial cells and polygonal granular cells with finely granular eosinophilic cytoplasm and
eccentrically located nuclei (Haematoxylin and eosin, original magnification ·400). (E) Granular cells PAS-positive (Periodic Acid-
Shift, original magnification ·400). (F) and (G) Immunostain showing granular cells positive to CD68 and epithelial cells PCNA-
positive, respectively (Streptoavidin–biotin, original magnification ·400).
Granular cell odontogenic tumour: Case report and review of literature
Incisional biopsy was then performed and the specimen
was fixed in 10% formalin buffer. The most important mor-
phologic finding was granular cells associated with cords
of odontogenic epithelium (Fig. 1C). The granular cells were
polygonal with finely granular eosinophilic cytoplasm and
had eccentrically located nuclei (Fig. 1D). Small calcified
bodies resembling cementum could also be seen (Fig. 1C
and D). A diagnosis of granular cell odontogenic tumour
was made. Complete excision was performed and there is
no sign of recurrence after seven months.
The granular cell cytoplasm was periodic acid-Schiff po-
sitive and diastase resistant (Fig. 1E). Immunohistochemical
reactions were also performed to investigate the CD68 and
PCNA antigens. Almost all the granular cells were positive
for CD68 (Fig. 1F). The PCNA immunolabelling was quantita-
tively assessed. More than 500 epithelial and mesenchymal/
granular cells were counted to obtain the PCNA index (% po-
sitive cells/total number of cells). While 81.7% of the
epithelial cells were PCNA positive, only 1.9% of the granu-
lar showed positive staining (Fig. 1G).
Discussion
Reviewing the literature we found that in 1962 Couch and
associates reported two cases of central-jaw lesions that
microscopically were composed of granular cells associated
with nests of odontogenic epithelium.1 Small calcified struc-
tures resembling cementum were sometimes associated
with the granular cells. They called these lesions granular
cell ameloblastic fibroma.1
Some years later, in 1978, White et al. reported four new
cases.2 The authors stated that the primitive-appearing stro-
mal tissue characteristic of the ameloblastic fibroma was not
observed. According to them, as the morphology of the cells
at the connective tissue resembled the granular cells of the
granular cell myoblastoma (granular cell tumour), the tu-
mour should be named as central granular cell tumour of
the jaws. These authors also believed that this lesion could
not be a variant of the ameloblastic fibroma because the
odontogenic epithelium showed no proliferative activity. In
the present study, the significant PCNA labelling of the
epithelium, in contrast to the low index presented by the
granular cells, suggests that the odontogenic epithelium
may have an important role on the GCOT tumorigenesis.
The GCOT tends to occur in the posterior region of the
mandible. Twenty-four out of the 34 cases of CGCOT re-
ported in the literature were located in the mandible, 8 in
the maxilla and 2 in an unreported location. In addition to
this, the mean age of the 34 cases was 46.2 years with a
range between 16 and 77 years. The sex was known in 33 pa-
tients: 25 cases occurred in women, accounting for 76% of
the cases, while only 8 cases occurred in men. GCOT are
usually assymptomatic and they can lead to a localized
swelling of the affected area. Radiolographically, GCOT
presents usually as well defined unilocular or multilocular
radiolucency, with or without focal areas of opacity.19
Morphologically, the GCOT is composed of granular cells
associated with nests or islands of odontogenic epithelium
that may present clear cells. The granular cells are of vari-
able size, round to polygonal, with finely granular, eosino-
philic cytoplasm and present small, eccentrically located,
279
ovoid to round nuclei. These cells are often arranged in lob-
ules separated by thin, fibrous connective tissue septa con-
taining vessels. Small calcified structures resembling
cementum can be found. The microscopic findings of our
case reported are in agreement with this description.
The origin of the granular cells has been a matter of dis-
pute. An origin from Schwann cells is rejected by immuno-
chemical studies where negative staining for S-100 and
glial fibrilar acid proteins were found.4,20,22A histiocytic dif-
ferentiation of the granular cells is supported by the strong
expression of the CD68 previously reported20 and confirmed
in the current case.
The treatment of GCOT consists of local enucleation and
there are no reports of recurrence. Clinical, radiographic
and the follow-up data lead to the conclusion that this le-
sion has a benign biological behaviour.20 However, long
term follow-up is recommended because a malignant coun-
terpart of the GCOT has already been reported.23
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