Thyroid & parathyroid

Other thyroid nonneoplastic

Teflon



Topic Completed: 1 June 2015

Minor changes: 27 January 2021

Copyright: 2015-2021, PathologyOutlines.com, Inc.

PubMed Search: teflon thyroid

Andrey Bychkov, M.D., Ph.D.
Page views in 2020: 282
Page views in 2021 to date: 311
Cite this page: Bychkov A. Teflon. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/thyroidteflon.html. Accessed November 27th, 2021.
Definition / general
  • Intracordal injection of Teflon was used to relieve dysphonia in patients with unilateral vocal cord paralysis due to recurrent nerve injury, because associated inflammation improved phonation
  • Commonly used in 1960s to 1990s but rarely used today (Medscape: Unilateral vocal fold paralysis)
Terminology
  • Material: Teflon = PTFE (polytetrafluoroethylene), Polytef (Teflon glycerine paste)
  • Lesion: Teflon granuloma = teflonoma
Epidemiology
  • Teflonoma is a rare complication of intracordial injection - occurs in 1% mostly intralaryngeal (Laryngoscope 1980;90:281)
  • Less than 20 cases of extralaryngeal teflonoma have been reported
Sites
Pathophysiology
  • Overinjection and misplaced injection of polytef (Arch Otolaryngol 1975;101:114) causes direct migration from vocal cord through the cricothyroid membrane (Ultrastruct Pathol 1980;1:471)
  • Granulomatous response to injected polytef progresses to an indolent phase of mild reaction and dense fibrosis within 4 - 6 months, resulting in a sharp demarcation between the encapsulated foreign body reaction granuloma and surrounding tissue (Arch Otolaryngol 1967;86:550)
Clinical features
  • Neck mass and persistent hoarseness occurring weeks to months after vocal cord injection (Hum Pathol 1990;21:617)
Diagnosis
  • Histological examination after nodule biopsy or surgery; history of Teflon intracordial injection
Radiology images

Images hosted on other servers:

PET: increased FDG

CT: amorphous area of high attenuation

Case reports
Treatment
Gross description
  • Firm, irregular / polypoid mass up to 2 cm, overlying thyroid gland, often densely adherent to adjacent tissues
Microscopic (histologic) description
  • Numerous foreign body granulomas composed of giant cells and histiocytes
  • Birefringent particles (10 - 50 micron) inside giant cells
  • Encapsulation, fibrosis and mild nonspecific chronic inflammatory infiltrate
  • Similar changes within injected vocal cord
  • Thyroid is intact, rarely the lobe may be atrophied due to pressure (Arch Otolaryngol 1975;101:262)
Microscopic (histologic) images

Images hosted on other servers:

Intracranial teflonoma after trigeminal nerve decompression

Cytology description
  • Scanty cellular material, no / few follicular cells
  • Numerous refractile particles, 5 - 50 µm, birefringent under polarized light
  • Giant cells contain teflon particles (Diagn Cytopathol 1987;3:156)
Electron microscopy description
Differential diagnosis
  • Neck mass: thyroid or laryngeal tumor
  • Nonspecific foreign body granuloma or subacute thyroiditis: includes talc, silicone, suture material
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