Introduction - PDF document

B-ENT , 2018, 14 , 29-30 Introduction Granular cell tumours are rare, benign, slowly growing neoplasms, usually of Schwann cell origin. 1-5 Granular cell tumours can occur anywhere in the body. However, approximately 50% of granular cell tumours involve the head and tongue. 1-5 Granular cell tumours of the larynx are rare, accounting for only 7 to 10% of all reported cases. 1-5 Herein, we report the case of a patient with an incidentally detected granular cell tumour of the false vocal cord. Case report A 40-year-old male, who had a mass on the left false vocal cord, which was found incidentally during a local hospital, was referred to our department. The patient’s medical history was not remarkable and without any intubation or laryngeal trauma. Furthermore, the patient had no symptoms, including hoarseness, dysphagia or sense of a lump. Physical examination revealed smooth, polypoid, yellow lesions and a mass that was approximately 2 cm in size on the left false vocal cord. Examination of the head and neck was otherwise unremarkable. We performed pharyngoscopic removal of the mass with a CO 2 laser. The mass originated in the left posterior edge of the false vocal cord and was sharply excised at its base (Figure 1). A direct relation between the mass and surrounding tissue was not identi�ed. The post-operative course was uneventful. The histopathological analysis of the false vocal cord mass demonstrated a granular cell tumour. The mass was strongly positive for S-100 protein on immunohistochemical staining (Figure 2). Since surgery, the patient has been regularly followed up without any evidence of recurrence. An incidentally detected granular cell tumour of the false vocal cord D. H. Lee, T. M. Yoon, J.K. Lee, S. C. Lim Department of Otolaryngology - Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, South Korea Key-words. Granular cell tumour; larynx; false vocal cord Abstract. An incidentally detected granular cell tumour of the false vocal cord Objective Granular cell tumours of the larynx are rare, benign, slowly growing neoplasms. Case report : We present the case of an incidentally detected granular cell tumour of the false vocal cord, which was successfully removed by the transoral approach using a CO2 laser. Conclusion : Clinicians should consider the possibility that a granular cell tumour may originate in the false vocal cord, mimicking the other more frequently observed lesions. Financial Disclosures: No �nancial disclosures. Authors do not have proprietary interest and any �nancial support or grants have been received. Figure 1 (A) An intra-operative photograph showing smooth, polypoid, yellow lesions and a mass of approximately 2 cm in size on the left false vocal cord. surgical resection of the granular cell tumour by the transoral approach using a CO2 laser. 30 D. H. Lee et al. resistant. 1-5 The use of a surgical excision approach depends on the size and site of the tumor. 2 In most cases, transoral endoscopic resection of a granular cell tumour is the preferred and most feasible method. 2-4 Laryngo�ssure and partial laryngectomy may be required in some cases, such as those involving a large or malignant tumor. 2,3 Despite proper surgical resection, there is an 8 to 21% recurrence rate, usually at the primary site. 3, 5 The causes of recurrence may be the failure to diagnose multiple granular cell tumours or the presence of positive surgical margins. 3,5 In addition, malignant transformation occurs in about 1 to 2% of granular cell tumors. 1,5 Therefore, regular lon

g-term follow- up after surgery is necessary. 5 In conclusion, granular cell tumours of the false vocal cord are extremely rare. We presented the case of an incidentally detected granular cell tumour of the false vocal cord, which was successfully removed by the transoral approach using a CO2 laser. Clinicians should consider the possibility that a granular cell tumour may originate in the false vocal cord, mimicking the other more frequently observed lesions. Discussion The most common site of granular cell tumours of the larynx is the true vocal cord, but they are also found on the anterior commissure, arytenoids, false vocal cord, subglottis and the posterior cricoid region. 1,3,5 The pathogenesis of a granular cell tumour of the larynx is unclear. Some authors suggested that local trauma to the larynx, such as physical or chemical, may be connected to the occurrence of granular cell tumors. 5 However, this patient had no history of laryngeal trauma. The most common presenting symptom is hoarseness, but it can also manifest as dysphagia, stridor, sense of a lump or haemoptysis.1-3 Some tumours may also be asymptomatic and are detected incidentally during a routine physical examination, as was the case with our patient. 1,2 Endoscopic and radiologic examinations are helpful for assessing the location and extension of the lesion; however, they are not suf�cient for diagnosing granular cell tumor. 3,5 The de�nitive diagnosis of a granular cell tumour of the larynx is usually made by histopathologic examination. 1-5 Granular cell tumours classically have polygonal or elongated cells with eosinophilic granules, small nuclei and absent mitosis. 2,3,5 Showing positive for S-100 protein on immunohistochemical staining can help to con�rm the diagnosis of a granular cell tumour. 2,3,5 The differential diagnosis of a granular cell tumour of the larynx includes squamous cell carcinoma, chondrosarcoma, chondroma and schwannoma. 3,6 our case, we con�rmed the diagnosis of a granular cell tumour by histopathologic examination. The treatment of choice for a granular cell tumour of the larynx is surgical excision because these tumours are usually benign and radio- Figure 2 (A) Histological examination of the specimen reveals that graular cell tumours composed of polygonal cells with eosinophilic granules (haematoxylin and eosin stain, x100). (B) Immunohistochemical staining for S-100 protein shows strong positivity in the nucleus and cytoplasm of tumour cells (x200). References 1. Sataloff RT, Ressue JC, Portell M, Harris RM, Ossoff R, Merati AL, Zeitels S. Granular cell tumors of the larynx. J Voice. 2000;14(1):119-134. 2. Hus JL, Su CY, Lin JW. Resection of a granular cell tumor of the larynx followed by medicalization laryngoplasty with bipedicled sternohyoid muscle transposition. Otolaryngol Head Neck Surg. 2006;135(6):983-985. 3. White JB, Glade R, Rossi CT, Bielamowicz S. Granular cell tumors of the larynx: diagnosis and management. J Voice. 2009;23(4):516-517. 4. Thompson LD. Laryngeal granular cell tumor. Ear Nose Throat J. 2009;88(3):824-825. 5. Park JH, Do NY, Cho SI, Choi JY. Granular cell tumor on larynx. Clin Exp Otorhinolaryngol . 2010;3(1):52-55. 6. De Cock M, Van Laer C, Vanwambeke K, Salgado R. Chondrosarcoma of the larynx: a report of two cases and a review of the literature. B-ENT . 2006;2(1):21-26. Joon Kyoo Lee, MD, PhD Department of Otolaryngology - Head and Neck Surgery Chonnam National University Medical School and Hwasun Hospital, 160 Ilsimri, Hwasun, Jeonnam, South Korea 519-809 Tel.: +82-61-379-8190 Fax: +82-61-379-7761 E-mail: joonkyoo@jnu.ac.k