A Case of Granular Cell Tumor of the Vocal Cord

Summary

This study presents a case of a 45-year-old male with a laryngeal granular cell tumor (diagnosed via histology and staining), who was treated with plasma ablation without recurrence.

Abstract

Granular cell tumor (GCT) is a rare benign neoplasm that most commonly arises in the head and neck region. Laryngeal involvement is exceptional. A 45-year-old man presented with a 3-year history of progressive hoarseness without apparent precipitating factors. Occasional cough produced white, viscous sputum; neither dyspnea nor dysphagia was reported. Laryngoscopy revealed a smooth-surfaced, broad-based elevation involving the anterior two-thirds of the right true vocal fold. Histology revealed polygonal cells with abundant granular cytoplasm and a low nuclear-to-cytoplasmic ratio, set within a delicate fibrovascular stroma. Periodic acid-Schiff staining highlighted cytoplasmic granules. Immunohistochemistry demonstrated diffuse positivity for S-100, CD68, and neuron-specific enolase (NSE), confirming the diagnosis of GCT. The lesion was completely excised in two stages using low-temperature plasma radiofrequency ablation (LTP-RFA). At 24 months of follow-up, no evidence of recurrence was observed. GCT may be mistaken histologically for squamous cell carcinoma (SCC). Recognition of this differential diagnosis is essential for otolaryngologists.

Introduction

Granular cell tumor (GCT, Abrikossoff tumor) was first described in 1926 and popularized by Abrikossoff in 1962¹. The cytoplasm exhibits a granular appearance resulting from lysosomal aggregation, leading to the designation "granular cell tumor". Current evidence suggests a neurogenic origin, with immunohistochemical and ultrastructural findings supporting derivation from Schwann cells or their precursors². GCT can occur at any age and at any site³. Peak incidence occurs in adults aged 40-60 years⁴. The incidence of multifocal GCT in adults is 5%-16%

Protocol

The research protocol adheres to the guidelines of the Ethics Committee for Human Research at Hangzhou First People's Hospital. Written informed consent for participation was obtained from the patient.

1. Preoperative preparation

1. Place the patient in the supine position. Use general combined anesthesia. Perform endotracheal intubation using a cuffed endotracheal tube. The tube should be thin, with an internal diameter of 6.5 mm for male patients. Disinfect and drape the surgical area.
2. After satisfactory anesthesia, use a laryngoscope to fully expose the surgical field. Connect the laryngeal endoscope and adjust the....

Results

In this case report, two microlaryngoscopic surgeries under suspension laryngoscopy were performed on the patient. For the first surgery, to ensure the integrity of the patient's vocal ligament, a conservative tumor resection was performed. Five months later, the second surgery was performed, during which the tumor tissue was completely removed. Pathological examination revealed the following findings: for the 'vocal cord (frozen section + routine specimen submission)', the mu.......

Discussion

GCT is characterized by slow growth and insidious symptoms⁸. The most common symptoms of laryngeal granular cell tumor are dysphonia and hoarseness, but cough, dysphagia, and odynophagia may also occur⁹. Under laryngoscopy, GCT can have various morphologies, and it is difficult to distinguish it from polyps, cysts, and malignant tumors with the naked eye. It must be confirmed by pathological examination. Differential diagnoses that should be considered include laryngeal cys.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Disposable RF plasma scalpel head	Shenzhen Viewwall Medical Technology Co., Ltd.	VAM-Q-3830230	Sterile, ethylene oxide sterilized, disposable
Laryngeal endoscope	KARLSTORZ Germany	8714AA	Sterile,dry heat sterilized, reusable