Laryngeal granuloma occurring after surgery for laryngeal cancer treated by surgical removal and immediate post-operative radiotherapy: A case report

Abstract

Rational: Laryngeal granulomas are benign lesion that rarely occurs after surgery of laryngeal cancer. Until now there has not been standard treatment for it.

Patient concern: The patient was diagnosed with laryngeal neoplasm one and half a month ago. Endoscopic low-temperature plasma knife in the radical excision of left vocal cord was performed under the general anesthesia. Postoperative histopathological examination confirmed left vocal cord tumor was highly differentiated invasive squamous cell carcinoma (SCC). Then the patient suffered unexplained intermittent dyspnea which persisted nearly 1 month after the surgery. Laryngoscope examination showed granulation formation on the glottis.

Diagnoses: The patient was diagnosed with laryngeal granuloma 1 month after the surgery of laryngeal cancer.

Interventions: The patient received resection of the laryngeal mass, and pathological examination confirmed the granuloma. Postoperative radiotherapy (RT) was performed within 24 hours after surgery.

Outcomes: The patient was followed up for 3 years after surgery and the laryngeal granuloma and laryngeal cancer did not recur during follow-up. The symptoms of intermittent dyspnea disappeared and a satisfactory outcome was achieved.

Lessons: Usually for primary laryngeal granulomas, surgical treatment alone is not enough, because it is easy to relapse. RT within 24 hours after operation can significantly reduce the recurrence of laryngeal granuloma.

Figure 1

Hematoxylin and eosin staining. Microscopically, an invasive, highly differentiated squamous cell carcinoma (A, B 200×).

Figure 2

Laryngoscope. Granulation formation and scar formation in the glottis area before reoperation (A, B); after radiation DT20Gy/10f, the laryngoscope showed a white pseudo membranous was attached to the glottis(C, D); after radiation completed, no swelling was observed in the epiglottis, the white pseudo membrane can still be seen on the glottis (E, F).

Figure 3

Hematoxylin and eosin staining (reoperation): hyperplastic fibrous tissue, focal epithelium atypical hyperplasia, in which chronic inflammatory cells can be seen (A: 100×; B: 200×); immunohistochemistry: immunohistochemical staining revealed positive staining for CK-pan (C, D: 200×).