Pyogenic Granuloma of the Vocal Cords: A Rare Benign Lesion Mimicking Malignancy

Pyogenic Granuloma of the Vocal Cords: A Rare Benign Lesion Mimicking Malignancy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Pyogenic Granuloma of the Vocal Cords: A Rare Benign Lesion Mimicking Malignancy nakkabi ismail This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5830141/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The pyogenic granuloma (or botryomycoma) of the vocal cords is a rare benign tumor. It is typically located in the posterior part, near the vocal process of the arytenoid cartilage. Etiologies include gastroesophageal reflux, intubation, and vocal strain. Macroscopically, laryngoscopic examination usually reveals a nodular lesion; however, it may also present as an ulceration of the vocal cord. Its appearance can therefore be misleading, resembling a malignant laryngeal lesion, with the diagnosis confirmed by histopathological examination. Histologically, a pyogenic granuloma is not a true granuloma. It is rather a reactive process, characterized by the presence of intact or ulcerated squamous epithelium overlying granulation tissue or fibrosis. Treatment primarily involves surgical excision of the lesion, under direct laryngoscopy, coupled with management of gastroesophageal reflux, which may be silent. Despite its benign nature, pyogenic granuloma has a potential for recurrence, especially if the underlying cause persists. Otorhinolaryngology Pyogenic granuloma botryomycoma vocal cords dysphonia gastroesophageal reflux intubation benign laryngeal tumor Figures Figure 1 Introduction Lesions of the glottic region, which primarily present as dysphonia, encompass a wide spectrum of pathologies with varying degrees of malignancy. These range from inflammatory conditions and benign lesions such as vocal cord nodules and polyps to malignant neoplasms. Management depends on the exact nature of the lesion and its underlying cause. Vocal process granuloma, also known as pyogenic granuloma, is a benign lesion that can nonetheless raise clinical suspicion due to its presentation, which may resemble laryngeal cancer. Synonyms for this lesion include contact ulcer, intubation granuloma, vocal granuloma, or inflammatory polyp of the larynx. A thorough clinical evaluation is therefore essential to differentiate this benign condition from malignant lesions and provide appropriate management. Case Report A 58-year-old patient presented with a one-year history of dysphonia. His medical history included a smoking habit of 7 pack-years, stopped over 30 years ago, type 2 diabetes, hypertension, and basal cell carcinoma (BCC) of the nasal tip. The BCC required six surgical interventions, including re-excisions for inadequate tumor margins and reconstruction procedures, each involving orotracheal intubation. The reported dysphonia, present for a year, had worsened 15 days before consultation. No history of vocal strain was noted. The patient also described persistent respiratory discomfort due to nasal obstruction but denied dysphagia or pharyngeal pain. Endoscopic examination of the vocal cords using a 70-degree rigid scope revealed a reddish, exophytic nodular lesion occupying the posterior glottic region, leaving only an anterior glottic gap. Vocal cord mobility was preserved. Cervical-thoracic CT scan revealed a glottic lesion lateralized to the right, extending to the overlying ventricular band without paraglottic space invasion. No abnormalities of the laryngeal cartilages were noted. The patient underwent surgical management with complete tumor excision during direct laryngoscopy in suspension. Histological examination identified polypoid fragments corresponding to polymorphic granulation tissue with numerous engorged capillary-sized vessels arranged in lobules. These vessels had thin walls lined by regular endothelial cells. No evidence of malignancy was observed, concluding the diagnosis of pyogenic granuloma of the vocal cords. Discussion Pyogenic granuloma (PG) of the vocal cords, although rare, constitutes a benign pathology that can be misinterpreted as malignant due to its clinical and endoscopic presentation. In our case, the lesion’s development was likely influenced by a combination of repeated orotracheal intubations during multiple surgeries for basal cell carcinoma (BCC) and a possible component of silent gastroesophageal reflux, which is a well-documented etiological factor. The laryngoscopic appearance of PG—a reddish, exophytic nodular lesion localized to the vocal process—is suggestive but not specific. As highlighted in the literature, these lesions may also present as ulcerations or masses, which can affect one or both vocal cords and, in rare cases, extend to other laryngeal regions (1, 2). Consequently, histological analysis is essential for an accurate diagnosis, confirming the presence of richly vascularized granulation tissue organized in lobules with endothelial cell-lined vessels, while ruling out malignancy. PG is most commonly observed in the gingiva, lips, and facial regions, with rare occurrences in the larynx. A review conducted at the University of Virginia Medical Center and Martha Jefferson Hospital analyzed 639 vascular lesions of the oral cavity and upper airway. Among these, 73 cases (11% of which occurred during pregnancy) were diagnosed as PG, primarily affecting the lips (38%), nose (29%), oral mucosa (18%), and tongue (15%). Notably, none of the laryngeal or tracheal lesions initially resembled PG on microscopic examination (3). Andrea et al. reported a rare case of laryngeal PG in a 23-year-old pregnant woman presenting with hemoptysis. Excision of the lesion after delivery revealed characteristic lobular proliferation of closely packed capillaries in an edematous stroma (4). Similarly, Arkadi et al. described a 12-year-old girl with hemoptysis caused by an exophytic, multilobular reddish mass nearly obstructing the hypopharynx and covering the laryngeal inlet. Histological examination ultimately confirmed PG, highlighting the importance of pathology in differentiating this benign condition from other vascular or malignant lesions (5). Further, in a study by Epivatianos et al., PG was documented as a lobular capillary hemangioma of the oral cavity, supporting its benign nature but emphasizing the potential for misdiagnosis due to its appearance (6). Cawson et al. highlighted that hormonal influences, particularly during pregnancy, could exacerbate the presentation of PG in areas like the oral cavity and upper respiratory tract (7). Surgical excision remains the mainstay of treatment for PG, as demonstrated in our patient. However, addressing underlying etiological factors, such as silent gastroesophageal reflux, is crucial to minimizing recurrence risk. A multidisciplinary approach—encompassing otolaryngologists, gastroenterologists, and potentially speech therapists—may be required to ensure comprehensive management and optimal outcomes. This case underscores the critical importance of a systematic approach to persistent dysphonia, a common yet often overlooked symptom, necessitating vigilance for potential malignancy-mimicking lesions. While PG is a benign entity, delayed or inappropriate treatment can lead to complications or recurrence. Moreover, this report highlights the indispensable role of endoscopic exploration and imaging in evaluating lesion extent, guiding surgical intervention, and optimizing postoperative follow-up. Conclusion Pyogenic granuloma of the vocal cords is a rare benign lesion but can be challenging due to its clinical presentation mimicking malignancy. This case highlights the importance of a thorough diagnostic approach combining endoscopy, imaging, and histopathological examination to establish an accurate diagnosis and rule out malignancy. Identifying and managing underlying etiological factors, such as gastroesophageal reflux or laryngeal trauma, is essential to prevent recurrence. Multidisciplinary care remains the key to optimal management and follow-up. Declarations The author confirms that patient consent for publication of this case report was received. References Shah M, Feldman M, Patel A. Pyogenic granuloma of the larynx: A rare presentation mimicking malignancy. Laryngoscope . 2019;129(7):1526-1530. Bhaskar SN, Jacoway JR. Pyogenic granuloma—clinical features, incidence, histology, and result of treatment: report of 242 cases. J Oral Surg . 1966;24(5):391-398. Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and maxillofacial pathology. 2nd ed. Philadelphia: Saunders; 2002. Andrea M, Lee K, Johnson L. Pyogenic granuloma of the larynx as a rare cause of hemoptysis in pregnancy. Am J Otolaryngol . 2008;29(5):360-362. Arkadi L, Smith T, Rhodes A. Massive pyogenic granuloma of the larynx in a pediatric patient: A rare presentation. J Pediatr Otorhinolaryngol . 2020;138:110354. Epivatianos A, Zaraboukas T, Papanayotou P. Pyogenic granuloma: a lobular capillary hemangioma of the oral cavity. J Oral Surg Oral Med Oral Pathol Oral Radiol Endod . 2005;89(5):525-531. Cawson RA, Odell EW, Porter S. Cawson’s Essentials of Oral Pathology and Oral Medicine. 7th ed. London: Churchill Livingstone; 2002. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5830141","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":402220206,"identity":"c095656e-8104-4605-aec7-49e91099487c","order_by":0,"name":"nakkabi ismail","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYBACNgYGZsYGhgM8/CBeQgEpWiQbQFoMiLMIrIXB4ACITYwWPunmx4Yzau7IGJ9fnfjhgQGDPL/YAQIOkzlmnLjh2DMesxtvN0sAHWY4c3YCAS0SCcYHH7AdBmo5uwGkJcHgNkEt6Z8PPvh3mMd4xtnNP4jUkmOcuLHtMI8Bf+82Ym3JKTac2feMR+IG7zaLBAMJwn6Rn5G+WbLn2x17/v6zm2/+qLCR55cmoAUBJMAqJYhVDgL8B0hRPQpGwSgYBSMJAABIDkWJP0OLngAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-8186-2846","institution":"ENT and Head and neck surgery departement, Oued Eddahab Military Hospital of Agadir - Morocco","correspondingAuthor":true,"prefix":"","firstName":"nakkabi","middleName":"","lastName":"ismail","suffix":""}],"badges":[],"createdAt":"2025-01-15 00:15:11","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5830141/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5830141/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":74425851,"identity":"c0c0562d-b01b-420d-ba1e-2ab173f6ed13","added_by":"auto","created_at":"2025-01-22 07:57:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":191950,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003ePolypoid lesion occupying the posterior part of the vocal cord\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5830141/v1/1dae9ab3ec356553b6e8ce25.png"},{"id":74425859,"identity":"78c45fcd-9aef-455b-a9f6-d6b078c73199","added_by":"auto","created_at":"2025-01-22 07:57:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":541760,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5830141/v1/a2004c6d-230f-4db7-820a-a8b2f405a368.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003ePyogenic Granuloma of the Vocal Cords: A Rare Benign Lesion Mimicking Malignancy\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLesions of the glottic region, which primarily present as dysphonia, encompass a wide spectrum of pathologies with varying degrees of malignancy. These range from inflammatory conditions and benign lesions such as vocal cord nodules and polyps to malignant neoplasms. Management depends on the exact nature of the lesion and its underlying cause.\u003c/p\u003e \u003cp\u003eVocal process granuloma, also known as pyogenic granuloma, is a benign lesion that can nonetheless raise clinical suspicion due to its presentation, which may resemble laryngeal cancer. Synonyms for this lesion include contact ulcer, intubation granuloma, vocal granuloma, or inflammatory polyp of the larynx. A thorough clinical evaluation is therefore essential to differentiate this benign condition from malignant lesions and provide appropriate management.\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003eA 58-year-old patient presented with a one-year history of dysphonia. His medical history included a smoking habit of 7 pack-years, stopped over 30 years ago, type 2 diabetes, hypertension, and basal cell carcinoma (BCC) of the nasal tip. The BCC required six surgical interventions, including re-excisions for inadequate tumor margins and reconstruction procedures, each involving orotracheal intubation.\u003c/p\u003e\n\u003cp\u003eThe reported dysphonia, present for a year, had worsened 15 days before consultation. No history of vocal strain was noted. The patient also described persistent respiratory discomfort due to nasal obstruction but denied dysphagia or pharyngeal pain.\u003c/p\u003e\n\u003cp\u003eEndoscopic examination of the vocal cords using a 70-degree rigid scope revealed a reddish, exophytic nodular lesion occupying the posterior glottic region, leaving only an anterior glottic gap. Vocal cord mobility was preserved.\u003c/p\u003e\n\u003cp\u003eCervical-thoracic CT scan revealed a glottic lesion lateralized to the right, extending to the overlying ventricular band without paraglottic space invasion. No abnormalities of the laryngeal cartilages were noted.\u003cbr\u003e The patient underwent surgical management with complete tumor excision during direct laryngoscopy in suspension.\u003cbr\u003e Histological examination identified polypoid fragments corresponding to polymorphic granulation tissue with numerous engorged capillary-sized vessels arranged in lobules. These vessels had thin walls lined by regular endothelial cells. No evidence of malignancy was observed, concluding the diagnosis of pyogenic granuloma of the vocal cords.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePyogenic granuloma (PG) of the vocal cords, although rare, constitutes a benign pathology that can be misinterpreted as malignant due to its clinical and endoscopic presentation. In our case, the lesion\u0026rsquo;s development was likely influenced by a combination of repeated orotracheal intubations during multiple surgeries for basal cell carcinoma (BCC) and a possible component of silent gastroesophageal reflux, which is a well-documented etiological factor.\u003c/p\u003e \u003cp\u003eThe laryngoscopic appearance of PG\u0026mdash;a reddish, exophytic nodular lesion localized to the vocal process\u0026mdash;is suggestive but not specific. As highlighted in the literature, these lesions may also present as ulcerations or masses, which can affect one or both vocal cords and, in rare cases, extend to other laryngeal regions (1, 2). Consequently, histological analysis is essential for an accurate diagnosis, confirming the presence of richly vascularized granulation tissue organized in lobules with endothelial cell-lined vessels, while ruling out malignancy.\u003c/p\u003e \u003cp\u003ePG is most commonly observed in the gingiva, lips, and facial regions, with rare occurrences in the larynx. A review conducted at the University of Virginia Medical Center and Martha Jefferson Hospital analyzed 639 vascular lesions of the oral cavity and upper airway. Among these, 73 cases (11% of which occurred during pregnancy) were diagnosed as PG, primarily affecting the lips (38%), nose (29%), oral mucosa (18%), and tongue (15%). Notably, none of the laryngeal or tracheal lesions initially resembled PG on microscopic examination (3).\u003c/p\u003e \u003cp\u003eAndrea et al. reported a rare case of laryngeal PG in a 23-year-old pregnant woman presenting with hemoptysis. Excision of the lesion after delivery revealed characteristic lobular proliferation of closely packed capillaries in an edematous stroma (4). Similarly, Arkadi et al. described a 12-year-old girl with hemoptysis caused by an exophytic, multilobular reddish mass nearly obstructing the hypopharynx and covering the laryngeal inlet. Histological examination ultimately confirmed PG, highlighting the importance of pathology in differentiating this benign condition from other vascular or malignant lesions (5).\u003c/p\u003e \u003cp\u003eFurther, in a study by Epivatianos et al., PG was documented as a lobular capillary hemangioma of the oral cavity, supporting its benign nature but emphasizing the potential for misdiagnosis due to its appearance (6). Cawson et al. highlighted that hormonal influences, particularly during pregnancy, could exacerbate the presentation of PG in areas like the oral cavity and upper respiratory tract (7).\u003c/p\u003e \u003cp\u003eSurgical excision remains the mainstay of treatment for PG, as demonstrated in our patient. However, addressing underlying etiological factors, such as silent gastroesophageal reflux, is crucial to minimizing recurrence risk. A multidisciplinary approach\u0026mdash;encompassing otolaryngologists, gastroenterologists, and potentially speech therapists\u0026mdash;may be required to ensure comprehensive management and optimal outcomes.\u003c/p\u003e \u003cp\u003eThis case underscores the critical importance of a systematic approach to persistent dysphonia, a common yet often overlooked symptom, necessitating vigilance for potential malignancy-mimicking lesions. While PG is a benign entity, delayed or inappropriate treatment can lead to complications or recurrence. Moreover, this report highlights the indispensable role of endoscopic exploration and imaging in evaluating lesion extent, guiding surgical intervention, and optimizing postoperative follow-up.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePyogenic granuloma of the vocal cords is a rare benign lesion but can be challenging due to its clinical presentation mimicking malignancy. This case highlights the importance of a thorough diagnostic approach combining endoscopy, imaging, and histopathological examination to establish an accurate diagnosis and rule out malignancy. Identifying and managing underlying etiological factors, such as gastroesophageal reflux or laryngeal trauma, is essential to prevent recurrence. Multidisciplinary care remains the key to optimal management and follow-up.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe author confirms that patient consent for publication of this case report was received.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eShah M, Feldman M, Patel A. Pyogenic granuloma of the larynx: A rare presentation mimicking malignancy. \u003cem\u003eLaryngoscope\u003c/em\u003e. 2019;129(7):1526-1530.\u003c/li\u003e\n \u003cli\u003eBhaskar SN, Jacoway JR. Pyogenic granuloma\u0026mdash;clinical features, incidence, histology, and result of treatment: report of 242 cases.\u0026nbsp;\u003cem\u003eJ Oral Surg\u003c/em\u003e. 1966;24(5):391-398.\u003c/li\u003e\n \u003cli\u003eNeville BW, Damm DD, Allen CM, Bouquot JE. Oral and maxillofacial pathology. 2nd ed. Philadelphia: Saunders; 2002.\u003c/li\u003e\n \u003cli\u003eAndrea M, Lee K, Johnson L. Pyogenic granuloma of the larynx as a rare cause of hemoptysis in pregnancy.\u0026nbsp;\u003cem\u003eAm J Otolaryngol\u003c/em\u003e. 2008;29(5):360-362.\u003c/li\u003e\n \u003cli\u003eArkadi L, Smith T, Rhodes A. Massive pyogenic granuloma of the larynx in a pediatric patient: A rare presentation.\u0026nbsp;\u003cem\u003eJ Pediatr Otorhinolaryngol\u003c/em\u003e. 2020;138:110354.\u003c/li\u003e\n \u003cli\u003eEpivatianos A, Zaraboukas T, Papanayotou P. Pyogenic granuloma: a lobular capillary hemangioma of the oral cavity. \u003cem\u003eJ Oral Surg Oral Med Oral Pathol Oral Radiol Endod\u003c/em\u003e. 2005;89(5):525-531.\u003c/li\u003e\n \u003cli\u003eCawson RA, Odell EW, Porter S. Cawson\u0026rsquo;s Essentials of Oral Pathology and Oral Medicine. 7th ed. London: Churchill Livingstone; 2002.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pyogenic granuloma, botryomycoma, vocal cords, dysphonia, gastroesophageal reflux, intubation, benign laryngeal tumor","lastPublishedDoi":"10.21203/rs.3.rs-5830141/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5830141/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe pyogenic granuloma (or botryomycoma) of the vocal cords is a rare benign tumor. It is typically located in the posterior part, near the vocal process of the arytenoid cartilage. Etiologies include gastroesophageal reflux, intubation, and vocal strain.\u003c/p\u003e \u003cp\u003eMacroscopically, laryngoscopic examination usually reveals a nodular lesion; however, it may also present as an ulceration of the vocal cord. Its appearance can therefore be misleading, resembling a malignant laryngeal lesion, with the diagnosis confirmed by histopathological examination.\u003c/p\u003e \u003cp\u003eHistologically, a pyogenic granuloma is not a true granuloma. It is rather a reactive process, characterized by the presence of intact or ulcerated squamous epithelium overlying granulation tissue or fibrosis.\u003c/p\u003e \u003cp\u003eTreatment primarily involves surgical excision of the lesion, under direct laryngoscopy, coupled with management of gastroesophageal reflux, which may be silent. Despite its benign nature, pyogenic granuloma has a potential for recurrence, especially if the underlying cause persists.\u003c/p\u003e","manuscriptTitle":"Pyogenic Granuloma of the Vocal Cords: A Rare Benign Lesion Mimicking Malignancy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-22 07:49:46","doi":"10.21203/rs.3.rs-5830141/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c89ec046-2590-4075-8391-7568084da520","owner":[],"postedDate":"January 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":42870783,"name":"Otorhinolaryngology"}],"tags":[],"updatedAt":"2025-01-22T07:49:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-22 07:49:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5830141","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5830141","identity":"rs-5830141","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}