Ganglion cell like cells, diagnostic dilemma
A 41 year old man, otherwise healthy, presented with an asymptomatic, painless, solitary, nontender, cutaneous swelling over the left anterior axillary fold []. It was measuring 2 cm in size. There were no local inflammatory changes. The nodule was firm with relatively well defined borders. Regional lymphnodes were not palpable. The patient had no constitutional symptoms. An excision biopsy was performed without any complications. The specimen was sent for histopathologic examination.\nGross examination revealed a relatively well circumscribed mass measuring 2 × 1.5 × 1.5 cm with a solid grey white glistening appearance on the cut surface []. Microscopy showed a relatively well circumscribed tumor composed of spindle cells arranged in whorls and fascicles with thin elongated nuclei interspersed with few blood vessels lined by plump endothelial cells. There were numerous large ganglion-like mononuclear rounded basophilic cells with prominent nuclei and nucleoli. Compressed fibro-adipose tissue and blood vessels were seen outside the margin of the tumor []. Based on these histologic features a diagnosis of ganglioneuroma was made. However, immunohistochemical studies showed strong positive staining for vimentin and negative for smooth muscle actin, CD34, S100 protein and chromogranin []. Based on these immunohistochemistry finding a final diagnosis of fibromatosis with ganglion cell like cells was offered.