(A552) Granular Cell Tumor of the Pharynx: Management Using a Transoral Robotic Approach

Introduction: Granular cell tumor (GCT) of the pharynx is a rare entity with only one other reported case in the known literature.

Methods: This is a single institution retrospective review of a single case of large GCT of the right pharynx in a 57 year old male.

Results: The patient presented initially to clinic with symptoms of voice change, noisy breathing, and marked weight loss for 8 months. Physical examination revealed a large mass obstructing 75% of the oropharynx and hypopharynx. Contrasted CT of the neck revealed a homogenous right lateral oropharyngeal mass, measuring 3.2 x 3.8 x 6.5 cm with effacement of the oropharyngeal airway. Ultrasound-guided core needle biopsy was performed, and pathology was initially nondiagnostic. No overt features of high-grade dysplasia or malignancy were seen.

A transoral robotic surgical approach (TORS) was used for tumor resection, and subsequent histopathology revealed bland spindle cells with both neural and granular features. Immunohistochemical analysis showed positive staining for S100 and SOX10, confirming the diagnosis of GCT. His immediate post-operative course was initially notable for mild post-obstructive respiratory symptoms requiring SICU admission. He was subsequently able to be discharged uneventfully on post-operative day 2. At the time of initial post-operative follow-up, he was found to be healing well and noted no issues with breathing or alimentation.

Conclusions: This case highlights a rare case of granular cell tumor presenting as a pharyngeal mass. Transoral robotic approach allowed for safe tumor extirpation. No adjuvant therapy is required given benign clinicopathologic behavior.