Malignant laryngeal lesions mimicking vocal process granuloma on flexible laryngoscopy: Two case reports

Vocal process granuloma (VPG) is a common benign inflammatory lesion of the posterior glottis, typically induced by intubation injury, laryngopharyngeal reflux, or vocal abuse. Clinicians usually make an initial clinical impression of VPG merely through laryngoscopy, and routine biopsy is generally not performed. However, malignant lesions arising at the vocal process may appear highly similar to laryngeal granulomas under flexible laryngoscopy. We present two patients with a history of tracheal intubation. Their granuloma-like lesions were initially regarded as benign VPG, while postoperative histopathology confirmed laryngeal carcinoma. Such diagnostic discrepancies stem from typical intubation history suggestive of granuloma, overlapping lesion morphology, insufficient preoperative biopsy sampling and inherent clinical diagnostic preconception. For posterior glottic lesions that are large, exophytic or morphologically atypical, biopsy or complete surgical resection for pathological examination is recommended to rule out malignancy.