Home Laser excision of a large granular cell tumor of the vocal cord with subglottic extension: A case report
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Laser excision of a large granular cell tumor of the vocal cord with subglottic extension: A case report

  • Manal Bukhari EMAIL logo
Published/Copyright: August 7, 2025
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Open Medicine
From the journal Open Medicine Volume 20 Issue 1

Abstract

Granular cell tumors (GCTs) are rare, benign tumors typically originating from Schwann cells, with the head and neck being the most common sites. Laryngeal GCTs, particularly those affecting the vocal cords, are exceedingly rare in adults. This report presents a 28-year-old female with a GCT of the left vocal cord extending into the subglottic region. The patient presented with progressive dysphonia, and laryngoscopy revealed a 2 cm × 1 cm mass on the left vocal cord. Microlaryngeal examination confirmed subglottic extension, and the tumor was excised using carbon dioxide (CO2) laser. Histopathological analysis confirmed GCT with S100 positivity. Two months later, the patient developed a late complication – granuloma formation at the excision site – necessitating revision surgery. The patient was symptom-free at the 12-month follow-up. GCTs in the vocal cords with subglottic extension are rare and challenging to diagnose and treat. They are generally benign lesions and rarely undergo malignant transformation. Diagnosis is confirmed through histology, and treatment involves wide local excision, with re-excision needed for recurrence. GCTs are chemo- and radio-insensitive, making surgery the primary treatment. This case underscores the importance of accurate diagnosis and tailored treatment, highlighting the need for further research on this rare condition.

Keywords: Abrikossoff’s tumor; dysphonia; granular cell tumor; laryngeal neoplasm

1 Introduction

Granular cell tumors (GCTs) are extremely rare, benign neoplasms of soft tissue that likely originate from Schwann cells [1]. First described by Abrikossoff in 1926, these tumors are also known as Abrikossoff’s tumors [2]. Approximately 50% of all GCTs occur in the head and neck region, with the tongue being the most frequently implicated organ, accounting for nearly 30% of all cases. Less than 10% of cases involve the larynx [3]. Laryngeal GCTs, particularly those affecting the vocal cords, are exceptionally rare, with the majority of cases occurring in the adult age group [3]. The occurrence of GCTs in the vocal cords of adults is even rarer, underscoring the need for further research to gather more data, which will be crucial for advancing our understanding and management of this uncommon entity. Here, we present the case of a GCT of the vocal cords in a 28-year-old woman.

2 Case report

A 28-year-old female presented to the otolaryngology clinic with a complaint of progressive dysphonia over the past year. She denied any history of dyspnea, dysphagia, or choking and had no previous history of allergies or surgery. She is a non-smoker and does not consume alcohol.

A direct laryngoscopy revealed a 2 cm × 1 cm mass with a smooth appearance and whitish coloration in the posterior two-thirds of the left vocal cord (Figure 1a). Both vocal cords were mobile with a 2 mm anterior glottic gap during phonation, and there was mass effect (Figure 1b). A microlaryngeal examination under general anesthesia revealed that the mass extended into the subglottic area. The mass was firm on palpation and sheltered by epithelium. A complete resection of the mass was achieved using a carbon dioxide (CO2) laser.

Figure 1 GCT of the vocal cord. (a) Direct laryngoscopy revealing a 2 × 1 cm mass with a smooth surface and whitish coloration in the posterior two-thirds of the left vocal cord. (b) Direct laryngoscopy revealing a 2 mm anterior glottic gap during phonation, and there was mass effect. (c) Light microscopy image of the resected vocal cord tumor showing polygonal cells with abundant eosinophilic cytoplasm (hematoxylin and eosin stain; ×20). (d) Immunohistochemical staining of the resected vocal cord tumor showing nuclear and cytoplasmic positivity for S100 (×20).
Figure 1

GCT of the vocal cord. (a) Direct laryngoscopy revealing a 2 × 1 cm mass with a smooth surface and whitish coloration in the posterior two-thirds of the left vocal cord. (b) Direct laryngoscopy revealing a 2 mm anterior glottic gap during phonation, and there was mass effect. (c) Light microscopy image of the resected vocal cord tumor showing polygonal cells with abundant eosinophilic cytoplasm (hematoxylin and eosin stain; ×20). (d) Immunohistochemical staining of the resected vocal cord tumor showing nuclear and cytoplasmic positivity for S100 (×20).

The patient was discharged the day post-surgery with no intraoperative or early postoperative complications. She was instructed to rest her voice for 5 days. During the first follow-up (1 week later), the patient’s voice had significantly improved. A follow-up laryngoscopy showed whitish slough tissue at the posterior third of the glottis. Histopathological results revealed a mass covered by non-keratinizing stratified squamous epithelium with large polygonal cells containing granular cytoplasm (Figure 1c). S-100 staining was positive (Figure 1d).

Two months later, the patient developed dysphonia again. A direct laryngoscopy revealed a 2 cm × 0.5 cm mass with an irregular, granular surface and red coloration, extending from the posterior infraglottic area to the posterior two-thirds of the vocal cord (Figure 2a). Revision surgery was performed using a CO2 laser to remove the mass, with intraoperative local steroid injection at the surgery site. The patient was discharged the next day and instructed to rest her voice for 1 week, take oral corticosteroids for 1 week, and use a proton pump inhibitor for 1 month. Histology showed intense inflammatory cell infiltrate with blood vessel proliferation, suggesting granuloma (Figure 2b), but was negative for GCT.

Figure 2 Recurrent mass of the vocal cord. (a) Direct laryngoscopy revealing a 2 × 0.5 cm mass with an irregular, granular surface and red coloration, extending from the posterior infraglottic area to the posterior two-thirds of the vocal cord. (b) Light microscopy image of the recurrent vocal cord mass showing surface ulceration with underlying lobular arrangement of capillary vessels (hematoxylin and eosin stain; ×40).
Figure 2

Recurrent mass of the vocal cord. (a) Direct laryngoscopy revealing a 2 × 0.5 cm mass with an irregular, granular surface and red coloration, extending from the posterior infraglottic area to the posterior two-thirds of the vocal cord. (b) Light microscopy image of the recurrent vocal cord mass showing surface ulceration with underlying lobular arrangement of capillary vessels (hematoxylin and eosin stain; ×40).

Two months later, the patient’s voice was clear, and follow-up laryngoscopy showed complete closure during phonation with good healing. Twelve months after the last surgery, the patient was symptom-free and had no recurrence (Figure 3).

Figure 3 Direct laryngoscopy demonstrating remarkable healing of the left vocal cord, with no evidence of mass recurrence 1 year after surgery.
Figure 3

Direct laryngoscopy demonstrating remarkable healing of the left vocal cord, with no evidence of mass recurrence 1 year after surgery.

  1. Informed consent: Written informed consent was obtained from the patient for publication of this case report and accompanying images.

  2. Ethical approval: Ethical approval for this case report was waived from the Institutional Review Board at King Saud University, Riyadh, Saudi Arabia.

3 Discussion

GCTs are known by several other names, including Abrikossoff’s tumor, granular cell nerve sheath tumor, granular cell schwannoma, and granular cell myoblastoma [2]. Epidemiologically, GCTs are believed to be more prevalent in adults [4], females [3], and individuals of African descent [5].

While GCTs can affect any part of the body, laryngeal involvement is not common [3]. Patients with laryngeal GCTs may be asymptomatic. However, those who do experience symptoms may report hoarseness, cough, difficulty swallowing, painful swallowing, ear pain, a high-pitched breathing sound, or coughing up blood [3]. In our study, the patient presented with voice changes but had no history of shortness of breath or difficulty swallowing.

GCTs typically present as solitary, well-circumscribed, firm, pink, or greyish-yellow masses [4]. Multifocality may suggest the presence of syndromes like Noonan syndrome or neurofibromatosis type I [4]. GCTs of the vocal cords most commonly affect the anterior one-third. In contrast, our patient had involvement of the posterior two-thirds with subglottic extension, a presentation that is rarely reported. GCT of the vocal cord with subglottic extension is clinically significant due to its impact on diagnosis, symptoms, treatment, and prognosis. Subglottic involvement can complicate diagnosis and treatment, potentially affecting the airway and leading to symptoms such as difficulty breathing, stridor, or dysphagia. It may also require more invasive treatments. The extension into the subglottis may necessitate a more extensive surgical resection, with risks of airway compromise or recurrence if not fully excised.

The histogenesis of GCTs has been widely debated. Our understanding has evolved since Abrikossoff’s 1926 description, in which he proposed a myogenous origin [2]. Later evidence in 1962, however, reinforced a neural source, linking these neoplasms to Schwann cells [1]. Features such as S100 protein positivity, neuron-specific enolase, the similarity between myelin granules and those in GCT cells, and the concentric organization of granular cells positioned around nerve endings corroborate the neural origin hypothesis. Additionally, the presence of lipoproteins and sphingomyelin further suggests a Schwann cell origin [1].

Although the majority of GCTs are benign, less than 2% of cases could undergo malignant transformation and exhibit aggressive biological behavior [6]. The differential diagnoses of GCTs include polyps, granulomas, and cysts, which are often difficult to distinguish through direct visualization alone. Therefore, a definitive diagnosis is typically made through histological examination of biopsy samples obtained during direct laryngoscopy. Microscopically, GCTs display a distinctive appearance, with hematoxylin-eosin staining revealing plentiful eosinophilic, granular cytoplasm. Immunohistochemical analysis for S100 and neuron-specific enolase positivity may be necessary to confirm the diagnosis [7].

Treatment of GCTs of the vocal cords involves wide local excision with the aim of achieving negative margins. Carbon dioxide (CO2) laser excision has proven to be an effective method for removing the tumor with negative margins [8]. Recurrence is largely rare. GCTs are resistant to chemotherapy and radiotherapy [9], so re-excision is preferred in case of relapse. Small-sized GCTs can be excised via direct laryngoscopy, while larger ones require laryngofissure or more radical approaches like laryngectomy.

4 Conclusion

GCTs of the vocal cords are extremely rare benign neoplasms, with the majority occurring in the adult population. Laryngeal GCTs, especially those involving the vocal cords and subglottic extension, present diagnostic and therapeutic challenges due to their potential airway impact and the need for extensive surgical resection. While GCTs are typically benign, malignant transformation is possible in a small percentage of cases. Diagnosis is confirmed through histological examination, with S100 and neuron-specific enolase staining aiding in identification. Treatment involves wide local excision, with re-excision recommended for recurrences, as these tumors are resistant to chemotherapy and radiotherapy. Further research is needed to better understand and manage this rare entity.

Acknowledgments

None.

  1. Funding information: Author states no funding involved.

  2. Author contribution: MB conceived the study, collected and analyzed the data, and wrote and approved the final manuscript.

  3. Conflict of interest: Author states no conflict of interest.

  4. Data availability statement: The data supporting the findings of this study are available within the article. Additional data related to the study can be requested from the corresponding author upon reasonable request.

References

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Received: 2025-03-07
Revised: 2025-06-13
Accepted: 2025-07-07
Published Online: 2025-08-07

© 2025 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  184. Semaglutide treatment for type 2 diabetes in a patient with chronic myeloid leukemia: A case report and review of the literature
  185. Diverse electrophysiological demyelinating features in a late-onset glycogen storage disease type IIIa case
  186. Giant right atrial hemangioma presenting with ascites: A case report
  187. Laser excision of a large granular cell tumor of the vocal cord with subglottic extension: A case report
  188. EsoFLIP-assisted dilation for dysphagia in systemic sclerosis: Highlighting the role of multimodal esophageal evaluation
  189. Molecular hydrogen-rhodiola as an adjuvant therapy for ischemic stroke in internal carotid artery occlusion: A case report
  190. Coronary artery anomalies: A case of the “malignant” left coronary artery and its surgical management
  191. Rapid Communication
  192. Biological properties of valve materials using RGD and EC
  193. A single oral administration of flavanols enhances short-term memory in mice along with increased brain-derived neurotrophic factor
  194. Letter to the Editor
  195. Role of enhanced external counterpulsation in long COVID
  196. Expression of Concern
  197. Expression of concern “A ceRNA network mediated by LINC00475 in papillary thyroid carcinoma”
  198. Expression of concern “Notoginsenoside R1 alleviates spinal cord injury through the miR-301a/KLF7 axis to activate Wnt/β-catenin pathway”
  199. Expression of concern “circ_0020123 promotes cell proliferation and migration in lung adenocarcinoma via PDZD8”
  200. Corrigendum
  201. Corrigendum to “Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism”
  202. Corrigendum to “Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis”
  203. Corrigendum to “The progress of autoimmune hepatitis research and future challenges”
  204. Retraction
  205. Retraction of “miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway”
  206. Retraction of: “LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through downregulating SP-A by sponging to miR-424”
  207. Retraction of: “SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways”
  208. Special Issue Advancements in oncology: bridging clinical and experimental research - Part II
  209. Unveiling novel biomarkers for platinum chemoresistance in ovarian cancer
  210. Lathyrol affects the expression of AR and PSA and inhibits the malignant behavior of RCC cells
  211. The era of increasing cancer survivorship: Trends in fertility preservation, medico-legal implications, and ethical challenges
  212. Bone scintigraphy and positron emission tomography in the early diagnosis of MRONJ
  213. Meta-analysis of clinical efficacy and safety of immunotherapy combined with chemotherapy in non-small cell lung cancer
  214. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part IV
  215. Exploration of mRNA-modifying METTL3 oncogene as momentous prognostic biomarker responsible for colorectal cancer development
  216. Special Issue The evolving saga of RNAs from bench to bedside - Part III
  217. Interaction and verification of ferroptosis-related RNAs Rela and Stat3 in promoting sepsis-associated acute kidney injury
  218. The mRNA MOXD1: Link to oxidative stress and prognostic significance in gastric cancer
  219. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part II
  220. Dynamic changes in lactate-related genes in microglia and their role in immune cell interactions after ischemic stroke
  221. A prognostic model correlated with fatty acid metabolism in Ewing’s sarcoma based on bioinformatics analysis
  222. Red cell distribution width predicts early kidney injury: A NHANES cross-sectional study
  223. Special Issue Diabetes mellitus: pathophysiology, complications & treatment
  224. Nutritional risk assessment and nutritional support in children with congenital diabetes during surgery
  225. Correlation of the differential expressions of RANK, RANKL, and OPG with obesity in the elderly population in Xinjiang
  226. A discussion on the application of fluorescence micro-optical sectioning tomography in the research of cognitive dysfunction in diabetes
  227. A review of brain research on T2DM-related cognitive dysfunction
  228. Metformin and estrogen modulation in LABC with T2DM: A 36-month randomized trial
  229. Special Issue Innovative Biomarker Discovery and Precision Medicine in Cancer Diagnostics
  230. CircASH1L-mediated tumor progression in triple-negative breast cancer: PI3K/AKT pathway mechanisms
https://doi.org/10.1515/med-2025-1250
Keywords for this article
Abrikossoff’s tumor; dysphonia; granular cell tumor; laryngeal neoplasm
Creative Commons
BY 4.0

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  190. Coronary artery anomalies: A case of the “malignant” left coronary artery and its surgical management
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  194. Letter to the Editor
  195. Role of enhanced external counterpulsation in long COVID
  196. Expression of Concern
  197. Expression of concern “A ceRNA network mediated by LINC00475 in papillary thyroid carcinoma”
  198. Expression of concern “Notoginsenoside R1 alleviates spinal cord injury through the miR-301a/KLF7 axis to activate Wnt/β-catenin pathway”
  199. Expression of concern “circ_0020123 promotes cell proliferation and migration in lung adenocarcinoma via PDZD8”
  200. Corrigendum
  201. Corrigendum to “Empagliflozin improves aortic injury in obese mice by regulating fatty acid metabolism”
  202. Corrigendum to “Comparing the therapeutic efficacy of endoscopic minimally invasive surgery and traditional surgery for early-stage breast cancer: A meta-analysis”
  203. Corrigendum to “The progress of autoimmune hepatitis research and future challenges”
  204. Retraction
  205. Retraction of “miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway”
  206. Retraction of: “LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through downregulating SP-A by sponging to miR-424”
  207. Retraction of: “SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways”
  208. Special Issue Advancements in oncology: bridging clinical and experimental research - Part II
  209. Unveiling novel biomarkers for platinum chemoresistance in ovarian cancer
  210. Lathyrol affects the expression of AR and PSA and inhibits the malignant behavior of RCC cells
  211. The era of increasing cancer survivorship: Trends in fertility preservation, medico-legal implications, and ethical challenges
  212. Bone scintigraphy and positron emission tomography in the early diagnosis of MRONJ
  213. Meta-analysis of clinical efficacy and safety of immunotherapy combined with chemotherapy in non-small cell lung cancer
  214. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part IV
  215. Exploration of mRNA-modifying METTL3 oncogene as momentous prognostic biomarker responsible for colorectal cancer development
  216. Special Issue The evolving saga of RNAs from bench to bedside - Part III
  217. Interaction and verification of ferroptosis-related RNAs Rela and Stat3 in promoting sepsis-associated acute kidney injury
  218. The mRNA MOXD1: Link to oxidative stress and prognostic significance in gastric cancer
  219. Special Issue Exploring the biological mechanism of human diseases based on MultiOmics Technology - Part II
  220. Dynamic changes in lactate-related genes in microglia and their role in immune cell interactions after ischemic stroke
  221. A prognostic model correlated with fatty acid metabolism in Ewing’s sarcoma based on bioinformatics analysis
  222. Red cell distribution width predicts early kidney injury: A NHANES cross-sectional study
  223. Special Issue Diabetes mellitus: pathophysiology, complications & treatment
  224. Nutritional risk assessment and nutritional support in children with congenital diabetes during surgery
  225. Correlation of the differential expressions of RANK, RANKL, and OPG with obesity in the elderly population in Xinjiang
  226. A discussion on the application of fluorescence micro-optical sectioning tomography in the research of cognitive dysfunction in diabetes
  227. A review of brain research on T2DM-related cognitive dysfunction
  228. Metformin and estrogen modulation in LABC with T2DM: A 36-month randomized trial
  229. Special Issue Innovative Biomarker Discovery and Precision Medicine in Cancer Diagnostics
  230. CircASH1L-mediated tumor progression in triple-negative breast cancer: PI3K/AKT pathway mechanisms
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