Vocal cord polyps: biochemical and histologic evaluation

[The electron microscopic study of tumour-like structures on the vocal cords]

We have undertaken the electron microscopic investigation into peculiarities of six tumour-like structures on the vocal cords. The study has demonstrated changes in the number and distribution patterns of intercellular junctions, keratin and tonofilament contents in epithelial cells, basal membrane structure, and composition of the basic substance in lamina propria. All the examined tumour-like structures contained bacteria an two of them had viral particles in vacuoles of fibroblasts. Moreover, the bacteria were found on the surface of epithelium, between epithelial cells and in the basic substance in lamina propria. Cytoplasm of epithelial cells and fibroblasts not infrequently contained bacteria in the phase of division.

Pólipos de pregas vocais e alterações estruturais mínimas: lesões associadas?

Pólipos são lesões comuns de pregas vocais. O fonotrauma é o principal fator relacionado com o início desta lesão. A associação entre pólipos de pregas vocais e alterações estruturais mínimas de cobertura mucosa (sulco vocal, cisto epidermóide, ponte de mucosa, microdiafragma laríngeo e vasculodisgenesia) foi pouco estudada na literatura, por isso o objetivo deste trabalho foi quantificar e analisar essa associação. FORMA DE ESTUDO: Clínico retrospectivo. MATERIAL E MÉTODOS: Realizamos um estudo retrospectivo com 68 pacientes, idade média de 39,5 anos, operados de pólipo de pregas vocais no período entre janeiro de 1999 e maio de 2003. Procuramos analisar a presença de pólipo de pregas vocais e as possíveis AEMC associadas no levantamento realizado. RESULTADOS: A presença de AEMC associada ao pólipo ocorreu em 16 (23,5%) pacientes, sendo que em 8 (50%) pacientes o achado foi o sulco vocal (7 sulco estria e 1 sulco bolsa). Em 4 (25%) pacientes o achado foi o cisto de prega vocal, em 2 (12,5%) pacientes a ponte mucosa, em 1 (6,25%) a vasculodisgenesia e em 1 (6,25%) paciente o microdiafragma laríngeo. A AEMC era contralateral ao pólipo de prega vocal em 11 pacientes. Dos sulcos, 6 (75%) eram contralaterais e dos cistos, 3 (75%) eram contralaterais ao pólipo. CONCLUSÃO: A associação entre pólipos de pregas vocais e alterações estruturais mínimas de cobertura mucosa é relativamente freqüente, 23,5% em nosso estudo. A exploração cuidadosa de ambas pregas vocais é essencial no intraoperatório das cirurgias de exérese de pólipo na procura destas alterações estruturais associadas.

Possible involvement of nitric oxide and peroxynitrite in the pathogenesis of human vocal polyps and nodules

Nitric oxide (NO) is a molecule involved in multiple functions including vasodilatation, neural transmission, immune response and inflammation. However, the role of NO in the pathophysiology of vocal cord diseases is not clear. The present study investigated the possible involvement of NO and its toxic metabolite, peroxynitrite, in the pathogenesis of vocal polyps and nodules. Vocal polyps and nodules were obtained from patients receiving surgery for their conditions. Immunohistochemistry was applied to evaluate the expression of the inducible form of nitric oxide synthase (iNOS) as well as the production of peroxynitrite represented by the formation of its biological footprint, 3-nitrotyrosine (3-NT). Each section was given a score of 0 to 4 according to the labeling intensity seen, with the highest number representing the highest labeling intensity. The results showed that vocal polyp had an average iNOS labeling score of 3.2, which was significantly higher than the value of 1.9 in vocal nodules. The average labeling score of 3-NT was 2.8 in vocal polyps, which was also significantly higher than the value of 1.8 in vocal nodules. There was also a positive correlation between the level of iNOS expression and the extent of 3-NT formation. These results suggest that increased peroxynitrite production, resulting from increased iNOS expression and NO formation, may have an important pathogenic role in these vocal diseases.

Lamina propria of the mucosa of benign lesions of the vocal folds

OBJECTIVE/HYPOTHESIS

To demonstrate a correlation between the duration and specific pattern of trauma of benign lesions of the vocal folds and their histopathologic appearance. Benign lesions of the vocal folds have various macroscopic appearances. Investigations demonstrate characteristic histopathologic features for three clinically well-defined lesions: 1) vocal fold polyps, 2) Reinke edema, and 3) vocal fold nodules. It is expected that additional histological stainings can contribute to additional insight into the pathophysiology of these lesions.

STUDY DESIGN

Retrospective.

METHODS

Histological stainings were used to study the constitution of the lamina propria of the mucosa: Verhoeff-van Gieson, Masson trichrome, alcian blue and alcian blue after pretreatment with hyaluronidase.

RESULTS

Estimation of the age of a lesion was not possible. Specific observations: 1) accumulation of hyaluronic acid around vessels occurred uniquely in polyps and 2) transverse orientation of elastic fibers was more often seen in vocal fold nodules. Combinations of histopathologic findings were specific to the lesion.

CONCLUSIONS

The additional stainings support our previous observations, but had no additional discriminating value in making a histopathologic diagnosis.

Cytokeratin and vimentin expression in normal epithelium and benign lesions of the vocal cords

The expression of cytokeratins and vimentin was studied immunohistochemically in normal epithelium and 12 benign lesions of the vocal cord with the use of a broad panel of monoclonal antibodies against cytokeratins and vimentin. Histology showed that the various lesions contained hyperkeratotic, hyperplastic and atrophic epithelium, irrespective of their clinical appearance. Especially the Ck profile of the (hyper)keratotic lesions was changed in comparison with the native epithelium. Increased expression of the keratinization marker Ck 10 was associated with decreased expression of the stratification markers Cks 4 and 13. Expression of the basal cell marker Ck 14 and hyperproliferation-associated Cks 16 and 17 was increased in all the benign lesions, except in atrophic epithelium. These expression patterns differ from those observed in malignant epithelial lesions. The latter show a marked expression of simple cell Cks and vimentin and more pronounced expression of hyperproliferation-associated markers than the benign lesions.

Benign lesions of the vocal folds: histopathology and phonotrauma

Benign lesions of the vocal folds have various appearances. Histopathologic examination might provide the true diagnosis. Therefore, histologic slides of 74 patients (92 vocal folds) with clinically well-defined diagnoses were single-blind examined by a pathologist. Single histologic features did not differentiate between different clinical entities, but combinations make some diagnoses more likely than others. Ultrastructural examination of submucosal vessels in the three most common clinical entities (polyps, Reinke edema, and vocal fold nodules) showed an entity-unique pattern of abnormal increase of layers of basement membrane-like material. A potential pathogenetic model of benign lesions of the vocal folds is presented, employing a combination of histopathologic findings and their possible relations with various forms of trauma inducing and maintaining these lesions.

Benign lesions of the vocal folds: uniformity in assessment of clinical diagnosis

The names given to a number of benign lesions of the vocal folds are not well standardized and lead to difficulties in comparing treatment. In the present study photographs of benign lesions of the larynx were presented to groups of clinicians together with a questionnaire, and the answers analysed. The results show great variation between clinicians in interpretation and naming of these lesions. Definitions are suggested for different benign conditions in order to standardize the nomenclature.