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Both of these myocutaneous flaps can supplant forehead and deltopectoral flaps, in certain indications. They are additional arterialized flaps for the armamentarium of the reconstructive surgeon, and can be useful in many repairs in the head and neck region.
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We have described two children with multiple cutaneous granular cell tumors (GCT) and have reviewed the literature. Multiple tumors of the skin are relatively rare, especially in children, with only 18 pediatric cases previously reported. Surgical excision of rapidly growing or symptomatic lesions is the treatment of choice. In these two children with multiple GCT, three lesions were excised. Specific stains for enolase and S-100 protein clearly demarcated tumor margins after surgical excision. Despite intensive investigation, the histogenesis of this tumor is still in dispute. The most tenable theory at this time is that these tumors are derived either directly from Schwann cells or from undifferentiated cells developing neural characteristics.
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Immunoperoxidase staining using five antisera to human carcinoembryonic antigen (CEA), including a mouse monoclonal antibody, was performed to investigate the expression of CEA reactivity in ten cases of granular cell myoblastoma. The granular cells were negative with four of the antisera although control sections of CEA producing colon carcinoma were positive. The single positive antiserum gave intense granular cytoplasmic staining of all tumour cells in the ten specimens studied. This reactivity was abolished after absorption of the antiserum with a perchloric acid extract of human lung to remove cross-reacting antibodies against non-specific cross-reacting antigen (NCA); a procedure which did not affect the staining of colon carcinoma specimens. The results indicate that the granular cells do not contain CEA but express a related antigen and that care in the choice of primary antiserum is important if the immunocytochemical detection of this antigen is to be used as a diagnostic aid.
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Elastosis, a previously unreported feature, was found to be common in granular cell tumours. Twenty-four of 28 consecutive granular cell tumours were shown to display elastosis. The elastosis was found in three main sites: adventitial, interstitial and septal. Elastosis is statistically associated with the fibrosis present within this tumour. It appears that elastic fibres are synthesized by connective tissue cells, possibly induced by the tumour cells.
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Granular cell tumours are uncommon benign tumours, occurring in various sites in the body, and very rarely in the orbit or ocular adnexa. Four cases of orbital granular cell tumour are described, with detailed light and electron microscopic description of one tumour arising in the orbital apex of a child. The histogenesis of granular cell tumour is uncertain, with many authors proposing an origin from Schwann cells. In central nervous system granular cell tumours, an astrocytic cell origin has been proposed. Evidence is presented for an origin from astrocytes in a child whose tumour arose in or adjacent to the optic nerve.
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