Elsevier

Journal of Voice

Volume 23, Issue 4, July 2009, Pages 516-517
Journal of Voice

Granular Cell Tumors of the Larynx: Diagnosis and Management

https://doi.org/10.1016/j.jvoice.2007.10.016Get rights and content

Summary

In this case study, a retrospective review of chart and literature was done to discuss the presentation and treatment of granular cell tumors of the larynx. One patient was diagnosed and treated successfully with surgical resection of a laryngeal granular cell tumor. Excellent voice recovery was obtained and there is no evidence of recurrence 6 months after surgery. Granular cell tumors should be considered in the differential diagnosis of laryngeal masses, particularly in the posterior glottis.

Introduction

Granular cell tumors of the adult larynx are rare and occur between the third and sixth decade of life. They are twice as common in females as in males, with a particular susceptibility in the African American population.1 Patients with one granular cell tumor have a 4–10% chance of another granular cell tumor elsewhere in the body. Grossly, they are well-circumscribed, firm, pink masses that grow slowly, with patients presenting an average of 7 months after initiation of symptoms.2 Although some patients may be asymptomatic, common symptoms are hoarseness, cough, dysphagia, odynophagia, otalgia, stridor, and hemoptysis. Most often, the diagnosis is a surprise to the surgeon, made after histologic examination of biopsied material from direct laryngoscopy. The differential diagnosis includes granuloma, schwannoma, glomus tumor, amyloid, carcinoid, hemangioma, chondroma, chondrosarcoma, and squamous cell carcinoma. On CT scan, granular cell tumors are solid and homogenously enhancing, often mimicking a squamous cell carcinoma. MRI characteristics of this tumor are hypointensity on T1 with homogeneous contrast enhancement and there is heterogeneously increased signal on T2.3

Fifty percent of granular cell tumors occur in the head and neck. The tongue is the most common location in this region; however, the larynx is involved in 10% of the cases. When in the larynx, they generally appear in the posterior third of the true vocal folds, although it has also been found on the anterior commissure, arytenoids, the false vocal folds, subglottis, and the postcricoid region. When located in the posterior third of the larynx, they can often be confused with laryngeal granulomas; however, the former is not responsive to antireflux therapy. The following is a case report of a patient who was diagnosed recently with a granular cell tumor of the larynx.

Section snippets

Case report

A 41-year-old, nonsmoking female who presented with a chief complaint of a nonproductive cough and worsening dysphonia that had developed over many years, but had noticeably worsened over the past 6 months. Her only significant past medical problem was a possible history of asthma. Flexible fiberoptic laryngoscopy revealed a subepithelial mass within the posterior larynx affecting the cricoid cartilage and left arytenoid cartilage (Figure 1). The lesion obscured the posterior one third of the

Discussion

Granular cell tumors are well-circumscribed, non-encapsulated lesions that are composed of large, polygonal cells arranged in sheets and strands, often with poorly defined borders that seem to indicate soft tissue infiltration. Despite this appearance, more than 98% of these tumors are benign. The histologic defining characteristic is the abundant, eosinophilic cytoplasm that is filled with periodic acid-Schiff and Sudan black B positive granules, which represent lysosomes.4 In 50–65% of the

Conclusion

Granular cell tumors should be considered in the differential diagnosis of laryngeal masses, particularly in the posterior glottis. These lesions are usually benign and although complete excision of laryngeal granular cell tumors is desired, destruction of the functional larynx is excessive treatment for this benign lesion. A subtotal resection is preferred if this will ensure a functional larynx for both voice production and airway maintenance in patients with a granular cell tumor of the

References (9)

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    Granular cell tumor was first described in 1926 [7]. The first theory suggested a myogenic origin, ruled today ruled out by the presence of the tumor in areas without muscle fibers and the absence of myoglobin in the granular cells [8]. Currently, the neurogenic origin of the cells (Schwann cells) that form the tumor has begun to be defended, mainly on the basis of immunohistochemical studies [9].

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    Preoperative diagnose is hindered by its nonspecific imaging and ubiquity.14 On CT scan, GCT are solid and homogenously enhancing while on MRI they show homogenous contrast enhancement and hypointensity on T1 and heterogeneously increased signal on T2.7 Abrikosoff first described the GCT in 1926, and suggested the tumor originate from striated muscle myoblasts, so referred to it as myoblastoma.

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All work was conducted at The George Washington University.

There was no financial support or funding for this paper.

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