Larynx, hypopharynx & trachea

Benign tumors / nonneoplastic

Vocal cord polyp


Editorial Board Member: Bin Xu, M.D., Ph.D.
Deputy Editor-in-Chief: Kelly Magliocca, D.D.S., M.P.H.
Kyriakos Chatzopoulos, M.D., Ph.D.

Topic Completed: 13 August 2021

Minor changes: 13 August 2021

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PubMed Search: Vocal cord polyp [TIAB]

Kyriakos Chatzopoulos, M.D., Ph.D.
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Cite this page: Chatzopoulos K. Vocal cord polyp. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/larynxvocalcordpolyp.html. Accessed September 16th, 2021.
Definition / general
  • Common benign laryngeal lesion, also known as laryngeal nodule or singer's nodule
  • Clinical terms: nodule (sessile) versus polyp (pedunculated) (J Voice 2004;18:125)
Essential features
  • Benign exophytic, pedunculated (polyp) or sessile (nodule) lesion of the vocal cord, frequently related to voice overuse or irritation, lined by unremarkable squamous epithelium or with mild reactive atypia, overlying an edematous, myxoid or hyalinized fibroblastic stroma with telangiectatic vessels
Terminology
  • Laryngeal nodule, singer's nodule, Reinke edema
Epidemiology
  • Patients of all ages, even in pediatric population (Otolaryngol Clin North Am 2019;52:657)
  • More common in heavy smokers, patients with history of chronic irritant inhalation or singers, due to inflammation, allergic or immunologic causes, possibly secondary to hemorrhage
  • Can be secondary to irritation from gastroesophageal reflux disease (J Med Case Rep 2020;14:2)
Sites
  • True vocal cords
Clinical features
Diagnosis
  • Combination of clinical presentation, laryngoscopy findings and biopsy interpretation
Case reports
Treatment
  • Nodule: voice therapy, phonomicrosurgery or intralesional corticosteroid injection
  • Polyp: similar as for nodule, plus angiolytic laser treatment (Otolaryngol Clin North Am 2019;52:745)
Clinical images

Contributed by Kyriakos Chatzopoulos, M.D., Ph.D.
Vocal cord nodule

Vocal cord nodule

Gross description
  • Smooth, round, 1 - 3 mm growths on true vocal cords, often on anterior third
Microscopic (histologic) description
Microscopic (histologic) images

Contributed by Kyriakos Chatzopoulos, M.D., Ph.D.
Hyperplastic squamous mucosa

Hyperplastic squamous mucosa

Fibroblastic myxoid stroma

Fibroblastic myxoid stroma

Stromal hyalinization

Stromal hyalinization

Negative stains
Sample pathology report
  • Larynx, left true vocal cord, biopsy:
    • Vocal cord polyp
Differential diagnosis
Board review style question #1
Which of the following is the most helpful diagnostic clue in the differential diagnosis of vocal cord polyp from spindle cell carcinoma?

  1. Dysplasia in the superficial squamous mucosa
  2. Immunoreactivity for keratins AE1 / AE3
  3. Presence of atypical stromal cells
  4. Telangiectatic blood vessels in the stroma
Board review style answer #1
A. Dysplasia in the superficial squamous mucosa of a polypoid laryngeal lesion should prompt the differential diagnosis of spindle cell carcinoma. The squamous mucosa of vocal cord polyps is usually unremarkable or can show mild atypia. Nonspecific immunostaining of keratins AE1 / AE3 in stomal fibroblasts or the presence of bizarre stromal cells can be diagnostic pitfalls, especially in the absence of overt dysplasia. Telangiectatic blood vessels can be seen in the stroma of both vocal cord polyps and spindle cell carcinomas.

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Reference: Vocal cord polyp
Board review style question #2

Which of the following ancillary studies is the most cost efficient in further evaluating the amorphous material seen in the laryngeal polyp of the photo?

  1. Amyloid typing by mass spectrometry
  2. Congo red histochemical stain
  3. Immunohistochemistry for A and P components
  4. TTR gene sequencing
Board review style answer #2
B. Congo red histochemical stain is a low cost, sensitive method of screening specimens for amyloid, although interpretation needs the use of special polarizing lenses. The remaining methods, although more specific, are much more expensive and their use should be reserved for the further workup of specimens with confirmed amyloidosis.

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Reference: Vocal cord polyp
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