Novel surgical management of a laryngeal granular cell tumour

Abstract

Granular cell tumour (GCT) is a rare benign tumour occurring, most commonly, in the head and neck. Multiple tumours occur in 5–16% of patients. These tumours are chemo-radio-resistant and have high recurrence rates despite their benign histopathological features. Traditional management, depending on access, involves total tumour resection with wide margins due to the high rates of recurrence with incomplete resection. We present a patient with two synchronous GCTs of their upper airway: in the larynx and the trachea. Complete excision of the supraglottic lesion would have rendered the patient's larynx incompetent. Therefore, after multidisciplinary team (MDT) discussion, and following a discussion with the patient regarding the risks and benefits, a novel surgical management approach was agreed. Subtotal CO2laser excision of the upper GCT was performed enabling functional organ preservation. A subsequent procedure was required when the patient became symptomatic due to tumour recurrence.

Granular cell tumor on the larynx

“…The most common symptoms and signs are hoarseness, coughing, dysphagia, odynophagia 4 . Other rare symptoms include stridor, otalgia and hemoptysis 1 .…”

“…Granular cell tumor on the larynx recurrence is multicentric in 16% of the uncompleted excisions 4 . According to the localization, planning is crucial for the total or subtotal tumor excision to keep a functional larynx 4 .…”

Seltene Erkrankungen des Larynx, der Trachea und der Schilddrüse

“…Die Tumoren imponieren als blasse, submukös wachsende Masse auf den Stimmlippen, das Leitsymptom ist die Dysphonie [159]. In 5 % der Fälle zeigen sich mehrere laryngeale Manifestationen [160]. Granularzelltumore kommen auch in der Trachea vor, hier ist das weibliche Geschlecht häufiger betroffen.…”

“…The tumors impose as pale, submucously growing mass on the vocal folds, the initial symptom is dysphonia [159]. In 5 % of the cases, several laryngeal manifestations are observed [160]. Granular cell tumors also appear in the trachea, hereby the female gender is more frequently affected.…”

Subglottische Pathologien

“…Es wird ein neuroektodermaler Ursprung diskutiert [34,35]. Üblicherweise treten GZT solitär auf, es werden jedoch auch in 5-16 % multiple Satellitenknoten beobachtet [36]. Sie treten üblicherweise während der 3. bis 6.…”