A 65-year-old woman with malignant granular cell tumor metastatic to lung, lymph node, and soft tissue presented for evaluation. Her performance status was excellent. Eighteen months previously she had resection of a 6.2 cm malignant granular cell tumor from the right periscapular area with no osseous involvement, or involvement of the glenohumeral joint (Fig 1A, low power view demonstrating nests of large cells with abundant eosinophilic cytoplasm [H&E, ϫ40 optical magnification]; Fig 1B, high power view of nests of tumor cells in a