see: Granular Cell Tumor of the Larynx; Microdirect Laryngoscopy case example
A 39-year-old male presented with a persistent voice change and intermittent throat discomfort not relieved by Omeprazole for a year and half. Past medical history significant for gastroesophageal reflux disease relieved by Omeprazole, and a history of seasonal allergies. He used to smoke for 10 years and quitted smoking 5 years before presentation.
Physical examination findings were within normal. His neck was supple and negative for palpable masses and lymph nodes.
Fiberoptic Transnasal Laryngoscopy Showed a smooth yellow lesion on the dorsal surface of the right vocal process; laryngoscopy also showed abundant of lymphoid tissue in the adenoid fossa.
The patient elected to proceed with excision of the right vocal cord lesion with microdirect laryngoscopy under general anaesthesia (Microdirect Laryngoscopy (Suspension Microlaryngoscopy or Direct Laryngoscopy) concomitantly with endoscopic biopsy of adenoid tissue.
Histopathological examination demonstrated granular cell tumor of the right vocal cord lesion with positive margins and hyperplastic lymphoid tissue without atypia of the adenoid tissue.
Postoperative course was marked by gradual and significant improvement of voice production with no dysphagia or dyspnea. Fiberoptic Transnasal laryngoscopy on postoperative visit showed healthy healing of excision site with no signs of pathological inflammation. Four- and nine-month follow-ups, respectively, did not show any evidence of disease recurrence.
Preoperative images:
Intraoperative images:
Postoperative, four-month follow-up
Postoperative, nine-months follow-up
References
Park J-H, Do N-Y, Cho S-I, Choi J-Y. Granular Cell Tumor on Larynx. Clinical and Experimental Otorhinolaryngology. 2010;3(1):52-55. doi:10.3342/ceo.2010.3.1.52.
Osipov OV, Shidham VB, Rao N, Pandit AW. Granular cells tumor. Medscape Web site. http://emedicine.medscape.com/article/282430-overview. Updated 2016. Accessed 10/9, 2016.
Strong EW, McDivitt RW, Brasfield RD. Granular cell myoblastoma. Cancer. 1970;25(2):415-422.
Berkowitz SF, Hirsh BC, Vonderheid E. Granular cell tumor: A great masquerader. Cutis. 1985;35(4):355-356.
Lazar RH, Younis RT, Kluka EA, Joyner RE, Storgion S. Granular cell tumor of the larynx: Report of two pediatric cases. Ear Nose Throat J. 1992;71(9):440-443.
Mukherji SK, Castillo M, Rao V, Weissler M. Granular cell tumors of the subglottic region of the larynx: CT and MR findings. AJR Am J Roentgenol. 1995;164(6):1492-1494.
Luke AS, Mairson TM, Husain IA, Kaplan SE. Granular Cell Tumors of the Larynx: A Systematic Review. Laryngoscope. 2023 Oct 2. doi: 10.1002/lary.31071. Epub ahead of print. PMID: 37782552.