Atypical Arytenoid Lesion Revealing Lobular Capillary Hemangioma: Diagnostic and Therapeutic Challenges

Lobular capillary hemangioma (LCH), historically referred to as pyogenic granuloma, is a benign vascular proliferation rarely identified within the larynx. Due to its uncommon location and variable endoscopic appearance, laryngeal LCH may mimic other benign laryngeal lesions, including contact granuloma, creating diagnostic and therapeutic challenges. Unlike conventional laryngeal granuloma, which is frequently managed conservatively, LCH often requires surgical excision and histopathological confirmation for definitive diagnosis. We present the case of an 18-year-old female patient with persistent globus sensation, dysphonia, and odynophagia who was found to have an atypical exophytic lesion arising from the right arytenoid cartilage. Initial endoscopic evaluation demonstrated a smooth, translucent, well-circumscribed lesion without overt ulceration or typical inflammatory features of contact granuloma. Given the atypical appearance of the lesion, persistent symptomatology, and ongoing diagnostic uncertainty, direct laryngoscopy with blue laser excision was performed for both diagnostic and therapeutic purposes. Histopathological examination revealed LCH. Follow-up at three and eight weeks demonstrated complete symptomatic resolution without evidence of recurrence. This case highlights the importance of considering LCH within the differential diagnosis of atypical laryngeal granulomatous lesions. Histopathological evaluation remains essential in lesions with unusual endoscopic characteristics, as management strategies and therapeutic implications may differ significantly from those of conventional laryngeal granuloma.