Granular cell myoblastoma of the larynx

Granular Cell Tumors of the Larynx: A Systematic Review

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.

Laryngeal granular cell tumors in children: A literature review

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.

Granular cell tumors of the larynx

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.

Granular Cell Tumors Arising Nearly Simultaneously in the Larynx and Subcutaneous Cervical Region

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.

Granular Cell Tumor of the Larynx in a Six-Year-Old Child: Case Report and Review of the Literature

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.

Granular cell tumour of the larynx in an eight-year-old girl

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.

Granular cell tumors of the head and neck in children: the experience at the Children's Hospital of Philadelphia

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.

Granular cell tumour of the larynx

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.

Granular cell tumour of the larynx in childhood

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.

Esophageal metastasis from breast carcinoma associated with pseudoepitheliomatous hyperplasia: an unusual endoscopic diagnosis

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.

Granular cell myoblastoma of the supraglottis

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.

Contiguous granular cell myoblastoma and squamous cell carcinoma in the oesophagus

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Granular cell tumor of the larynx in a 5-year-old child

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.

Coexisting granular cell myoblastoma and squamous carcinoma of the bronchus

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Multicentric tracheobronchial and oesophageal granular cell myoblastoma

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.

Granular cell myoblastoma of the larynx

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.

Rhabdomyosarcoma of the larynx. Report of two cases and a review of the literature

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.

Rhabdomyoma of the hypopharynx and larynx. Report of two cases and a review of the literature

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.

Granular cell tumors of the larynx

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.

Rhabdomyoma purum of the larynx

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.