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Luke AS, Mairson TM, Husain IA, Kaplan SE. Granular Cell Tumors of the Larynx: A Systematic Review. Laryngoscope 2024; 134:1523-1530. [PMID: 37782552 DOI: 10.1002/lary.31071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE Granular cell tumor of the larynx is an uncommon, typically benign lesion that may be confused for a malignant neoplasm based on histopathology. This review examines cases of granular cell tumor of the larynx in adults to highlight key distinctions in diagnosis/management and demonstrate how misclassification may lead to unnecessary escalations in therapy. DATA SOURCES AND METHODS A systematic search of PubMed, Ovid, and EBSCO Search Hosts was completed in December 2021. The search yielded 501 articles with 87 full-text articles included in the review. Primary search terms included granular cell, tumor, larynx, and adult. Primary endpoints were patient presentation, primary management, pathological features, and disease course. RESULTS A systematic review of 87 articles identified 200 patients with granular cell tumors (GCTs) of the larynx. Of the 200 patients, 50.3% were males and 49.7% were females. Of these, 54.0% were reported as white patients, and 46.0% were reported as black patients. The most common presenting symptoms were dysphonia (85.9%) and stridor/dyspnea (14.1%). On examination, the lesions were most commonly polypoid/nodular and firm. Pseudoepitheliomatous hyperplasia (PEH) was identified in 33.5% of cases, and 2% of cases were malignant. GCTs were misdiagnosed as other malignant lesions in 11% of cases. In benign cases, 13.5% of patients underwent additional surgeries beyond simple excision/laryngofissure, including laryngectomy and neck dissection. Less than 2% of lesions reoccurred. CONCLUSION Granular cell tumors of the larynx are typically benign lesions that may be misdiagnosed with unnecessary escalation of treatment. However, most lesions resolve via primary surgical excision. Laryngoscope, 134:1523-1530, 2024.
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Affiliation(s)
- Alex S Luke
- Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, Houston, Texas, USA
| | - Theresa M Mairson
- School of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Inna A Husain
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Seth E Kaplan
- Department of Otolaryngology-Head and Neck Surgery, Lenox Hill Hospital - Northwell Health, New York, New York, USA
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Mur TA, Pellegrini WR, Tracy LF, Levi JR. Laryngeal granular cell tumors in children: A literature review. Int J Pediatr Otorhinolaryngol 2020; 138:110193. [PMID: 32705988 DOI: 10.1016/j.ijporl.2020.110193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/02/2020] [Accepted: 06/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Granular cell tumors of the larynx are exceedingly rare in the pediatric population. The purpose of this review is to further characterize features of these tumors and trends in their management. METHODS A search of the PubMed, Ovid Medline and Cochrane Collaboration databases was undertaken using the terms: pediatric, child, laryngeal, larynx, granular cell tumor, granular cell myoblastoma, benign mass. RESULTS A total of 38 children with laryngeal granular cell tumor were identified. Their ages ranged from 4 to 16 years. The most common presenting symptom was dysphonia. Five patients were previously treated for asthma. Within the laryngeal subsites, 49% presented with subglottic tumors, while 43% were found at the level of the glottis. Subglottic tumors were found anteriorly 42% of the time and posteriorly 53% of the time. Multifocal disease was present in four patients. Around half of patients were treated by cold steel excision and/or CO2 laser, 31% through laryngofissure, and two required laryngectomy. There were four documented cases of recurrence ranging from 4 months to 3 years after treatment. CONCLUSIONS Laryngeal granular cell tumor during childhood occurs most commonly in the subglottis. Posterior laryngeal tumors were more frequent than anterior tumors. Patients should be carefully evaluated for multifocal disease. Long-term surveillance for recurrence is recommended.
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Affiliation(s)
- Taha A Mur
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA
| | | | - Lauren F Tracy
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | - Jessica R Levi
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA.
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Sataloff RT, Ressue JC, Portell M, Harris RM, Ossoff R, Merati AL, Zeitels S. Granular cell tumors of the larynx. J Voice 2000; 14:119-34. [PMID: 10764124 DOI: 10.1016/s0892-1997(00)80102-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Granular cell tumor is a rare neoplasm that may involve the larynx. It is almost always benign. Laryngologists should be familiar with this unusual tumor, its implications and appropriate treatment.
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Affiliation(s)
- R T Sataloff
- The Graduate Hospital, Philadelphia, Pennsylvania, USA
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Kawaida M, Fukuda H, Kohno N. Granular Cell Tumors Arising Nearly Simultaneously in the Larynx and Subcutaneous Cervical Region. EAR, NOSE & THROAT JOURNAL 2000. [DOI: 10.1177/014556130007900309] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Granular cell tumors are benign, relatively rare lesions that can occur in any organ in the body. Tumors are known to occasionally arise in two or more different organs. We report the case of a 60-year-old woman in whom granular cell tumors arose almost simultaneously in her subcutaneous cervical region and her larynx. The two tumors were surgically resected and examined histopathologically, and they exhibited the same histopathologic features. The tumor of the larynx was resected with the help of a carbon dioxide laser. Immunohistochemical staining revealed that both were positive for S-100 protein and neuron-specific enolase. Cases of the nearly simultaneous appearance of granular cell tumors in the neck and larynx are rather unusual. The results of immunohistochemical staining suggested that this tumor originates in nerve tissue.
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Affiliation(s)
- Masahiro Kawaida
- Departments of Otolaryngology, Tokyo Metropolitan Ohtsuka Hospital
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Holland RS, Abaza N, Balsara G, Lesser R. Granular Cell Tumor of the Larynx in a Six-Year-Old Child: Case Report and Review of the Literature. EAR, NOSE & THROAT JOURNAL 1998. [DOI: 10.1177/014556139807700814] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Granular cell tumors (granular cell myoblastomas) are uncommon neoplasms in the adult population, occurring predominantly in the head and neck and most frequently in the tongue. Laryngeal presentations are unusual, and granular cell tumors of the larynx in children are extremely rare, with a total of 19 cases reported in the literature in children under the age of] 7 years. We report an additional case of a laryngeal granular cell tumor, in a six-year-old boy, and discuss the clinical, histologic, ultrastructural and therapeutic aspects of these neoplasms.
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Affiliation(s)
- Ruth S. Holland
- Medical College of Pennsylvania and Hahneman University, East Falls Campus, Philadelphia, Pennsylvania
| | - Nabil Abaza
- Medical College of Pennsylvania and Hahneman University, East Falls Campus, Philadelphia, Pennsylvania
| | - Gulnar Balsara
- Medical College of Pennsylvania and Hahneman University, East Falls Campus, Philadelphia, Pennsylvania
| | - Raymond Lesser
- Medical College of Pennsylvania and Hahneman University, East Falls Campus, Philadelphia, Pennsylvania
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6
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Abstract
Granular cell tumour is a rare benign neoplasm, that can affect many parts of the body, as single or multiple lesions. It is more common in black people and females. Typically it occurs between the fourth and fifth decades of life, with the median age for the laryngeal variety as 36 years. About 30 to 50 per cent occur in the tongue and 30 per cent in the skin. A case of granular cell tumour of the larynx is reported in an eight-year-old girl, presenting with hoarseness of voice. She was successfully treated with local excision of the tumour. This tumour is rare in the larynx where it is more common in males than females although granular cell tumours are found more frequently in females generally. For these reasons the authors suspect that their case, of a laryngeal granular cell tumour occurring in an eight-year-old girl might be the youngest to be reported.
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Affiliation(s)
- A M Hamid
- ENT Department, Hamad General Hospital, Doha City, State of Qatar
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8
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Torsiglieri AJ, Handler SD, Uri AK. Granular cell tumors of the head and neck in children: the experience at the Children's Hospital of Philadelphia. Int J Pediatr Otorhinolaryngol 1991; 21:249-58. [PMID: 1651292 DOI: 10.1016/0165-5876(91)90006-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Granular cell tumors are rare, usually benign tumors of controversial histogenesis. These tumors are uncommon in children. Granular cell tumors in adults have a predilection for the head and neck, but this was not noted in our experience with children. Of the 22 granular cell tumors diagnosed and managed at the Children's Hospital of Philadelphia from 1960 to 1988, 7 were from the head and neck. One child with a subglottic granular cell tumor is of particular interest and is presented in detail.
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Affiliation(s)
- A J Torsiglieri
- Division of Otolaryngology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine 19104
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Abstract
A granular cell tumour may present as clinically innocuous lesions on the vocal cords and the diagnosis is usually made by histopathology. However, the granular cells characteristic of this tumour may not be obvious and accompanying epithelial hyperplasia may be interpreted by the pathologist as invasive squamous cell carcinoma. Good communication between pathologist and surgeon is required to ensure that clinically benign lesions on the vocal cords are not misdiagnosed. The diagnosis of granular cell tumour can be confirmed by immunocytochemical staining for S100 antigen.
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Affiliation(s)
- I A Cree
- Department of Otolarynology, Ninewells Hospital and Medical School, Dundee, Scotland
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Abstract
The youngest patient reported to date with granular cell tumour of the larynx is presented, with a review of other reported cases in childhood. The basis of histological diagnosis of granular cell tumour is described.
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Affiliation(s)
- R G Wight
- Department of Otolaryngology, Royal Hallamshire Hospital, Sheffield
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Haim N, Krugliak P, Cohen Y, Schwartzman Z, Benharroch D. Esophageal metastasis from breast carcinoma associated with pseudoepitheliomatous hyperplasia: an unusual endoscopic diagnosis. J Surg Oncol 1989; 41:278-81. [PMID: 2547117 DOI: 10.1002/jso.2930410416] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The clinicopathologic findings in a patient who developed dysphagia and obstruction of the middle third of the esophagus 12 years after mastectomy for breast carcinoma are presented. Endoscopic biopsy revealed metastatic breast carcinoma with pseudoepitheliomatous hyperplasia of the overlying esophageal mucosa. To the best of our knowledge, the case represents the first reported association between esophageal metastasis and pseudoepitheliomatous hyperplasia of the esophageal squamous epithelium.
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Affiliation(s)
- N Haim
- Department of Oncology, Soroka Medical Center, Faculty of Health Science, Ben-Curion University, Beer-Sheva, Israel
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12
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Abstract
Granular cell myoblastoma is an unusual benign tumour, which, when occurring in the larynx usually affects the vocal cords and causes hoarseness. We present a case presenting with symptoms strongly suggestive of globus pharyngis. These tumours probably arise from neuroectodermal tissue, and the current nomenclature is a misnomer. Complete excision rather than biopsy is recommended, as biopsy material may be misinterpreted as squamous carcinoma. In this case, endoscopic removal of the tumour was successful in producing complete symptomatic relief.
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Affiliation(s)
- P J Robb
- Department of Otolaryngology, Guy's Hospital, London
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13
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Affiliation(s)
- N B Solomons
- Department of Otolaryngology, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
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Mannion P, Honan RP, Fitzgerald MD, Hasleton PS. Contiguous granular cell myoblastoma and squamous cell carcinoma in the oesophagus. Thorax 1985; 40:551-3. [PMID: 2994248 PMCID: PMC460134 DOI: 10.1136/thx.40.7.551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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16
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Gårud O, Bostad L, Elverland HH, Mair IW. Granular cell tumor of the larynx in a 5-year-old child. Ann Otol Rhinol Laryngol 1984; 93:45-7. [PMID: 6703597 DOI: 10.1177/000348948409300111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The youngest reported case of laryngeal granular cell tumor is presented together with transmission electron micrographs of the tumor cells. Whereas subglottic involvement is unusual in adults, a review of the literature reveals that three of the seven youngest patients (including the present patient) with laryngeal granular cell lesions had a subglottic tumor immediately below the anterior commissure.
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17
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Granular cell tumour. Indian J Otolaryngol Head Neck Surg 1982. [DOI: 10.1007/bf02992359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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18
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Hurwitz SS, Conlan AA, Gritzman MC, Krut LH. Coexisting granular cell myoblastoma and squamous carcinoma of the bronchus. Thorax 1982; 37:392-3. [PMID: 6287661 PMCID: PMC459326 DOI: 10.1136/thx.37.5.392] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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19
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20
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O'Connell DJ, MacMahon H, De Meester TR. Multicentric tracheobronchial and oesophageal granular cell myoblastoma. Thorax 1978; 33:596-602. [PMID: 214892 PMCID: PMC470941 DOI: 10.1136/thx.33.5.596] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Two patients with multiple intrathorcic granular cell myoblastomas are described. In one case multiple tumours were present in the major airways and oesophagus. The patient presented with recurrent pulmonary infections and stridor due to airway obstruction. In the other case dysphagia caused by multiple oesophageal granular cell myoblastomas was the major symptom. Granular cell myoblastoma is a rare tumour of neurogenic origin with a characteristic histological appearance. The pattern of multiple tracheobranchial and oesophageal tumours is uncommon and forms the basis of this report.
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Abstract
Two cases of granular cell myoblastoma of the larynx are presented. In the first case the tumour was excised by laryngofissure, and in the second case by microlaryngoscopy. Based on this experience a review of this interesting tumour is made, and emphasis is given to the fact that this neoplasm may be mistaken for squamous cell carcinoma.
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22
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Winter LK, Lorentzen M. Rhabdomyosarcoma of the larynx. Report of two cases and a review of the literature. J Laryngol Otol 1978; 92:417-24. [PMID: 650071 DOI: 10.1017/s0022215100085546] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The rhabdomyosarcoma is a relatively rare tumour form. Two cases in the larynx--a site which is extremely rare--are reported. So far, only 9 cases have been described and documented, and of one of our cases seems to be the first of the alveolar type found at this site. Diagnostic and differential-diagnostic considerations are discussed. Hoarseness is the commonest and earliest symptom. As stated by most authors, the treatment should be radical operation, often with laryngectomy, supplemented by irradiation and chemotherapy.
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23
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Winther LK. Rhabdomyoma of the hypopharynx and larynx. Report of two cases and a review of the literature. J Laryngol Otol 1976; 90:1041-51. [PMID: 1003030 DOI: 10.1017/s0022215100083092] [Citation(s) in RCA: 42] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Two cases of extracardiac rhabdomyoma are reported in a 54-year-old man with unexplained difficulty in breathing and in a 39-year-old man with a prolonged history of hoarseness. Attention is drawn to the necessity of doing hypopharyngo-and laryngoscopy in such cases. One tumour was found in the left vallecula in the hypopharynx and the other on the left vocal cord. The literature and the histological findings in 53 cases are reviewed. It appears that this rare tumour is most frequently found in muscles derived from the pharyngeal arches. A total of 40 cases have been diagnosed during the last decade, and this increase is likely to continue in the future. It may turn out that extra-cardiac rhabdomyoma is not so rare as was first presumed.
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Abstract
Granular cell tumors of the larynx are relatively uncommon, always benign, and most commonly located in the posterior portion of the larynx. They are easily identified and should be differentiated from other lesions. A possible problem in the differential diagnosis is the presence of pseudoepitheliomatous hyperplasia, which overlies the granular cell tumor and which may mimic squamous cell carcinoma. Careful histopathologic differentiation is important because the laryngeal granular cell lesion should be managed conservatively, with transoral local excision usually being adequate. The histogenesis of these lesions remains in doubt, with a neural or epithelial derivation being the most likely possibility.
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Abstract
A case of pure well-differentiated rhabdomyoma of the larynx occurring in a 50-year-old male is reported. The lesion was localized to the interarytenoid region. From an accurate revision of the world literature on the subject it appears that the cases so far described number only seven, including the one in the present report. Furthermore, the differential histological and histochemical criteria for distinguishing rhabdomyoma from granular cell Schwannoma are discussed and tabulated, as the two neoplasms may be easily confused. In our case, there has been no evidence of recurrence of the tumour for more than 1 year, which is in accordance with the previous cases reported in the literature.
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Peterson LJ. Granular-cell tumor. Review of the literature and report of a case. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1974; 37:728-35. [PMID: 4363978 DOI: 10.1016/0030-4220(74)90138-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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